Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 145 6 Sina Javidmehr Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Ali Samanpour Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Ramezanpour School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Sanaz Dehghani Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran 2025 04 28 2025 12 01 No Abstract No Abstract No Abstract https://jost.tums.ac.ir/index.php/jost/article/view/676 https://jost.tums.ac.ir/index.php/jost/article/download/676/440

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 147 55 Daniel Encarnación-Santos Resident, Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russia Gennady Chmutin Professor, Department of Neurosurgery of People of Friendship University, Moscow, Russia. Egor Chmutin Professor associated ,Department of Neurosurgery of People of Friendship University, Moscow, Russia. Ismail Bozkurt Assistant Professor; Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey Bipin Chaurasia Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal 2025 05 17 2025 11 22 Background: Robotic assistance in spinal surgery has completely changed the face of the practice over recent decades. The concept of pedicle screw fixation, introduced in the early 1950s, has grown to be one of the cornerstones of treatment for various spinal pathologies. The purpose of this study is to evaluate surgical outcomes and different treatment modalities in spinal pathologies by comparing robotic-assisted techniques with conventional freehand techniques. Methods: A systematic review and meta-analysis were performed based on the PRISMA guidelines. A literature search was conducted using major databases such as ScienceDirect and PubMed/MEDLINE. Statistical analyses were performed using IBM SPSS software, R software, and Microsoft Excel. Peer-reviewed studies published in the English language up to January 2025 were included. Results: Results were compiled from a total of 2,592 patients who underwent robotic neuronavigation-guided spinal surgery, reflecting the precision and efficacy of state-of-the-art robotic technologies in spinal surgery. Of these, 2,219 patients were treated with robotic assisted pedicle screw placement, while 2,294 patients were treated with conventional freehand or fluoroscopy-guided techniques. Conclusion: Our findings have shown that robotically assisted spine surgery is indeed more accurate, with reported rates of up to 90% precision in pedicle screw placement compared to freehand techniques. https://jost.tums.ac.ir/index.php/jost/article/view/678 https://jost.tums.ac.ir/index.php/jost/article/download/678/441

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 159 62 Ishani Patel Associate Professor, Department of Orthopedics, NHL Medical College, Ahmedabad, India Tarkik Amin Associate Professor, Department of Orthopedics, NHL Medical College, Ahmedabad, India Ruchit Vyas Associate Professor, Department of Orthopedics, NHL Medical College, Ahmedabad, India Bruhad Patel Junior Resident, NHL Medical College, Ahmedabad, India Hiten Kayastha Junior Resident, NHL Medical College, Ahmedabad, India Dhaval Modi Professor, Department of Orthopedics, NHL Medical College, Ahmedabad, India 2025 01 29 2025 11 10 Background: Intramedullary nailing (IMN) of radius and ulna has its own advantages and disadvantages. The chances of infection are significantly decreased, as it is usually a closed procedure and has less periosteal stripping. This study was undertaken to evaluate the results of radius ulna nailing and its radiological and functional outcomes using this method. Methods: This study of forearm bones fracture treated by IMN was performed on 30 patients prospectively admitted at SVP Hospital Ahmedabad, India, from 2020 to 2022. Clinically, fracture was united when the patient was completely pain free. Patients were followed up at monthly intervals till union and were assessed clinically and radiographically, and details were recorded. Results: The evaluation of the result was done using Anderson et al. criteria. 28 (93.33%) patients had good to excellent results. Twenty-nine (96.66%) patients had good radiological union. Of these, one patient had union at 22 weeks and one had union at 36 weeks. Twenty-one (70%) patients had union within 4 months. Conclusion: Use of IMN has resulted in, and continues to result in, predictable and good outcomes. Complication rates are lower compared to plate osteosynthesis, although application of above-elbow (AE) slab is a downside of the procedure. The IMN has a future in repair of forearm fractures considering its low complication rates, low cost, and good results. https://jost.tums.ac.ir/index.php/jost/article/view/655 https://jost.tums.ac.ir/index.php/jost/article/download/655/443

