Medial opening wedge high tibial osteotomy (MOWHTO) is a knee-preserving surgical option for selected patients with symptomatic medial compartment osteoarthritis (OA) and varus malalignment. Successful outcomes depend on appropriate patient selection, accurate radiographic assessment, individualized correction planning, stable fixation, and careful intraoperative protection of the lateral hinge and posterior neurovascular structures. This educational review summarizes the practical steps in the evaluation and surgical planning of MOWHTO, including clinical assessment, classification of varus deformity, imaging, indications and contraindications, correction target, osteotomy orientation, hinge position, fixation options, bone grafting, drain use, and postoperative considerations. The review also compares MOWHTO with lateral closing wedge high tibial osteotomy (LCWHTO) and discusses areas where evidence remains inconclusive. Rather than proposing a single universal technique, this article emphasizes individualized decision-making based on patient anatomy, severity of OA, ligament status, patellofemoral joint condition, planned correction, and surgeon experience.

Background: Scheuermann’s kyphosis (SK), also known as juvenile kyphosis, is one of the most common causes of spinal deformity in adolescents. The objective of this study was to review the outcomes of posterior-only surgical correction for SK over 25 years.

Methods: We retrospectively reviewed patients diagnosed with SK who underwent posterior spinal surgery. Health-related quality of life was assessed using the Oswestry Disability Index (ODI) and the Scoliosis Research Society 30-item questionnaire (SRS-30), and radiographic parameters were evaluated preoperatively and at follow-up.

Results: A total of 210 patients with SKs underwent posterior-only surgical correction. The mean age at surgery was 17.5 years (range, 12–38 years), with a mean follow-up of 17.5 years. Significant improvements were observed in sagittal Cobb angle (85.9° to 43.2°, P < 0.001), coronal Cobb angle (32.5° to 11.5°, P < 0.001), L1–S1 lordosis (P = 0.001), and sagittal balance (P = 0.043). Clinical outcomes also improved significantly, with the ODI decreasing from 23.2 to 5.8 (P = 0.003) and the SRS-30 score increasing from 64 to 133.5 (P < 0.001). The mean pelvic incidence (PI) was 46°, with no significant correlation between pelvic incidence and either the preoperative sagittal Cobb angle (P = 0.46) or kyphosis correction (P = 0.7). However, kyphosis correction approximating PI was associated with more favorable postoperative outcomes. The overall complication rate was 4%, and the mean loss of correction at the final follow-up was 1.6°.

Conclusion: A posterior-only approach is an effective and safe treatment for SK; however, whether correction approximating PI can optimize individualized outcomes remains a hypothesis requiring prospective evaluation.

Background: Unstable pelvic ring fractures are high-energy injuries with complex anatomy and significant morbidity. Surgical fixation is the standard treatment; however, there is still controversy over the optimal sequence of anterior and posterior stabilization. An anterior-first fixation may help stabilize the pelvis, facilitate posterior reduction, and improve functional outcomes.

Methods: We retrospectively reviewed patients with unstable pelvic ring injuries using a standardized “anterior-first” fixation protocol. Radiographic reduction was assessed using Matta and Tornetta criteria on anteroposterior (AP), inlet, and outlet views. Functional outcomes at a minimum of 12 months were measured using the Iowa Pelvic Score (IPS) and Majeed Pelvic Score (MPS). Clinical complications, including bleeding requiring transfusion, hematuria, and limb-length discrepancy (LLD), were recorded.

Results: The study included 20 patients with a mean age of 40.7 ± 16.3 years. Excellent or good reductions were achieved in most patients, with 45% and 60% of cases rated as “Excellent” on the AP and inlet views, respectively. Outlet views showed greater variability, with 40% fair reduction. Mean IPS and MPS scores were 84.2 ± 16.7 and 78.9 ± 16.0, respectively, and were strongly correlated with each other (r = 0.82, P < 0.001). Older patients (> 50 years) achieved functional outcomes comparable to younger cohorts. Clinically, bleeding requiring transfusion occurred in 45%, hematuria in 35%, and LLD > 1 cm in 35%. No catastrophic complications were observed.

Conclusion: In this small retrospective case series, anterior-first fixation was associated with acceptable radiographic reduction and favorable functional outcomes in selected patients with unstable pelvic ring injuries. Given the limited sample size and the absence of a comparator group, these findings should be interpreted with caution. Larger prospective comparative studies are needed to clarify the optimal fixation sequence.

