Journal of Orthopedic and Spine Trauma

Efficacy of Tranexamic Acid on Perioperative Blood Loss in Hip Arthroplasty: A Comparative Study

Sun, 15 Jun 2025 10:16:03 +0430

Background: Using tranexamic acid (TXA) as a measure to ensure hemostasis during surgeries involving the hip region is a topic
that is still debated, with scarce literature. The aim of this study was to assess the effectiveness of TXA administration in improving
outcomes of hip arthroplasty.
Methods: This is a randomized comparative prospective study. It was conducted in the Department of Orthopedics, GMERS Medical
College and Hospital, Vadodara, India, from January 2023 to December 2023 on 60 patients undergoing hip arthroplasty.
Results: The postoperative mean hemoglobin (Hb) value after 24 hours in the test group was 10.9 ± 1.6 g/dl while it was 10.1 ± 1.4 in
the control group, which was statistically significant. The mean duration of surgery in the test group was 102.7 ± 28.2 minutes versus
125.2 ± 36.5 minutes in control with a P-value of 0.01, indicating less surgical duration in the test group.
Conclusion: TXA is an effective agent to reduce intraoperative blood loss, reduce surgical time, and improve post-operative Hb levels.

Relationship between Body Mass Index and Bone Mineral Density in People with Osteoporosis: A Cross-Sectional Analytical Study

Sun, 15 Jun 2025 10:18:59 +0430

Background: Obesity and osteoporosis are prevalent global health problems. This study aims to investigate the relationship
between bone density and body mass index (BMI) in patients with osteoporosis and osteopenia.
Methods: Demographic data, BMI, bone mineral density (BMD), and T-scores of the lumbar spine (L1-L4) and neck of the left femur
were collected using the files of individuals who were referred to the Bone Density Measurement Center, Nuclear Medicine Center,
Abadan, Iran, from February 2022 to September 2023. The relationship between BMD of the lumbar spine and neck of the left femur
and BMI in individuals with osteoporosis, osteopenia, and normal BMD, with varying weight categories ranging from underweight
to obese or overweight, was investigated.
Results: In this study, 475 people were included in three groups. The mean BMI was higher than normal. In the group with
osteoporosis, the BMD of the lumbar spine of the overweight and obese group was higher than the underweight and normal weight
groups (P < 0.001). There was a direct significant correlation between BMD of the spine and BMI in the group with osteoporosis
(r = 0.389, P < 0.001). A direct and significant correlation was observed between BMI and BMD of the femur (r = 0.296) and between
BMI and BMD of the lumbar spine (r = 0.233).
Conclusion: BMI and BMD of the neck of the femur and lumbar spine were directly correlated.

Common Foot Fracture Patterns: A Descriptive Study on 558 Cases

Sun, 15 Jun 2025 10:20:48 +0430

Background: Foot fractures are relatively common among trauma patients, and further research is needed to identify prevalent
fracture patterns. This study aimed to explore common foot fracture patterns.
Methods: This cross-sectional study included patients admitted to a trauma center between 2018 and 2020. All patients with acute
foot injuries were identified using the hospital information system (HIS). Data such as age, sex, trauma mechanism, mobile injuries,
hospitalization status, and whether the injury was open or closed were extracted from patient records. Radiographies were
reviewed to evaluate the location of fractures or dislocations and their anatomical classification.
Results: A total of 558 patients with an average age of 35.70 ± 16.55 years were studied, of whom 489 (67%) were men. The most
common mechanism of trauma was motor vehicle accidents (240/558, 43.1%). The forefoot was the most frequently affected area
(48.7%). Among the different bones, the calcaneus had the highest fracture incidence (233/558, 41.8%). There were 63 patients with
dislocations, with Lisfranc dislocation being the most common (32/558, 50.8%). Calcaneus fractures were significantly more
common in men than in women (P = 0.008), while fractures of the second (P = 0.010) and fifth (P = 0.011) metatarsals were
significantly more common in women.
Conclusion: Calcaneus fractures were most common, especially in men, while women had more metatarsal fractures. Motor vehicle
accidents were the primary cause of trauma. The mechanism of injury plays a crucial role.

