PROXIMAL FEMORAL FRACTURE (PFF) is one of the most important etiologies of mortality and morbidity in elderly. Reported mortality rate is in a range of 1.3-16% pre-operatively up to 22-42% postoperatively (1, 2).Mortality rate in elderly patients with this problem is estimated about 30%.In Iran, and there are a relatively lower number of incidences for hip FRACTURE than in western countries. Effective factors on mortality rate are aging, gender, intertrochanteric FRACTUREs and immobility before FRACTURE (3). PFF usually requires a great amount of health care which causes patients to be hospitalized for a long time. Increased life expectancy leads to increased age and senescence. On the other hand, disorders such as cardiovascular diseases and diabetes result in additional concerns about complications caused by these FRACTUREs (4). Also increased rate of obesity in general population have worsened complications which have made treatments less effective (5). One of the most important therapeutic goals is to achieve movement ability after FRACTURE in these patients. Walking with and without using crutch, and ability for mobility is expected in the cases (6). Established risk factors for decreased mobility in patients are osteoporosis, decreased bone density, prolonged consumption of corticosteroids, aging and central obesity. Several studies have shown direct relation between BMI and mortality rate in patients with the noted FRACTUREs (7, 8).

Introduction: Recently, PROXIMAL femur geometry has been identified as a risk factor for hip FRACTURE, and studies about the association of PROXIMAL FEMORAL geometric indices with these FRACTUREs worldwide have reported inconsistent results. In this study, this association was studied in an Iranian population. Materials and Methods: In this case control study that was performed in Ayatollah Kashani Hospital in 1395 in Shahrekord, 81 patients with PROXIMAL femur FRACTURE were trained with low energy and 83 healthy subjects over 50 years old. After recording the demographic data, the pelvic radiograph was taken and FEMORAL neck width (FNW), FEMORAL Shaft Diameter (FSD), FEMORAL neck axis length (FNAL), hip axis length (HAL) and neck shaft angle (NSA) parameters were measured in both groups using orthopedic ruler. Data analysis was performed using stata software. Results: The mean age of case group (70. 81± 13. 86 years) was significantly higher than control group (61. 35± 9. 89 years) (P=0. 00). Intrestingly, the mean height and weight of case group were lower than control group (P<0. 05). After adjusting for age, among the geometric indices, only FNW was lower in case group than control group (P=0. 01), and there was no significant difference in FNAL, HAL, FSD and NSA indices between the two groups (P>0. 05). Conclusion: In this study older age, female sex, shorter heights, and less weight were associated with the incidence of PROXIMAL FEMORAL FRACTUREs. Conclusively, FNAL, HAL, FSD, and NSA could not predict PROXIMAL FEMORAL FRACTUREs in our samples. However, FNW reduction significantly increased the risk of FEMORAL neck FRACTUREs in both male and female patients.

Background: Fascia Iliaca Compartment Block (FICB) is commonly used in older patients to provide effective analgesia following hip FRACTURE. Objectives: However, only limited Pharmacokinetic (PK) data about levobupivacaine are available to help clinical practice and establish safe volumes and amounts of local anesthetics. Methods: Ten patients aged between 53 and 87 years, who underwent hemiarthroplasty following FEMORAL neck FRACTURE were recruited into this study. A fixed volume (40 mL) of 0. 25% levobupivacaine was injected before the induction of anesthesia using ultrasound guidance. Venous blood samples were obtained at 0, 10, 20, 30, 45, 60, 75, 90, and 120 min time points and analyzed using mass spectrometry. Results: The median (interquartile range) maximum observed plasma concentration (Cmax) of levobupivacaine was 0. 48 (0. 45-0. 61) μ g/mL, with the time to reach Cmax (tmax) of 38 minutes (30– 105) after administration, a half-life of 2. 8 h (1. 65– 5. 8), and clearance rate of 0. 72 L/min (0. 36– 1. 26). The fixed volume (40 mL) of 0. 25% levobupivacaine FICB did not exceed the recognized toxic threshold in adults (2. 6 μ g/mL). Conclusion: The data described here indicate a similar levobupivacaine PK profile for older patients undergoing FICB for hip arthroplasty compared with the levobupivacaine PK profile for the general population.

