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 fsfully predicted key mechanical influences but showed limitations in capturing complete biological complexity. Conclusion: Mathematical models of OI face significant challenges in accurately considering both biological and mechanical factors simultaneously, often oversimplifying one aspect, while focusing on the other. Their key limitations include unrealistic boundary conditions, computational constraints, and incomplete understanding of biophysical signal translation. Moreover, most models rely on animal studies with interspecies differences and adapt bone healing algorithms rather than developing OI-specific approaches. Despite these challenges, mechanobiological models offer promising insights for optimizing implant design, though developing comprehensive models requires substantial experimental investment and computational resources. https://jost.tums.ac.ir/index.php/jost/article/view/690 https://jost.tums.ac.ir/index.php/jost/article/download/690/460

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 37 42 Seyyed Hadi Kalantar Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Omid Salkhori Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Nima Bagheri Associate Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyyed Saeed Khabiri Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Aidin Arabzadeh Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Alireza Talebi Orthopedic Surgeon, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hadi Jahanbin Orthopedic Surgeon, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Mohammadjavad Mortazavi Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hamed Naghizadeh Orthopedic Surgeon, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 09 13 2026 01 26 Background: Segmental bone defects of the lower extremity, particularly involving the femur and tibia, remain a major reconstructive challenge. Traditional techniques such as the Ilizarov method, Masquelet’s induced membrane, and vascularized fibular grafts are effective but often associated with prolonged treatment duration and significant morbidity. Recent advances in additive manufacturing have introduced patient-specific three-dimensional (3D)-printed implants as a promising alternative. Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was conducted to collect current knowledge on 3D-printed implants of the tibia and femur. Databases including PubMed, Scopus, Embase, and Web of Science were searched from January 2000 to April 2025 for studies reporting outcomes of treatment of tibial or femoral segmental bone defects. Primary outcomes included bone union rate and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, and pooled data were analyzed using a random-effects model. Results: Seventeen studies involving 174 patients were included. The mean bone defect length was 12.3 cm, and the mean follow-up was 27.2 months. The pooled union rate was 92.4% [95% confidence interval (CI): 89.0%-94.8%], with no statistically significant heterogeneity (I2 = 0%). The mean time to radiological union was 7.66 months. The pooled complication rate was 23.5% (95% CI: 15.6%- 33.8%), with reoperation, deep infection, and device-related events being the most common. Assessment of publication bias revealed no statistically significant effect. Conclusion: Custom-made 3D-printed implants represent a highly effective and safe option for the reconstruction of segmental bone defects in the lower extremity. The high union rate and acceptable complication profile support their utility in managing complex cases. Further prospective studies are needed to confirm these findings and define optimal indications.   https://jost.tums.ac.ir/index.php/jost/article/view/712 https://jost.tums.ac.ir/index.php/jost/article/download/712/461

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 43 9 Mohammadreza Golbakhsh Associate Professor, Department of Orthopedic Surgery, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Aref Daneshi Orthopedic Surgeon, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Tina Azimzadeh Bachelor of Nursing, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Amirmohammad Sharafi Medical Student, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mehrdad Sheikhvatan Assistant Professor, Department of Medical Genetics, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Hossein Shafiei Assistant Professor, Department of Orthopedic Surgery, Orthopedic Subspecialty Research Center (OSRC), Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2025 02 27 2026 01 26 Background: Caring for trauma patients is a paramount international concern. Delays in diagnosing patients in need of intensive care have unredeemable consequences. Identifying predicting factors of ICU admission in trauma patients is not without merit regarding this matter. This study aimed to investigate the underlying factors associated with ICU admission in trauma patients. Methods: A retrospective study was designed based on data from the National Trauma Registry of Iran from 2016 to 2021. ICU admission was considered the primary endpoint. Relationships between demographic variables, injury site, injury mechanism, vital signs, and trauma scores with the outcome were evaluated by univariate analyzes. ICU risk factors and their specific odds ratio were determined by multivariate analysis. Results: Following univariate and multivariate analysis, age> 55 years, widowhood, injuries due to road accidents, falling from a height, penetrating objects, and gunshot, underlying cardiovascular disease, injury to head, thorax, abdomen, spine, and lower extremities, hypotension, hypertension, tachycardia, bradycardia, hyperpnea, low oxygen saturation, high body temperature, GCS≤8, and ISS>15 were introduced as independent risk factors of ICU admission. Nonetheless, transport to the hospital (personal car) and upper extremity injury reduced the outcome incidence. Conclusions: Numerous contextual variables were significantly associated with ICU admission, each with its own matter. When entering the emergency room, paying attention to these factors can help diagnose people in need of ICU care sooner. https://jost.tums.ac.ir/index.php/jost/article/view/661 https://jost.tums.ac.ir/index.php/jost/article/download/661/462

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 50 4 Fenil Shah Junior Resident, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Chirag Thakkar Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Dhaval Pandya Assistant Professor, Department of Orthope