Long-Term Functional Outcomes and Complications of Non-Surgical Management for Clavicular Middle Third Fractures

Sun, 15 Jun 2025 10:22:06 +0430

Background: Clavicle fractures are relatively common, and most often occur in the middle third. Fractures that are not displaced or are displaced with no other indication for surgical intervention are treated supportively. Displaced fractures that have been managed non-surgically have had acceptable outcomes. The goal of this study is to evaluate pain scores, the resumption of daily activities, rates of acceptable healing, non-union, malunion, and the need for additional surgical intervention. Methods: This observational study was conducted on 432 patients with midclavicular fractures who were referred to a high-level trauma center. All patients were treated non-surgically and followed for six months. The primary outcomes were patients’ function or disability, assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) and University of California, Los Angeles (UCLA) scores. The secondary outcomes included the rate of pain relief, measured by the Verbal Numeric Scale (VNS) score, as well as complications such as malunion, nonunion, and the need for secondary surgical intervention. Results: A total of 432 patients were enrolled. The rates of malunion and nonunion were 63.4% and 2.3%, respectively. Patients with malunion exhibited a higher pain score (P < 0.001). The average UCLA score among patients was 32.53, which corresponds to good and excellent grades; it was significantly lower for those with malunion (P < 0.001). The mean DASH score was 5.92, and there was no significant difference between the two groups regarding malunion and normal union (P > 0.05). Conclusion: Our study demonstrated a low non-union rate, good functionality, and a high rate of satisfaction among patients with middle third clavicle fractures who were treated non-surgically.

Kyphoplasty for Osteoporotic Vertebral Compression Fractures: Outcomes and Intradiscal Cement Leakage Type

Sun, 15 Jun 2025 10:23:36 +0430

Background: Kyphoplasty (KP) has been widely applied to treat painful osteoporotic vertebral compression fractures (VCFs).
However, knowledge about sequelae is still inadequate. This study aimed to assess outcomes following balloon KP in patients with
osteoporotic VCFs.
Methods: A total of 251 patients were included and classified into two groups: group A included 31 patients with braces for one
month after KP, and group B contained 220 patients without braces. Patients with intradiscal bone cement leakage were divided
into two groups according to spinal X-ray imaging with Round- type (n = 2) and Spike-type (n = 9). Operating efficacy was evaluated
via a comparison of the visual analog scale (VAS) and Oswestry Disability Index (ODI) before and after KP. Complications such as
adjacent vertebral fractures (AVFs) and remote vertebral fractures (RVFs) were observed.
Results: 361 vertebral bodies, including 153 thoracic vertebrae (42.4%) and 208 lumbar vertebrae (57.6%) were treated. Mean age of
patients was 73.3 [standard deviation (SD) = 6.4] years and 72.9% were women. Mean follow-up duration was 22.8 (SD = 13.2) months.
Operation average time was 35.2 (SD = 9.3) minutes. Average intraoperative fluoroscopy was 23.6 (SD = 9.8) times. Average volume of
bone cement injected into each vertebral body was 3.7 (SD = 0.9) ml. We observed 18 AVFs and nine RVFs within 1-31 months of
surgery. The remote fracture was 0% in group A and 4.1% in group B, which was also a statistically significant difference (P < 0.05). The
AVFs were 78% in group of Spike-type and 0% in group of Round-type, which shows a significant difference between the groups
(P < 0.05). All groups had significantly improved VAS and ODI at each follow-up time.
Conclusion: KP is an effective treatment for the management of osteoporotic VCFs, but it seems that intra-disc leakage with Spike-type
increases the risk of AVFs. We recommend patients wear braces for at least one month after KP to reduce pain and new fractures.

Educational Insights on Acetabular Percutaneous Screw Fixation: Posterior and Anterior Column Management in Prone Position

Sun, 15 Jun 2025 00:00:00 +0430

Background: Open reduction and internal fixation (ORIF) of acetabular fractures, while effective, carries significant morbidity.
Percutaneous techniques offer reduced soft-tissue damage and blood loss, but require precise radiographic guidance. This study
explores the safety and efficacy of prone positioning for percutaneous fixation of both acetabular columns, addressing the lack of
data on this approach.
Case Report: A 59-year-old man with a transverse acetabular fracture, classified by Letournel-Judet, underwent percutaneous fixation
in the prone position. The procedure involved retrograde posterior column screw placement and antegrade anterior column screw
placement. Fluoroscopic imaging was crucial for accurate guide pin and screw insertion, with specific attention to anatomical
landmarks and neurovascular structures. The surgical technique details the steps for each screw placement, including fluoroscopic
views and potential complications.
Conclusion: Prone positioning for percutaneous acetabular fracture fixation provides excellent surgical access and reliable imaging,
and facilitates conversion to open surgery if needed. While prone positioning has limitations, including potential cardiovascular
and pulmonary effects, this minimally-invasive technique demonstrated safety and reliability for treating specific acetabular
fracture patterns. Preoperative planning and intraoperative imaging are critical for successful outcomes.