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 192 3 Farid Najd Mazhar Professor, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Reza Mohammadi Orthopedic Surgeon, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Omid Mahmoudi Nasab Orthopedic Surgeon, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Sajjad Mohammadnabi Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran Meisam Jafari Kafiabadi Department of Orthopedics,Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran Hooman Shariatzade Associate Professor, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran 2025 03 05 2025 11 23 Abstract This technical note introduces a two-pin technique designed to improve exposure during the shotgun approach for hemi-hamate arthroplasty, a surgical procedure commonly used to treat comminuted intra-articular and chronic proximal interphalangeal (PIP) joint fractures. A 1.0 mm Kirschner wire (K-wire) is inserted into the middle phalanx (P2) distal to the fracture, and a second K-wire is placed into the head of the proximal phalanx (P1). These pins stabilize the joint, facilitate soft tissue retraction, and improve visualization of the fracture site. The graft is harvested from the dorsal distal hamate and shaped to fit the PIP joint before fixation. This method addresses key challenges in visualization and stabilization associated with the shotgun approach. Early feedback suggests improved surgical efficiency, increased accuracy of reduction, and potentially better functional outcomes. The described two-pin technique is simple and reproducible, significantly enhancing exposure and stability during hemi hamate arthroplasty. Further studies are needed to confirm its long-term effects. https://jost.tums.ac.ir/index.php/jost/article/view/664 https://jost.tums.ac.ir/index.php/jost/article/download/664/449

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 194 8 Reza Moulaei Department of Orthopedic and trauma surgery, Shariati hospital, Tehran university of medical sciences, Tehran, Iran Leila Oryadi Zanjani Associate Professor, Department of Orthopedics, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran 2025 04 18 2025 11 23 Background: Acromioclavicular (AC) joint dislocation is a quite common shoulder injury, especially among young, athletic people. Despite various treatment approaches, AC joint injuries still pose significant treatment challenges. Common concerns include postoperative pain, limited shoulder mobility, and hardware-related complications. In recent years, a number of surgical methods have been developed with the goal of improving functional outcomes while reducing complications. In this study, we report a surgical technique using semitendinosus allograft and an 8-plate for a patient with type III AC joint dislocation. Case Report: A 33-year-old man sustained a type III AC joint dislocation following a motorcycle accident. Initial non-surgical management failed to relieve pain or restore full shoulder mobility. As a result, the patient underwent surgical intervention using semitendinosus allograft in combination with an 8-plate device. At the three-month follow-up, the patient had complete shoulder range of motion (ROM) and showed no symptoms of discomfort, dislocation, or joint prominence. Conclusion: AC joint dislocation treatment remains debated, but recent advancements in surgical methods have made it more effective. Reconstruction using semitendinosus allograft and 8-plate device offers improved clinical outcomes with fewer complications. https://jost.tums.ac.ir/index.php/jost/article/view/673 https://jost.tums.ac.ir/index.php/jost/article/download/673/450

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 156 8 Mohammad Karimi shiraz university of medical sciences 2025 02 15 2025 11 10 Background: Various treatment approaches can be used for individuals with scoliosis deformity, with bracing playing a significant role. The aim of this review was to assess the effectiveness of bracing in controlling scoliotic curves based on studies published between 2018 and 2025. Method: A search was conducted in databases such as PubMed, Google Scholar, ISI Web of Knowledge, and Scopus using keywords like brace, orthosis, and scoliosis between 2018 and 2025. Papers were selected based on the research question of interest (effectiveness of bracing in preventing scoliotic curve progression). Results: This narrative review highlighted the importance of certain parameters in predicting the outcomes of brace treatment. Factors such as Risser sign, initial Cobb angle, in-brace correction, curve type, vertebral rotation, brace wearing time, type of brace, and poor compliance all influence the effectiveness of bracing treatment. Conclusion: It appears that the outcomes of bracing treatment in individuals with scoliosis can be predicted based on certain parameters. The findings of this review assist clinicians in determining the effectiveness of bracing in individuals with scoliosis. https://jost.tums.ac.ir/index.php/jost/article/view/657 https://jost.tums.ac.ir/index.php/jost/article/download/657/442

