Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 68 71 Iman Kiani Center for Orthopedic Trans-Disciplinary Applied Research, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Abolfazl Safari Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran Parham Talebian Orthopedic Surgeon and Spine Fellowship, Orthopedic Surgery Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran 2025 07 27 2026 04 11 Background: Sagittal spinopelvic alignment, encompassing parameters such as lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis (PL-SVA), is a critical determinant of outcomes following lumbar decompression surgery. While decompression is effective in alleviating neurogenic claudication in degenerative lumbar spinal stenosis (DLSS), its impact on sagittal alignment remains uncertain. This study evaluates the radiographic and clinical outcomes associated with decompression surgery. Methods: In this prospective cohort study, 24 patients underwent decompression via laminectomy or laminotomy between July 2017 and July 2018. Sagittal alignment parameters were assessed preoperatively and at follow-up using EOS imaging. Pain and functional outcomes were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Statistical comparisons were performed using paired t-tests. Results: Postoperative evaluation showed significant improvement in LL (29.50 ± 15.02 to 51.58 ± 5.99, p < 0.001), SS (31.15 ± 2.05 to 26.99 ± 5, p < 0.001), and a significant decrease in PT (11.68 ± 2.91 to 6.06 ± 4.62, p < 0.001). No statistically significant changes were noted in PI (p = 0.264) or PL-SVA (p = 0.540). Improvements in LL and SS were negatively correlated with reductions in VAS scores (p = 0.034 and p = 0.028). Conclusion: Lumbar decompression can significantly influence spinopelvic alignment and reduce pain in patients with DLSS. These findings suggest that realignment of sagittal parameters following decompression alone may contribute to improved clinical outcomes. https://jost.tums.ac.ir/index.php/jost/article/view/699 https://jost.tums.ac.ir/index.php/jost/article/download/699/465

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 107 11 EN Sadegh Saberi Associate Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Aysan Valinejad-Qanati Medical Student, Center for Orthopedic Trans-Disciplinary Applied Research, 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 2025 08 23 2026 05 18 This case-based expert review from ORTHOBIT 2025 Congress (Tehran, Iran) highlights the practical challenge of distinguishing between enchondroma/atypical cartilaginous tumor (ACT) (low-grade) and higher-grade chondrosarcoma (CS). A 57-year-old woman presented with 4 months of shoulder pain. Magnetic resonance imaging (MRI) revealed a proximal humeral metaphyseal intramedullary cartilaginous lesion with a focal cortical breach and a small extraosseous component. The core needle biopsy (CNB) suggested enchondroma, and the patient underwent extended curettage, cementation, and plate fixation. Final pathology upgraded the lesion to central CS, grade 2, prompting resection and reconstruction using a proximal humeral megaprosthesis. At 3 years, she was pain-free, recurrence-free, The Musculoskeletal Tumor Society Score (MSTS) 26/30, with moderate range of motion (ROM) limitation, and radiographic superior prosthetic migration without major complications. This case emphasizes the importance of radiology-pathology correlation and planning for possible diagnostic upgrading in borderline cartilaginous tumors. https://jost.tums.ac.ir/index.php/jost/article/view/704 https://jost.tums.ac.ir/index.php/jost/article/download/704/472