Conservative Treatment of Lumbar Canal Stenosis Secondary to Epidural Venous Plexus Engorgement: A Case Report

Sun, 15 Jun 2025 10:29:01 +0430

Background: Background: Epidural venous plexus (EVP) engorgement has been rarely reported as a cause of radiculopathy and back pain with different
possible underlying pathologies. Because of their rarity, these cases can be easily missed on imaging due to a lack of awareness.
Case Report: We present a case of a 58-year-old, obese woman with a history of treated breast cancer who had been experiencing lower back
pain and bilateral sciatica for one year. Clinical examination showed positive signs of neurotensin with no neurological deficit. Magnetic
resonance imaging (MRI) with contrast showed substantial engorgement of the epidural veins, causing lumbar canal stenosis at the level of
L5 and S1. Non-operative treatment with pain medications and pregabalin was successful and improved her symptoms significantly.
Conclusion: Lumbar canal stenosis secondary to epidural varicose veins is a rare cause, and it can be easily missed on imaging. An
engorged EVP should be considered in the differential diagnosis of radiculopathy in obese patients. There is an increased risk of
bleeding with surgical treatment of such a condition.

Massive Hip Heterotopic Ossification in a Polytrauma Patient: A Case Report

Reza Zandi, Shahin Talebi, Farnam Behroo; Saeed Nodehi; Akbar Ehsani — Sun, 15 Jun 2025 00:00:00 +0430

Background: Heterotopic ossification (HO) around the hip joint is correlated with a dramatic reduction in hip range of motion
(ROM) and quality of life (QOL).
Case Report: We report on a 45-year-old man with a massive right hip HO with intensive reduction in his right hip ROM. He
underwent surgical resection via Smith-Petersen approach by an experienced hip surgeon, as well as a vascular surgeon.
Neurovascular bundle was explored and protected. The mass was excised as much as possible. The ROM increased instantly to near
full. After surgery, we used indomethacin in order to hinder the HO relapse.
Conclusion: The surgical resection of hip HO is a feasible treatment option; however, it is challenging.

Prompt Diagnosis and Management of Morel-Lavallée Lesion: A Case Report

Reza Moulaei, Khadijeh Moulaei, Fardis Vosoughi — Sun, 15 Jun 2025 10:32:21 +0430

Background: The Morel-Lavallée lesion (MLL) is an unusual injury that occurs due to shearing forces separating the skin from the underlying layers. This lesion can lead to an infectious hematoma and create a life-threatening condition.

Case report: A case of a 21-year-old female patient is presented who visited the emergency department after a truck ran over her foot. It was later determined that she had an MLL in her thigh. The patient fully recovered using a vacuum-assisted closure.

Discussion: Articles on MLL and its diagnostic tools are reviewed to ensure accurate and rapid diagnosis of MLL, with a special emphasis on early diagnosis.

Conclusion: It is crucial for orthopedic surgeons to be aware of the diagnostic steps and symptoms to quickly identify and treat MLL before it causes irreversible damage to the patient.

Non-Absorbable Sutures Technique for Distal Patellar Pole Fracture: A Case Report

Reza Zandi, Shahin Talebi, Ahmadreza Ahmadi Abdashti; Mohsen Ghafari — Sun, 15 Jun 2025 10:33:50 +0430

Background: Patella fractures account for approximately 1% of all fractures and can be classified as simple or complex. Complex
fractures often require surgical intervention due to bone fragment displacement. Rehabilitation focuses on restoring range of
motion (ROM), strengthening muscles, and reducing knee stiffness, with recovery potentially taking several months. Treatment
options for distal pole patella fractures include fragment resection, which may lead to complications such as patella baja and
extensor mechanism weakness. Another method, the basket plate technique, has been associated with discomfort in about 30% of
patients, often requiring implant removal surgery.
Case Report: We present a novel technique for stabilizing distal pole patella fractures using multifilament polyester non-absorbable
coated braided sutures, offering an alternative to traditional fixation methods.
Conclusion: This technique provides stable fixation while avoiding the need for implant removal. Although further research is
required to compare its efficacy with conventional approaches, initial results suggest it may be a promising option for managing
distal pole patella fractures