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 163 9 Pranav Kothiyal Associate professor of orthopaedics Kunal Vij Professor, Department of Orthopedics, Sgrrimhs, Dehradun, Uttarakhand, India Meetul Gupta Senior Resident, Department of Orthopedics, Sgrrimhs Dehradun, Uttarakhand, India 2025 03 03 2025 11 22 Background: Anterior cruciate ligament (ACL) reconstruction commonly employs autologous hamstring grafts, with various techniques used for graft preparation. Standard 4-strand grafts are widely accepted; however, braided grafts have been proposed to offer improved biomechanical properties and graft fixation. This study aims to compare the clinical and functional outcomes of braided versus standard hamstring graft preparations in ACL reconstruction. Methods: In this prospective randomized study, 171 patients undergoing primary ACL reconstruction were assigned to two groups: group A (standard graft, n = 92) and group B (braided graft, n = 79). Intraoperative data such as graft length and diameter were recorded. Clinical and functional outcomes were evaluated using International Knee Documentation Committee (IKDC) and Lysholm scores and knee range of motion (ROM) at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Results: The braided graft group demonstrated a larger mean graft diameter (P = 0.492) but decreased graft length (P = 0.028). During follow-ups till 6 months, both groups showed progressive improvement but no significant difference between the two groups with respect to knee ROM, IKDC, or Lysholm scores. Difference in complications was statistically insignificant. Conclusion: The study suggests that both standard and braided hamstring grafts are effective options for ACL reconstruction, yielding comparable short-term clinical outcomes. However, the braided technique demonstrates potential advantages in terms of increased graft thickness and uniform fixation. While these findings are promising, further in vivo studies and long-term clinical trials are necessary to validate the superiority of the braided graft technique in ACL reconstruction. https://jost.tums.ac.ir/index.php/jost/article/view/663 https://jost.tums.ac.ir/index.php/jost/article/download/663/444

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 199 203 Ronald Cabral Chettinad hospital and research institute, Kelambakkam Ganesh Anantharamakrishnan Indian orthopedics association, Odisha orthopedics association, SICOT, AO Trauma society, Chettinad Hospital and research instituteYear> 10 27 Background: Triphalangeal thumb (TPT) is a rare congenital anomaly, especially in the Asian population. Traditional treatments depend on the type of deformity and the presence of concomitant anomalies and include either excision in addition to the ligament reconstruction or fusion and shortening osteotomy. Instability and stiffness are the major concerns following the traditional techniques. Case Report: In this study, we report a case of right TPT with a small delta phalanx in a nine-year-old boy who was treated by proximal phalanx radial closed wedge osteotomy without delta phalanx resection or intracapsular dissection. The angular deformity and the appearance of the thumb were corrected by this simple procedure without resulting in instability and stiffness in the interphalangeal joint. Conclusion: Proximal phalanx closed wedge osteotomy is a rapid, simple, and effective technique with a low risk of unexpected complications for correcting the appearance in the cases of TPT with a small delta phalanx. https://jost.tums.ac.ir/index.php/jost/article/view/508 https://jost.tums.ac.ir/index.php/jost/article/download/508/379

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 127 9 Sudhir Mane Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India - 509002 Jayaram P. Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India - 509002 Kyatham L. Rao Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India - 509002 2023 10 02 2024 10 27 Background:Missed or neglected Monteggia lesions are defined as classical fracture-dislocation presenting at least four weeks after injury. This injury in children is often challenging to treat and requires complex methods to achieve optimal results. Case Report: We report a 6-year-old girl with a 2-month-old neglected Bado type-I Monteggia fracture-dislocation. Our patient underwent ulnar osteotomy, bone grafting, and fixation with a semi-tubular plate along with open radial head reduction. Although the patient experienced wound complications at the bone graft harvest site, she achieved an excellent outcome with restored functionality and range of motion (ROM). Conclusion: Neglected Monteggia injuries in pediatric patients demand multifaceted treatment approaches due to their complexity and potential for long-term functional impairment. The absence of a consensus on definitive treatment underscores the importance of early diagnosis and open reduction to enhance long-term outcomes. This case report highlights the effectiveness of ulnar osteotomy, plate fixation, and open radial head reduction in achieving favorable results. https://jost.tums.ac.ir/index.php/jost/article/view/535 https://jost.tums.ac.ir/index.php/jost/article/download/535/380

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 135 8 Arash Sharafat Vaziri Tehran university of medical sciences Hamid Rabie Tehran university of medical sciences Iman Menbari Oskouie Tehran university of medical sciences Mohammad Tahami Assistant Professor, Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Nazanin Rahimdoost Tehran university of medical sciences 2024 06 04 2024 10 27 Background:Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane. Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up. Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion. https://jost.tums.ac.ir/index.php/jost/article/view/596 https://jost.tums.ac.ir/index.php/jost/article/download/596/382