Background: Idiopathic scoliosis is a lateral curvature of the spine with rotation, occurring without congenital or musculoskeletal abnormalities. This study evaluated outcomes of patients with idiopathic scoliosis (Lenke type 1 curves) who underwent posterior spinal corrective surgery between 2018 and 2021.

Methods: In this cross-sectional study, patients with Lenke type 1 curves treated at Imam Khomeini Hospital Complex, Tehran, Iran, were included based on defined criteria. Following subperiosteal dissection of paravertebral muscles, pedicle screws were inserted by the free-hand technique. Spinous processes were resected, and osteotomies were performed in rigid curves using an osteotome from the lamina’s inferior border to the pars interarticularis bilaterally. Patient data were extracted from the hospital information system (HIS), and radiographs were assessed pre- and postoperatively. Cobb angles were measured on standing anteroposterior (AP) and lateral spine radiographs, and thoracic kyphosis (T5-T12) was similarly evaluated.

Results: Twenty-one patients were studied. Mean Scoliosis Research Society-22 (SRS-22) scores and curve magnitudes exhibited significant postoperative improvements (P = 0.001). In right-sided curves, both SRS-22 scores and curve magnitudes improved significantly (P = 0.001), while in left-sided curves, only the curve magnitude improved (P = 0.001). Curve correction was significant in men (P = 0.038), whereas women demonstrated significant improvements in both SRS-22 and curve magnitude (P = 0.001).

Conclusion: Surgical outcomes were comparable between genders; however, differences in SRS-22 results may reflect higher cosmetic expectations among female patients.

Background: Pedicle subtraction osteotomy (PSO) is an established technique for correcting fixed sagittal plane deformities (FSPD), but it is associated with substantial blood loss and a risk of pseudarthrosis. This study aims to develop a modified PSO technique to treat FSPD and assess its technical efficacy and safety.

Methods: A retrospective review was conducted on patients with FSPD who underwent the modified PSO technique between 2004 and 2021. Radiographic outcomes were assessed using kyphotic angle and sagittal vertical axis (SVA), while clinical outcomes were evaluated using the visual analog scale (VAS) for back pain and the Oswestry Disability Index (ODI). Postoperative complications were assessed to evaluate the safety of the technique.

Results: Fifty-three patients (54.7% men) with a mean age of 34.5 years were included in the study, with a mean follow-up of 54.8 months. The mean intraoperative blood loss was 466.9 ± 252.9 ml. Postoperatively, the mean kyphotic angle improved significantly from 37.2° to 8.5° (P < 0.0001). At the final follow-up, a mean loss of correction of 6.4° was observed compared with the immediate postoperative measurement. Statistically significant improvements were observed in the SVA, ODI, and VAS between the preoperative and postoperative assessments (P < 0.0001 for all). Postoperative complications occurred in five patients (9.4%), including pseudarthrosis with rod breakage in two patients (3.8%). No intraoperative or early postoperative neurological complications were observed.

Conclusion: The modified compact-contact PSO technique was feasible and demonstrated favorable radiographic and clinical outcomes, with relatively limited estimated blood loss (EBL) in primary procedures and a low rate of pseudarthrosis. Prospective comparative studies are warranted.

Background: The optimal fixation method for humeral shaft fractures remains debated. This study compared functional and clinical outcomes after intramedullary nailing (IMN) and open reduction and internal fixation (ORIF) with plate fixation.

Methods: In this prospective, observational, comparative cohort study, 85 adults with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) type 12-B or 12-C humeral shaft fractures were enrolled at a tertiary orthopedic trauma center in Tehran, Iran, between April 2020 and April 2024. Patients underwent IMN (n = 43) or plate ORIF (n = 42) according to the treating surgeon’s judgment. The primary outcome was the 12-month Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; secondary outcomes included shoulder and elbow function, pain, union, hospital stay, return to work, and complications.

