Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 45 9 Shantanu Vijay Junior Resident, GMERS Medical College, Gotri, Vadodara, Gujarat, India Subham Verma Senior Resident, GMERS Medical College, Gotri, Vadodara, Gujarat, India Bharat Soni Senior Resident, GMERS Medical College, Gotri, Vadodara, Gujarat, India Tarun Desai Associate Professor, GMERS Medical College, Gotri, Vadodara, Gujarat, India Prashant Alwani Associate Professor, GMERS Medical College, Gotri, Vadodara, Gujarat, India Jeevan Appala Junior Resident, GMERS Medical College, Gotri, Vadodara, Gujarat, India Chirag Thakkar Professor, GMERS Medical College, Gotri, Vadodara, Gujarat, India 2024 09 02 2025 04 26 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. https://jost.tums.ac.ir/index.php/jost/article/view/624 https://jost.tums.ac.ir/index.php/jost/article/download/624/406

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 69 72 Sepand Heidari Resident, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Negar Hosseinaei General Practitioner, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammadamin Choobdar Omrani Resident, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Seyed Hadi Kalantar Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran 2024 11 05 2025 04 26 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. https://jost.tums.ac.ir/index.php/jost/article/view/635 https://jost.tums.ac.ir/index.php/jost/article/download/635/411

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 73 6 Mohd Alamlih Hamad medical corporation Isam Moghamis Specialist, Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar Jawad Derbas Hamad medical corporation Saed Owda Resident, Department of Orthopedics Surgery, Hamad Medical Corporation, Doha, Qatar Syed Alam Hamad medical corporation Saeed Qaimkhani Hamad medical corporation 2024 10 29 2025 04 26 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.  https://jost.tums.ac.ir/index.php/jost/article/view/634 https://jost.tums.ac.ir/index.php/jost/article/download/634/412

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 50 4 Seyed Mohammad Mohammadi Department of Orthopedics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohammad Lotfi Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Naser Kamyari Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran Fatemeh Shojaei Moghaddam Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Esmat Radmanesh Associate Professor, Department of Physiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran 2024 10 13 2025 04 26 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. https://jost.tums.ac.ir/index.php/jost/article/view/631 https://jost.tums.ac.ir/index.php/jost/article/download/631/407

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 77 80 Reza Zandi Associate professor of Department of Orthopedic Surgery, Musculoskeletal Research Center, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shahin Talebi Associate professor of Department of Orthopedic Surgery, Musculoskeletal Research Center, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Farnam Behroo Intern, Shahid Beheshti university of medical science, Tehran, Iran Saeed Nodehi Resident, Musculoskeletal Research Center, Taleghani Hospital, Shahid Beheshti university of medical science, Tehran, Iran Akbar Ehsani Department of Orthopedic Surgery, Faculty of Medicine, Shahid Beheshti University, Tehran, Iran 2024 09 24 2025 04 26 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. https://jost.tums.ac.ir/index.php/jost/article/view/627 https://jost.tums.ac.ir/index.php/jost/article/download/627/413

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 55 60 Sayyed-Hadi Sayyed-Hosseinian Orthopedics Surgeon, Orthopaedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Reza Sarshar Orthopaedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Mahdieh Parsaeian Orthopedics Surgeon, Orthopaedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Ebrahimzadeh Orthopedics Surgeon, Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Ali Birjandinejad Orthopedics Surgeon, Orthopaedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 2024 10 20 2025 04 26 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. https://jost.tums.ac.ir/index.php/jost/article/view/632 https://jost.tums.ac.ir/index.php/jost/article/download/632/408

