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Background and Objective: Treatment of scaphoid fractures is studied extensively due to the specific anatomic shape and position, blood flow and its performance. In recent years, several treatment methods have been devised which are associated with various findings. This study was done to evaluate the short-term results of limited dorsal approach in treatment of scaphoid fracture. Materials and Methods: In this descriptive study, 14 male patients with scaphoid fracture were gone under limited dorsal approach in treatment of scaphoid fracture in 5th Azar teaching hospital in Gorgan, Iran. Patients were followed up for 12 weeks and the onset of infection, screw breakage and joint degenerative changes were evaluated. Results: 64% of scaphoid fractures were in waist of the bone. The mean time to :::::union::::: was 10.5 weeks. 64% of patients returned to work after 12 weeks. In none of the patients, infection, wound breakdown and joint destruction were seen. There were two-delayed :::::union::::: (> 12 weeks) and two screw head prominency in the scaphotrapezial joint but patients did not complain and their hand movements had no problem. During procedures, two guide pin failures occurred with no adverse effect in fixations. Complications were minor and wrist movements were nearly normal. Conclusion: Limited posterior approach in the treatment of scaphoid fractures is an easier, faster and better :::::union::::: rate. Despite the short duration of follow-up study, this method is recommended in the treatment of scaphoid fractures.

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Pediatric femoral neck fracture is rare and account for less than 1% of all fractures in childhood. The proximal femur in children is extremely strong, and high-energy forces in 80-90%, following the axial force associated with hip rotation or direct blow are necessary to cause fracture. In this report, the method of femoral neck fracture fixation in eight-year-old girl after car accident is reported. During the operation, we noted a severe femoral neck fracture that was irreparable with the available tools (pin, screw, plate and DHS), which inevitably had to be used by Transosseous method with fiber wire #2, used in proximal humeral fracture fixation. Then, we obtained a fairly satisfactory result with a distal femoral pin inserting it into two-sided spica cast. Although, this kind of fracture is rare, but with a qualified clinical examination, early diagnosis, proper treatment, familiarity with surgical techniques and fixation reduces the complications and this method can be effective in obtaining the desired result.

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Posterior shoulder fracture dislocation (PSFD) is a rare and challenging injury. Early diagnosis and treatment can prevent serious complications and disability, reducing the risk of avascular necrosis of the humeral head and joint destruction. Several treatment options have been proposed, depending on the patient’s age, duration of dislocation, humeral head bone defect, length of the metaphysis attached to the reverse Hill-Sachs, osteopenia and functional demand, and concomitant diseases. Open anatomic reduction and internal fixation is a suitable option, particularly in young and active individuals. Humeral joint replacement is recommended for non-fixable 3- or 4-part fractures, particularly in elderly individuals with low demand and osteoporosis. This article reports a case of closed, irreducible PSFD that was treated with open reduction and internal fixation using a plate and deltopectoral approach.

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Background and Objective: Various surgical techniques, including Open Reduction and Internal Fixation (ORIF), Minimally Invasive Plate Osteosynthesis (MIPO), and External Fixation (EF), have been proposed for the tibial pilon fractures treatment. However, limited comparative data exist regarding the outcomes of these three methods. Despite advancements in surgical procedures, the outcomes have not consistently been excellent, and patients often experience numerous complications. This study aimed to evaluate the outcomes and complications of the tibial pilon fractures treatment in a six-month follow-up.
Methods: This descriptive-analytical prospective cohort study was conducted on 22 patients (18 men and 4 women; mean age=39.4±10.8 years) who presented with tibial pilon fractures at the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, from April 2020 to March 2022. All 22 eligible patients agreed to participate. Following the necessary treatment determined by the attending physician, patients were examined after six months, and their outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle score.
Results: The majority of fractures (54.5%) were of closed type. The surgical procedures performed included two-stage EF (40.9%), ORIF (31.8%), expert nailing (13.6%), and MIPO (13.6%), respectively. A total of 72.7% of patients experienced early or late postoperative complications. The most common postoperative complications were osteoarthritis and wound dehiscence, occurring at a rate of 18.2% each. The mean AOFAS score for patients was 82.3±11.2. AOFAS scores were classified as excellent in 4 patients (18.18%), good in 12 patients (54.55%), moderate in 4 patients (18.18%), and poor in 2 patients (9.09%). A statistically significant inverse correlation was observed between the mean surgical time and the AOFAS score (r=−0.661, P=0.001). Furthermore, a statistically significant direct correlation was found between the mean surgical time and the mean length of hospital stay (r=0.571, P=0.006). Surgical time for patients undergoing MIPO (68.3±7.6 minutes) was significantly shorter than that of the other three methods (P<0.05). For open fractures, the frequency of ORIF was significantly higher than that of other procedures (P<0.05). Osteoarthritis was observed as a treatment complication in both expert nailing and two-stage EF interventions. In contrast, non-union and wound dehiscence complications were exclusively observed following ORIF. Superficial infection and mal-union were only observed after two-stage EF, and all instances of deep infection occurred with MIPO.
Conclusion: Two-stage EF and ORIF were the most common surgical techniques employed for patients with tibial pilon fractures. Worse postoperative complications, including non-union and wound dehiscence, commonly occurred in ORIF procedures. However, there was no statistically significant difference in patient-reported outcomes based on the AOFAS self-report questionnaire among the various surgical techniques.