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 64 7 Ebrahim Piri PhD in Sports Biomechanics, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran Amir Jafarnezhadgro Associate Professor, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran 2025 08 22 2026 05 17 Securing a durable and effective reintegration into athletic activities after anterior cruciate ligament reconstruction (ACLR) viasurgery, constitutes an intricate and multifactorial endeavor. While most patients express strong optimism for unrestricted sports resumption, empirical outcomes reveal a notable disparity: only approximately 50% of individuals regain their prior competitive level, and among this group, one in five encounters a subsequent anterior cruciate ligament (ACL) rupture. In recent years, numerous assessment frameworks have been introduced to gauge postoperative readiness and mitigate the likelihood of recurrent injury. Nevertheless, contemporary studies indicate that a significant number of sports practitioners do not fulfill conventional clearance benchmarks, and notably, achieving these benchmarks does not invariably safeguard against a second injury, thereby calling into question their prognostic utility. This observed limitation implies that prevailing evaluation methods may possess inadequate discriminative capacity. The results derived from such assessments arguably mirror the caliber and comprehensiveness of the preceding rehabilitative intervention, thus inviting a rigorous reappraisal of standard therapeutic regimens. A pivotal inquiry emerges regarding the adequacy of contemporary preparation strategies in equipping athletes for the rigorous, dynamic, and stochastic challenges inherent in field and court sports. This integrative narrative analysis consolidates seminal findings from the last fifteen years, concentrating on three pivotal domains: 1) contemporary methodologies for evaluating return-to-sport readiness, 2) the architecture and efficacy of postoperative rehabilitation protocols, and 3) the conceptualization of the return-to sport process as a sequential continuum. These dimensions are examined through a unified and overarching analytical framework. https://jost.tums.ac.ir/index.php/jost/article/view/702 https://jost.tums.ac.ir/index.php/jost/article/download/702/464

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 72 6 Madhuchandra Puttamaregowda Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India Pawankumar Keelara Mahadevappa Professor, Department of Orthopedics, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Dayananda Sagar University, Bengaluru, India Nandeesh Shashidhar Associate Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India Raju Koluru Puttaswamygowda Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India 2025 09 25 2026 05 17 Background: The management of femoral neck fracture in elderly patients above 60 years of age remains controversial. Although internal fixation is one of the surgical options, it is associated with high failure rates due to complications such as non-union andvarus collapse. Hemiarthroplasty also has inherent complications, including acetabular erosion, secondary arthritis, and protrusio acetabuli. Primary total hip arthroplasty (THA) offers a stable hip joint with excellent functional outcomes. Methods: This study was conducted at a tertiary care institute between January 2020 and June 2024. A total of 48 THAs were performed in 47 patients as a primary procedure for femoral neck fracture. All procedures were cemented total hip replacements and were performed by a single surgeon. Preoperative evaluation was carried out using the Harris Hip Score (HHS). Radiological assessment was performed using standard radiological parameters. Results: At the end of the follow-up period, the mean HHS was 86.3 (range: 77-97). Of the 48 hips, 16 demonstrated excellent outcomes (HHS > 90), 27 showed good outcomes (HHS: 80-89), and 5 had fair outcomes (HHS: 70-79). Complications included three cases of superficial infection and four cases of deep vein thrombosis (DVT). Conclusion: Primary THA is an excellent alternative to internal fixation and hemiarthroplasty in the management of femoral neck fracture in elderly patients. The study also suggests that the modified lateral approach is a safer surgical approach in reducing the risk of dislocation.  https://jost.tums.ac.ir/index.php/jost/article/view/718 https://jost.tums.ac.ir/index.php/jost/article/download/718/466

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 77 85 Seyed Mohammad Mohammadi Assistant Professor, Department of Orthopedics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohammad Lotfi Medical Student, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Naser Kamyari Assistant Professor, Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran Fatemeh Shojaei Moghaddam Medical Student, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Gholamreza Goudarzi Professor, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Heidar Maleki PhD Candidate, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Jasem Salehi Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran Seyed Amin Hossaini Motlagh Associate Professor, Department of Environmental Health Engineering, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran Khadijeh Kanani Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran Sheyda Ghasemi Medical Student, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran Esmat Radmanesh Associate Professor, Research Center for Environmental Contaminants (RCEC), Abadan University of Medical Sciences, Abadan, Iran 2025 09 16 2026 04 04 Background: This study examined the correlation between bone mineral density (BMD) and particulate matter (PM) in patients with osteoporosis. Methods:  People with osteopenia, osteoporosis, and normal BMD were included in the study. BMD, bone mineral content (BMC), T-scores, and Z-scores of the lumbar vertebrae (L1-L4) and femur were obtained by dual-energy X-ray absorptiometry (DEXA). Daily PM2.5 and PM10 concentrations during the study period (January 21, 2022, to May 21, 2023) were obtained from local monitoring stations, with missing data estimated using satellite-derived aerosol optical depth (AOD).  Results: In patients with osteoporosis, an inverse correlation exists between PM2.5 and PM10 with BMD, BMC, T-score, and Z-score in different parts of the femur except the neck T-score and lumbar spine. Still, none of the correlations was statistically significant.  Conclusion: There was no significant correlation between the mean concentration of PM2.5 and PM10 and the parameters of BMD, BMC, T-score, and Z-score in the bones of the femur and lumbar spine of patients with osteoporosis. https://jost.tums.ac.ir/index.php/jost/article/view/714 https://jost.tums.ac.ir/index.php/jost/article/download/714/467

