Background: Open reduction and internal fixation is the standard surgical treatment of calcaneal fractures. However, it is associated with a high rate of wound problems. Objectives: In this study, we evaluated the clinical and radiologic outcomes, as well as the wound complication rates of Sinus tarsi minimally-invasive approach in the treatment of intraarticular calcaneus fracture. Methods: In a retrospective study, 62 patients who were referred with an intra-articular calcaneus fracture and treated with a minimally-invasive Sinus tarsi approach were included. The radiographic evaluations included the assessment of Bohler and Gissane angles before and after the surgery, as well as the height and length of the calcaneus. The clinical outcome was assessed with the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire. Results: The Mean± SD age of the patients was 41. 8± 12. 7 years. The Mean± SD follow-up of the patients was 21. 3± 10 months. After 6 months, in 43 patients (69. 3%) both Bohler’ s and Gissane’ s angles were significantly improved after the surgery (P=0. 003 and P<0. 001, respectively). The calcaneus height was significantly improved after the surgery (P=0. 009), as well. The Mean± SD AOFAS score of the patients was found 79. 6± 7. Wound infection was seen in only 1 case (1. 6%). Delayed wound healing occurred in 4 cases (6. 4%). No other wound complication such as dehiscence and skin necrosis was recorded. Conclusion: Minimally-invasive Sinus tarsi approach is an efficacious procedure for the treatment of intra-articular calcaneus fracture with a minimized rate of wound complications.

Sinus tarsi Syndrome is a cause of chronic ankle instability and pain. MRI of the ankle has been the modality of choice for diagnosing the condition. However, SPECTCT offers an alternate modality for diagnosing and evaluation of the condition. We present the case of a footballer who was suffering from chronic right leg pain despite receiving physiotherapy. He was being managed as a case of a chronic ankle sprain. Meanwhile, he was referred to the department as radiology for MRI of the ankle could not be performed as the patient felt claustrophobic. The patient subsequently underwent a 99mTc-MDP Bone scan. He was diagnosed to be suffering from Sinus tarsi syndrome as it showed a characteristic pattern noted on 99mTc-MDP Bone scintigraphy. This case report reveals the potential of SPECT-CT as an alternative in the evaluation of chronic ankle sprain to MRI in segment of cases where MRI is not performed due to various reasons...

Background: The calcaneofibular ligament is cut to increase vision in surgical field in minimally invasive surgery of displaced intraarticular calcaneus fractures with subtalar incision. We aimed to investigate whether this causes talar tilt instability in ankle stress radiographs due to the calcaneofibular ligament deficiency in postoperative period. Methods: The files of 38 patients who were operated with the diagnosis of displaced calcaneus fracture between 2013 and 2018 were examined retrospectively. All the cases underwent with subtalar approach and the calcaneofibular ligament was repaired after the operation. The age, sex, injury mechanism, follow-up length, type of fracture by the Sanders classification, preoperative and postoperative Bohler’ s and Gissane’ s angle measurements, talar tilt measurements of intact and fractured side, postoperative calcaneal length, calcaneal height and calcaneal width of the cases were recorded. The obtained data were evaluated statistically. Results: 31 (81. 6%) of the cases were men, seven (18. 4%) were women. The average age was 31. 92± 7. 95 years. The average follow-up time was 15. 82± 3. 33 months. The preoperative Bohler’ s angle was 14. 16± 3. 67 degree, while the postoperative Bohler’ s angle was 31. 53± 4. 60 degree (P<0. 05). The average talar tilt was 0. 96± 0. 87 degrees on the intact side and 1. 19± 1. 12 degrees on the fractured side (P: 0. 001). Although the talar tilt values were statistically higher on the fractured side than the intact side, no radiological instability finding was found in any case. The average postoperative Gissane’ s angles were 126. 45± 6. 69 degrees. The calcaneal length (P: 0. 665), calcaneal width (P: 0. 212) and calcaneal height (P: 0. 341) were statistically similar between the postoperative fractured foot and intact foot. Conclusion: Sectioning of the calcaneofibular ligament in the surgical treatment with subtalar approach does not cause lateral ankle instability in stress radiographs but may cause laxity. Possible postoperative lateral ankle injuries can be prevented by ankle proprioception exercises.

We describe a 72 years old lady with chief complain of headache, ptosis, partial 3rd nerve palsy and visual loss of left eye, biochemistrywas normal except to mild hyperglycemia, work up of vasculitis was negative with normal E.S.R. MRI showed sphenoid mucocel, orbit at sign was improved with nasal endoscopic drainage of mucocel.      

This article introduces, analyzes, and criticizes the work of Lawrence M. Hinman, Ethics: A Pluralistic approach to Moral Theory. Hinman is a Philosopher of Ethics in the multimedia learning. He believes that multiculturalism is important factor of nowadays so the most important responsibility of philosophers of Ethics is prevention of moral conflict. The global communication and information in 21st century needs global tolerance and respect of various nations, cultures, and moralities together because different people and societies have a common human nature and common natural rights that obligate to justice and moral relationship between different people and various societies’ beliefs throughout the world. Moral communication in multiculturalism approach is against racial, gender, national, and ethnic prejudice. Hinman believes in moral dialogue and global learning across different cultures. The book of Ethics: A Pluralistic approach to Moral Theory has a proper category of new ethical problems, and the candid standpoint of author is considerable. He has a logical method, and in the end of every part of book there are some questions for evaluation of students learning. So this book is proper for the philosophy of ethics in universities.

Introduction: Mediastinal tumors consist of wide spectrum of benign and malignant disease. Some of these tumors which locate in the thoracic apex can produce many problems in decision making due to developing to neck spaces. with thoracotomy approach most of these tumors cannot be resected totally because of close attachment of these tumors to great vessels and removal of these tumors accompanied with dangerous complications and massive hemorrhages during surgery. The goal of this study is to report the operated cases of these kinds of tumors with anterior trans cervical-thoracic approach.Materials and Methods: Depending on the tumor extension in neck spaces, first with on oblique incision near the SCM (Sternoclidomastoeid) muscle neck space dissection is done, In all patients the clavicle head is resected to see the subclavian vessels, then with continuing the incision, as in partial sternotomy, the mediastinal space is being assessed for complete removal of tumor. If needed, for complete removal of mediastinal tumor, the operation is completed with an anterior thoracotomy.Case reports: There were 3 patients in our study; all were females; with age between 10 to 21 years old. Pathology reports of them were: one case ganglioneuroblastoma, one case neurofibroma and the other, medullary carcinoma of thyroid. Tumor extension in neck spaces in 2 patients was at the left side and in one patient in right side. In all three patients tumors were completely removed by mentioned technique and only in one case an anterior thoracotomy was needed to remove the huge mediastinal tumor. Total resection of tumors were done in all 3 patients and there were no severe injuries to great vessels and all patients were discharged from hospital without any complications and are being observed for 6 months until now without tumor recurrence. The median time for hospitalization was 5.5 days.Conclusions: Due to good exposure of neck and mediastinal great vessels and succeed in removing these tumors, we advise using this technique for approaching them. Of course it is obvious that more studies are needed in future.