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 2 2025 06 15 81 5 Reza Moulaei Department of Orthopedic and trauma surgery, Shariati hospital, Tehran university of medical sciences, Tehran, Iran Khadijeh Moulaei Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran Fardis Vosoughi Department of Orthopedic and trauma surgery, Shariati hospital, Tehran university of medical sciences, Tehran, Iran 2024 12 26 2025 05 31 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 fJournal of Orthopedic and Spine Trauma 2538-2330 11 1 2025 03 02 23 26 EN Hindalahally Karthik Junior Resident, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Tushar Ubale Associate Professor, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Mahesh Shinde Senior resident, H.B.T Medical college and Dr R.N. Cooper hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Mihir Patel Associate Professor, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Atharva Sharma Junior Resident, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Kshitij Sarwey Junior resident H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Vinod Bhuktar Junior Resident, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Sanket Jethliya Junior resident H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Naman Khurana Medical Student, H.B.T Medical college and Dr R.N. Cooper hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Tej Bopardikar Medical Student, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Vedita Bapat Medical Student, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra Manni Dwivedi Medical Student, H.B.T Medical College and Dr R.N. Cooper Hospital Bhaktivedanta Swami Road Mumbai Juhu Mumbai, Maharashtra 2024 11 26 2025 02 24 Background: Spondylolisthesis is characterized by the anterior or posterior displacement of a vertebra relative to the adjacent inferior vertebra. Patients with grade I-IV spondylolisthesis are initially treated by conservative measures, but surgical intervention becomes necessary for those with persistent symptoms. Surgical options range from pars repair in spondylosis to various fusion techniques, including instrumented reduction and fusion, or instrumented in situ fusion. The study aimed to evaluate the functional outcomes of surgical instrumentation in low-grade spondylolisthesis. Methods: This retrospective study included 30 patients with low-grade spondylolisthesis who underwent surgical instrumentation. Pain and functional outcomes were evaluated using the Visual Analog Scale (VAS) and modified Oswestry Disability Index (ODI) at baseline and follow-up intervals. Results: The baseline mean VAS score of 7.4 improved significantly at 6, 12, and 24 months (P < 0.01). The baseline mean ODI score of 66.8 also improved significantly at these intervals, with a final mean score of 12.51 at 24 months. Complications occurred in 3 patients, including neurological deficits and bone graft retropulsion. Conclusion: Surgical instrumentation leads to significant improvements in pain and function in patients with low-grade spondylolisthesis, offering excellent outcomes for those unresponsive to conservative treatment. https://jost.tums.ac.ir/index.php/jost/article/view/638 https://jost.tums.ac.ir/index.php/jost/article/download/638/400

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 1 2025 03 02 27 31 Reza Zandi Associate professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Nima Keyhaninejad assistant professor, Department of Orthopedics, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shahin Talebi assistant professor, Department of Orthopedics, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Nodehi Resident, Shahid Beheshti university of medical science, Tehran, Iran Akbar Ehsani Orthopedic Surgeon, Shaheed Beheshti university of medical science, Tehran, Iran 2024 08 31 2025 02 24 Background: This study evaluates the radiologic and functional outcomes of femoral head fractures, focusing on the correlations between radiologic parameters and complications. Methods: We conducted a retrospective analysis of 26 Pipkin fractures. Complications and outcomes were documented, with measurements taken for head-neck ratio, surface ratio in multiple planes, and head volume for further analysis. Results: Associated injuries were observed in 65.38% of cases. Osteoarthritis developed in 61.53%, avascular necrosis of the femoral head in 50%, and heterotopic ossification in 26.92%. According to the Epstein scale, among the 26 patients, seven (26.92%) rated their outcomes as excellent, 11 (42.30%) as good, five (19.23%) as fair, and three (11.53%) as poor. Our findings indicate that head volume ratio, differences in head-neck ratio, and surface ratios in various planes correlate with late complications. Specifically, osteoarthritis was associated with the sagittal surface ratio (P=0.026) and coronal surface ratio (P=0.034) in Type II fractures, while in Type IV fractures, it correlated with the axial surface ratio (P=0.023), head volume (P=0.020), and differences in head-neck ratio (P=0.017). Heterotopic ossification was linked to head volume ratio (P=0.028) in Type II, and to coronal surface ratio (P=0.017) and differences in head-neck ratio (P<0.001) in Type IV. Avascular necrosis correlated with differences in head-neck ratio (P=0.041) in Type IV, and with head volume ratio (P=0.012) and sagittal surface ratio (P=0.012) in Type II. Conclusion: In summary, head-neck ratio, head volume ratio, and surface ratios are predictive of late complications following femoral head fractures. https://jost.tums.ac.ir/index.php/jost/article/view/622 https://jost.tums.ac.ir/index.php/jost/article/download/622/401

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 1 2025 03 02 32 4 Mansi Patel Ms Orthopaedics, Assistant Professor, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India Dhyey Baldha Ms Orthopaedics, Senior Resident, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India Aaksh Koladiya SMT. NHL MEDICAL COLLEGE, AHMEDABAD Lalit Bambhaniya Ms Orthopaedics,Resident doctor, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India Utkarsh Panchal Ms Orthopaedics,Resident doctor, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India Tejas Jogi Ms Orthopaedics,Resident doctor, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India Ishani Patel Ms Orthopaedics, Associate Professor, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India Neel Bhavsar Ms Orthopaedics, Professor, Department Of Orthopaedics, Smt Nhl Medical College, Ahmedabad , India 2024 06 23 Background: Distal end radius fractures constitute 16%-20% of all fractures. Extra-articular fractures are managed with closed reduction and casting, while intraarticular fractures require more invasive treatment due to instability and conservative treatment complications. Despite extensive research, the optimal treatment