A fever above 38°, C is a common complication in the first few days after major surgery. Drug-induced fever is the most common cause of fever among the noninfectious causes of postoperative fever. Antimicrobial drugs and heparin, widely used for venous thromboembolism prophylaxis after major Orthopedic surgery, are the drugs most commonly associated with postoperative fever. This case study, showing that enoxaparin may be the drug responsible for unexplained fever, may help significantly reduce patient morbidity and the additional costs of investigating the underlying causes of fever. At this stage, the approaches of the clinical pharmacist to provide counseling services to the patient and the healthcare professional in the treatment of medications, the detection of side effects of medications and the suggestion of a solution are important.

Introduction: The patient's perception of postoperative medical advice effectively affects treatment outcomes. Some factors, including education level, patient-physician communication, and financial limitations, can affect the patient's perception. This study assessed the patient’s perception of medical recommendations after Orthopedic surgery. Methods: This cross-sectional study was conducted on patients who referred for postoperative follow-up visit during the first half of 2022. Two separate questionnaires, for patients' and companions' questions and a surgeon's recommendations form, were designed and were asked to patients and their companions 10 minutes after finishing the visit. Education level, marital status, and city of residence were assessed among the samples. Also, the data were analyzed by R software. Results: Literacy level was significantly related to patient perception (P-value = 0.004). In 15.9%, neither the patient nor the companions understood the surgeon’s recommendations (Kapa Coefficient = 0.34). Conclusion: Perception of the post-surgical recommendations at the postoperative follow-up is important in the final outcomes of Orthopedic surgery. The patient's literacy level can affect the patient's perception.

Context: Prolotherapy is a popular injection-based complementary treatment, which hasshownpromising results in the treatment of sprained and degenerated ligaments, and damaged dense connective tissues’ structures. More research was conducted in this area and many authors declared successful results for different indications. Evidence Acquisition: The purpose of this study was to present a literature review regarding the current concepts of prolotherapy injections and improvements in the Orthopedic clinical care practice. The Medline and PubMed databases were searched for the articles related to prolotherapy injections in the field of Orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results: Numerous studies have been conducted on prolotherapy injections for different indications for Orthopedics clinical care practice. Prolotherapy injections have successfully used for major Orthopedic procedures in terms of rotator cuff lesions, knee ligamentous lesions, osteoarthritis-cartilage defects, and ligament-tendon injuries. Most of the studies showed that prolotherapy provided faster and better healing of tissues. Conclusions: There is a great interest to prolotherapy in Orthopedic clinics, especially to manage musculoskeletal lesions. More research conducted in this area and many authors declared successful results in their studies. In spite of this increasing trend for prolotherapy injections, there were only one or two clinical studies investigated prolotherapy injections for different indications and most of them have limited participants, short-term follow-up or poor quality studies. There is still need for further high-quality studies investigated optimal strategy of the injections of prolotherapy.

Complications, specially infection after Orthopedic surgery, can result in severe disability in patients. Efforts have been done to use inflammatory factors such as Erythrocyte Sedimentation Rate (ESR), C - reactive protein (CRP) and White Blood Cell Count (CBC) to predict infection after surgery and to indicate that the courses of these factors are predictable. The aim of the present study was to characterize the changes of CRP, ESR and WBC after elective Orthopedic surgery. In 94 patients who underwent elective Orthopedic surgery and had normal values of inflammatory factors such as ESR, WBC and CRP serial measurements of CRP, ESR and WBC were done before and 1, 3, 5, 7, 14, 28 and 59 days after surgery from December 2002 to February 2003. The results indicated a maximal count of WBC on the first day after surgery, maximal CRP values on the third day and maximal ESR rates on the fifth day after surgery. Changes of WBC were irregular, but ESR and CRP, after achieving maximal values on mentioned days, became respectively normal after 28 and 14 days following post-operation. Age and sex did not influence the pattern of changes but extensive surgeries were accompanied with higher values of ESR and CRP. Pattern of changes in CRP and ESR values are so typical that any deviation from this pattern can indicate occurance of complications such as infection. CRP was sensitive than ESR in this regard.

Context: Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in Orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system. Evidence Acquisition: The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in Orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of Orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results: Various sources of stem cells have been studied for Orthopedics clinical care practice. Stem cell therapy has successfully used for major Orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues. Conclusions: Large amounts of preclinical studies have beenmadeof stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells.