Introduction: Comminuted patella fractures comprise 55 % of patellar fractures. In spite of advances in internal fixation of patella, patellectomy remains an effective treatment in comminuted fractures. In the shadow of different efficient methods of internal fixation, little attention is paid to patellectomy as an old treatment in patellar fracture which is a treatment option in circumstances like comminuted fractures and osteomyelitis. Presentation of case: A 54-year-old male presented with complaint of knee pain and limited range of motion. The patient experienced patella fracture four years ago and several sessions of surgery have been performed on his patella including tension band wiring, partial patellectomy, and arthroscopic release. Lastly, pain and severe limited range of motion, convinced us to perform total patellectomy. The result is satisfactory after one year; flexion is up to 90° and no limping or extension lag is observed. The only complaint is mild anterior knee pain. Discussion: Patella has two important biomechanical functions including linking and displacement. Preserving even a single fragment of the patella substantially improves linking and displacement function of the patella. Total patellectomy is reserved for conditions like failed internal fixation, comminuted fractures, and patellar osteomyelitis. Although function of the knee cannot be thoroughly restored after removing of the patella, total patellectomy can lead to a relative satisfaction in performing activities of daily living. Conclusion: In spite of various types of treatment for patellar fracture, total patellectomy, is still an efficient treatment option in circumstances like comminuted fractures, failed internal fixation, and osteomyelitis. Highlights:

Purpose: During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values.Methods: Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards.Results: Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X‐ray, while body mass index had a significant relation with D3 (p < 0.05).Conclusion: In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical.Level of Evidence: Level III.

Carpal tunnel syndrome (CTS) is a common musculoskeletal disorder during pregnancy, second only to back pain. Although the prevalence in the general population is approximately 4%, a prevalence of up to 43% has been reported in pregnant women. This review aimed to assess and summarize reported point-prevalence estimates of CTS among pregnant women in Iran. Five observational studies conducted in Iran were included. Diagnostic approaches varied across studies. Clinical diagnosis was defined as the presence of characteristic symptoms (paresthesia, numbness, nocturnal symptoms in the median nerve distribution) with or without positive provocative tests (Tinel and/or Phalen). Electrodiagnostic confirmation required abnormal nerve conduction velocity and/or EMG findings consistent with median nerve compression at the wrist. Data were extracted for the entire sample, including trimester, parity, bilateral involvement, and diagnostic tools. A total of 2065 pregnant women were assessed across the included studies. Based on clinical criteria, the estimated prevalence of CTS during pregnancy in Iran was approximately 10.5%. Subjective symptoms were reported in 10.84%, objective signs in 10.31%. Electrodiagnostic tests (EMG and nerve conduction velocity) confirmed CTS in 5.67% of these 2065 pregnant women. Bilateral involvement was observed in 47.7% of symptomatic patients. The highest prevalence was observed in the third trimester (64.4%), and most affected women were experiencing their first pregnancy (55%). Reported prevalence of CTS during pregnancy in Iranian studies varies substantially depending on diagnostic criteria and study design. Although this variability does not indicate systematic underdiagnosis or inconsistent reporting, it highlights methodological heterogeneity across studies. Importantly, there is a paucity of high-quality evidence addressing optimal treatment strategies for CTS during and after pregnancy, underscoring the need for well-designed clinical studies in this area. Prognostic III