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Background We report our experiences with COVID-19 in one of the largest referral orthopedic centers in the Middle East and aimed to describe the epidemiology and clinical characteristics of these patients. Methods During February 20 and April 20, 2020, patients who underwent orthopedic surgery and healthcare staff who were in contact with these patients were screened for COVID-19. To identify patients who were in the incubation period of COVID-19 during their hospital stay, all patients were tested again for COVID-19 4 weeks after discharge. Results Overall, 1244 patients underwent orthopedic surgery (1123 emergency and 121 elective) during the study period. Overall, 17 patients were diagnosed with COVID-19 during hospital admission and seven after discharge. Among the total 24 patients with COVID-19, 15 were (62.5%) males with a mean (SD) age of 47.0±1.6 years old. Emergency surgeries were performed in 20 (83.3%) patients, and elective surgery was done in the remaining 4 patients which included one case of posterior spinal fusion, spondylolisthesis, acromioclavicular joint dislocation, and one case of leg necrosis. A considerable number of infections occurred in patients with intertrochanteric fractures (n=7, 29.2%), followed by pelvic fractures (n=2, 8.3%), humerus fractures (n=2, 8.3%), and tibial plateau fractures (n=2, 8.3%). Fever (n=11, 45.8%) and cough (n=10, 37.5%) were the most common symptoms among patients. Laboratory examinations showed leukopenia in 2 patients (8.3%) and lymphopenia in 4 (16.7%) patients. One patient with a history of cancer died 2 weeks after discharge due to myocardial infarction. Among hospital staff, 26 individuals contracted COVID-19 during the study period, which included 13 (50%) males. Physicians were the most commonly infected group (n = 11), followed by operation room technicians (n = 5), nurses (n = 4), and paramedics (n = 4). Conclusions Patients who undergo surgical treatment for orthopedic problems, particularly lower limb fractures with limited ambulation, are at a higher risk of acquiring COVID-19 infections, although they may not be at higher risks for death compared to the general population. Orthopedic surgeons in particular and other hospital staff who are in close contact with these patients must be adequately trained and given appropriate personal protective equipment during the COVID-19 outbreak.

Introduction: Consumption of anabolic-androgenic steroids (AAS) is described as a major factor in tendon weakening process. The reports of bilateral quadriceps tendon rupture (QTR) following the AAS consumption are very rare. The current study described a case of simultaneous bilateral QTR following a low-energy trauma in a body builder with the history of ASS consumption. Case Presentation: A 32-year-old male body builder was referred to under study center with a history of falling down from the stairs nearly 2 weeks earlier. Magnetic resonance imaging (MRI) showed QTR in both knees from superior pole of patella. He denied any major trauma to explain the recent problem. Thus, the QTR was attributed to a low-energy trauma. While ruling out the tendon weakening conditions promptly, the history of oral and intramuscular consumption of AAS was noted. The patient was operated to repair QTR. At the last follow-up session, he was able to actively straighten his legs. The consumption of AAS was discontinued afterward. Conclusions: Consumption of AAS by athletes has considerably increased during the last few decades. An appropriate warning of orthopedic surgeons regarding AAS side effects is necessary in order to recognize the predisposing factor of tendon rupture in similar circumstances and address the case properly.

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Type III Monteggia equivalent fracture is a rare injury, and its optimal diagnosis and management are still unclear. Reporting two cases of type III Monteggia equivalent fracture in two boys who were surgically treated the day after the presentation.This study presents two cases of type III Monteggia equivalent fracture in two boys who were surgically treated the day after the presentation. These observations suggest that the timely surgical treatment of type III Monteggia equivalent fracture results in acceptable outcomes. However, the lack of a universal classification system limits the generalization of the results