PROXIMAL FEMORAL Focal Deficiency (PFFD) is a rare congenital defect with prevalence of one in 50000 to 200000 live births. It affects the PROXIMAL femur and frequently the acetabulum and may occurs unilaterally and/or bilaterally. The side effects of PFFD vary in patients. These include: limb length discrepancy, instability of the hip and knee joint, contractures of the hip and knee muscles, unequal level of the knees, short stature and associated anomalies. Usually, children with PFFD and their families are faced with many treatment decisions, both surgical and non- surgical. Therefore, the treatment of PFFD has always been a challenge for the specialists.In this report, a 3-years-old boy with PFFD with dysplasia of hip and acetabulum and femur shortness in both side and delay in motor milestones has been reported who was referred by physician to the faculty of rehabilitation for occupational therapy and rehabilitation treatment.

Background: Osteoporosis represents the most common bone disease and has to be respected in planning total hip replacement, especially against the background of increasing uncemented total hip replacement. In this context, the radiographic geometry of the PROXIMAL femur got into focus and is controversially discussed. The aim of the presented study was to find any difference regarding known indices for PROXIMAL femur bone geometry between patients with high-grade osteoarthritis and patients suffering from a FEMORAL neck FRACTURE caused by low impact trauma. Methods: Retrospective matched-paired analysis of 100 plane pelvic radiographs from 50 patients who suffered from high-grade hip osteoarthritis and 50 patients who suffered from FEMORAL neck FRACTURE was performed. Measurement of Canal-Bone Ratio (CBR), Canal-Calcar Ratio (CCR), Mineral Cortical Index (MCI) and Canal Flare Index (CFI) were performed. Results: CBR was significantly higher in the FRACTURE-group (0. 45 +/-0. 06 vs. 0. 41 +/-0. 08) (P-value= 0. 008). Moreover, the FEMORAL thickness 10 cm below the trochanter minor [F] was significantly higher in the osteoarthritis-group (34. 68 +/-4. 14 vs 32. 11 +/-3. 43) (P-value 0. 001). Conclusion: In conclusion, patients with a FEMORAL neck FRACTURE demonstrated a higher CBR, which indicates a poorer bone quality. In case of planning a THA, the CBR is an index which can easily be measured and can be seen as one decision criterion in THA regarding fixation technique.

Background: Interleukin-6 (IL-6) plays an important role in inflammatory. Epidural anesthesia is an appropriate method for controlling pain in lower limb surgeries. The aim of this study was to evaluate the effect of Dexmedetomidine and Lidocaine in the epidural injection by measuring IL-6 plasma levels. Materials and Methods: Fifty-two patients with lower limb FRACTUREs in two groups receiving Dexmedetomidine doses and controls for the quality of epidural anesthesia and IL-6 index. After explaining the design and obtaining informed written consent, patients were randomly divided into two groups. After 4– 6 minutes of administering the test dose, patients in group RC received 5 ml of 1. 5% Lidocaine solution via epidural catheter. Patients in group RD were administered 15 ml solution of 1. 5% ropivacaine and 0. 6 μ g/kg of Dexmedetomidine. The levels of IL-6 were evaluated before surgery and 6 hours after surgery. Results: The two groups did not show a significant difference in age and level of interleukin prior to the operation. There was a significant difference in the second injection time and total drug volume between the control and intervention groups. Dexmedetomidine reduced the volume of total drug needed and increased the time interval from the first injection to the second one (p <0. 001). There was also lower levels of interleukin 6 in the Dexmedetomidine group at the 6th hour after the operation. Conclusion: Dexmedetomidine does not only reduce the need for patients on the amount and frequency of analgesic drugs, but also reduces stress and cellular damage.

Background: A variety of options including titanium elastic nails (TENs) and locking plates (LPs) are available for the internal fixation of subtrochanteric FRACTUREs (STFs). However, the preferred treatment option among children and adolescents is still controversial. Methods: We report four cases of STFs in school-aged pediatric patients, treated with an adult PROXIMAL humerus LP. Results: Based on the Flynn scoring system at the last follow-up visit, all patients exhibited excellent clinical outcomes, along with satisfactory radiological outcomes based on the Beaty scoring system. There were no complications. Conclusion: Our findings suggest the efficacy of using adult PROXIMAL humerus LPs in treating pediatric STFs. The advantage of these plates lies in their ability to accommodate many screws at appropriate positions and angles without damaging the physis. This approach holds promise for the management of pediatric STFs.