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 139 141 Prem Kumar Kothimbakkam Chettinad Academy of Research & Education Vijayashankar Murugesan Chettinad Academy of Research and Education Bharath Vadivel Chettinad Academy of Research and Education Esa Gokulakrishnan Chettinad Academy of Research and Education 2024 01 23 2024 10 27 Background: Chaput tubercle fracture is a counterpart to adolescent Tillaux fracture, which occurs at the anterolateral part or the attachment site of the antero-inferior tibiofibular ligament on the distal tibia. It is rare, and its presentation may not be well appreciated in X-rays, which depicts the importance of a computed tomography (CT) scan of the ankle to reveal the same. Case Report: A 25-year-old gentleman presented to Chettinad Hospital, India, casualty with acute onset of pain, swelling, and restricted movements at the ankle joint following a road traffic accident. Ankle CT revealed a Chaput fracture along with a bimalleolar fracture (posterior and lateral malleoli). The complex displaced fracture was managed with open reduction internal fixation (ORIF) with plate osteosynthesis for the posterior malleoli and lateral malleoli, and tension band wiring was done for the Chaput tubercle fracture. At the end of two-year follow-up, the patient was able to mobilise without any support. Conclusion: Through this case report, we would like to enumerate the rarity of Chaput tubercle fracture associated with bimalleolar fracture of the ankle, which will be evaluated better with a CT evaluation in the first place. At the same time, it gives valuable information for the preoperative surgical plan. https://jost.tums.ac.ir/index.php/jost/article/view/565 https://jost.tums.ac.ir/index.php/jost/article/download/565/383

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 146 8 Arash Sharafat Vaziri Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Nazanin Rahimdoost Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Soodabeh Esfandiary Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran. Fardis Vosoughi Department of Orthopedics and Trauma Surgery, Shariati Hospital, TUMS, Tehran, Iran Mehdi Moezi Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran Iman Menbari Oskouie School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2023 11 09 2024 10 27 Background: Osgood-Schlatter disease (OSD), a form of traction apophysitis, predominantly affects adolescents engaged in high- impact activities. While conservative management is often effective, surgical intervention becomes necessary in refractory cases. Case Report: A 29-year-old male athlete with persistent OSD symptoms underwent arthroscopic surgery after unsuccessful non- surgical treatments. Arthroscopic removal of the bony particle was undertaken using six portals with a novel setting (consisting of medial and lateral superior, standard, and inferior portals) to minimize the damage to the patellar tendon and intermeniscal ligaments. This setting of portals also obviates the need for fluoroscopy since it provides adequate visualization for confirmation of complete removal of the bony particle. The lower portals also provide more convenient access to the bony particle, minimizing the possibility of incomplete removal and persistence of symptoms. The patient experienced complete resolution of anterior knee pain and prominence within six months post-surgery. Arthroscopic removal of the ossicle involved the use of superior portals for optimal access and visualization. Low portals were strategically employed to eliminate the need for fluoroscopy, offering a unique advantage. Postoperative rehabilitation included immobilization followed by a gradual return to weight-bearing and full range of motion (ROM). Conclusion: Arthroscopic removal remains the preferred method for treating OSD, emphasizing fewer complications. However, challenges related to limited access and anatomical restoration persist. https://jost.tums.ac.ir/index.php/jost/article/view/549 https://jost.tums.ac.ir/index.php/jost/article/download/549/385

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 3 2024 10 27 130 4 Hieu Huynh University of Medicine and Pharmacy at Ho Chi Minh City Maxime Lacroix Université Paris-Cité, Paris, France Pierre Guigui Université Paris-Cité, Paris, France Emmanuelle Ferrero Université Paris-Cité, Paris, France Tchao Meatchi Université Paris-Cité, Paris, France Marc Khalifé Université Paris-Cité, Paris, France 2023 06 04 2024 10 27 Background: Pseudomyxoma peritonei (PMP) is a rare condition, with no previously described location in the spine. Here is presented a case of PMP extension to the thorax and then the spine, treated with two-level vertebrectomy, laminectomy, and posterior fusion. Case Report: We report here the case of a 64-year-old man presenting pathological fractures of T6 and T7 due to PMP extension to the pleural cavity and thoracic spine. He presented interscapular pain with mild spinal cord compression symptoms. He was treated by achieving T5-T8 laminectomy, T2-T10 pedicle fixation, and T6-T7 vertebrectomy. The postoperative course was uneventful apart from a pulmonary embolism (PE) with favorable evolution under anticoagulants. Conclusion: To achieve spinal cord decompression, kyphosis correction, and spine stabilization, a two-level vertebrectomy, laminectomy, and posterior fusion would be beneficial for a PMP lesion of the thoracic spine. https://jost.tums.ac.ir/ind