Results: Mean age was higher in the IMN group compared to the ORIF group (41.53 ± 14.12 vs. 35.83 ± 11.82 years; P = 0.047). The duration of hospital stay was shorter after IMN in the unadjusted comparison (2.07 ± 0.34 vs. 2.26 ± 0.59 days; P = 0.043). Nonunion occurred in 2 patients in each group (4.7% vs. 4.8%, P > 0.999), and no statistically significant difference was observed in the unadjusted QuickDASH scores (10.93 ± 11.33 vs. 16.48 ± 15.23; P = 0.060). In an exploratory model adjusted only for age and sex, IMN was associated with a modestly lower QuickDASH score [B = −6.22, 95% confidence interval (CI): −12.20 to −0.25; P = 0.041]; this association remains susceptible to residual confounding. Both techniques achieved high union rates and favorable 12-month outcomes. The unadjusted QuickDASH comparison was not significant, and the modest association in a partially adjusted exploratory model should not be interpreted as clinical superiority of IMN. Treatment selection should remain individualized.

Background: Pulmonary tuberculosis (TB) is routinely encountered in developing countries such as India. However, osteoarticular TB is rarely seen and frequently presents with an atypical clinical-radiological presentation that may mimic bone tumors. For such lesions involving the bones, we need to be more vigilant in both clinical and radiological terms. The aim of this study was to bridge the gap between diagnosis and management for achieving good outcomes.

Methods: This retrospective study analyzed five cases referred to the orthopedic oncology unit with suspected bone sarcoma, based on clinical, radiological, and histopathological examinations (HPE).
Results: A total of five cases (three male and two female patients) with the suspicion of bone sarcomas were included in this study. The mean age of the study group was 20.6 years. The mean values of blood parameters were as follows: hemoglobin (Hb) 9.88 g/dl, white blood cell (WBC) count 10820/μl, erythrocyte sedimentation rate (ESR) 85 mm/h, and C-reactive protein (CRP) 48.8 mg/l. Two patients (40%) had infections as one of the differential diagnoses. Radiological evaluation suggested infection in four of the five patients (80%). A biopsy was planned and sent for both HPE and culture. HPE was positive in all cases (100%), whereas culture was positive in 60% of cases.

Conclusion: For all the aggressive bony lesions, a multidisciplinary team is of utmost importance for the diagnosis. The role of the oncopathologist is crucial in differentiating atypical presentations of osteoarticular TB from malignant bone tumors.

Background: Supracondylar humerus fractures are the most common pediatric elbow injuries, and maintaining stable reduction is essential to prevent late complications such as cubitus varus. Medial column comminution is an often underrecognized factor that can compromise stability, even in fractures that appear minimally displaced. This report highlights the clinical importance of medial column comminution in pediatric supracondylar fractures and emphasizes surgical strategies to prevent varus deformity.

Case Report: Two pediatric cases with supracondylar humerus fractures were evaluated. The first case involved a minimally displaced fracture initially treated non-operatively, which subsequently developed cubitus varus due to medial column collapse. The second case presented with medial column comminution and was managed with closed reduction and percutaneous pinning. Stable fixation and maintenance of alignment successfully prevented postoperative collapse and deformity.

Conclusion: Medial column comminution is a key determinant of stability in pediatric supracondylar humerus fractures. Early identification and a tailored surgical approach, including valgus reduction and selective medial pinning when indicated, are critical to prevent collapse, maintain alignment, and avoid late varus deformity.

Background: Revision anterior cruciate ligament reconstruction (rACLR) remains one of the most technically demanding procedures in orthopedic sports medicine, particularly in patients with generalized joint laxity (GJL), unrecognized medial collateral ligament (MCL) injuries, and meniscal pathology. Successful outcomes require meticulous diagnostic assessment, individualized graft selection, and simultaneous management of associated ligamentous and meniscal injuries.

Case Report: We report the case of a 23-year-old man with a history of failed primary anterior cruciate ligament reconstruction (ACLR), who presented with recurrent instability, medial knee pain, and episodes of giving way. Clinical and imaging evaluation revealed GJL, a previously unrecognized MCL rupture, meniscal tears, and tibial tunnel widening. A single-stage rACLR using a quadriceps tendon (QT) autograft, combined with concurrent MCL reconstruction and meniscal repair, was performed.

Conclusion: This case highlights the importance of comprehensive evaluation of medial laxity, GJL, and meniscal pathology in all anterior cruciate ligament (ACL) injuries. rACLR in such complex cases requires anatomy-based, patient-specific planning, careful graft selection, and concurrent management of associated injuries to optimize stability and functional outcomes. Hamstring autografts should be used with caution in patients with joint laxity, and double hamstring harvest is discouraged in combined ACL- MCL reconstruction.