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 86 90 EN Mahesh Shinde Assistant Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Mihir Patel Additional Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Bibhas DasGupta Professor and Head, Department of Orthopaedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Juhu Mumbai, Maharashtra Atharva Sharma Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Kshitij Sarwey Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Sanket Jethliya Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Shreyas Revankar Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Deepanshu Garg Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Rohan Bahl Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Samreen Chunawala Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Sidharth Mitra Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Juily Satam Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Yash Nav Singh Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Kiara Thakur Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India 2025 09 11 2026 05 17 Background: The quadriceps tendon (QT) graft provides better biomechanical strength, less donor site morbidity, and adjustable size, despite the fact that hamstring and bone-patellar tendon-bone (BPTB) grafts are frequently utilized. Recent research indicates similar results of other grafts, despite early reservations. In order to validate the QT graft's efficacy and dependability in clinical settings, this study will detail the surgical procedure for anterior cruciate ligament (ACL) repair and evaluate its three main dimensions: length, diameter, and thickness. Methods: Fifty patients with ACL injuries who received QT transplants participated in this 24-month prospective research. Patients with isolated ACL injuries and a normal body mass index (BMI) between the ages of 20 and 50 were eligible. Grafts were harvested, processed, and their thickness, diameter, and length were measured. Suspensory fixation was done and anatomical tunnels were made. The following day, rehabilitation got underway. A proforma was used to collect and analyze the data. Informed consent and institutional ethics approval were acquired. Results: In a study of 50 patients with ACL restoration, 84% had QT grafts of appropriate length (mean: 28.7 cm), while 70% had sufficient quadrupled lengths (mean: 7 cm). The majority of grafts’ diameter (96%, mean: 8.6 mm) and thickness (94%, mean: 6.8 mm) fell within the acceptable parameters. These findings show that QT grafts consistently produced adequate dimensions for ACL restoration, demonstrating their dependability and efficacy. Conclusion: The QT graft offers a consistent, adequate tissue source for ACL reconstruction, ideal for active patients needing strong, durable grafts. https://jost.tums.ac.ir/index.php/jost/article/view/711 https://jost.tums.ac.ir/index.php/jost/article/download/711/468

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 91 5 Roop Singh Senior Professor, Department of Orthopedics Surgery, Paraplegia and Rehabilitation, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India Ram Mishra Ex Resident, Department of Orthopedics Surgery, Paraplegia and Rehabilitation, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India Bhawna Verma Assistant Professor, College of Physiotherapy, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India Svareen Kaur Ex Intern, Dr. Baba Saheb Ambedkar Medical College, New Delhi, India 2025 09 21 2026 05 18 Background: A substantial number of patients with spinal cord injury (SCI) need support and care for their daily activities, and this is usually provided by a family member. This responsibility may have several physical and emotional consequences. The aim of the present study was to assess the caregiver burden and the coping strategies used by caregivers of patients with SCI. Methods: A cross-sectional study on 50 primary caregivers of persons with SCI was conducted. The caregiver burden was assessed using Caregiver Burden Inventory (CBI) and Brief Coping Orientation to Problems Experienced (COPE) was used to assess the coping strategies used by the caregivers. Results: The majority of caregivers (82%) were under 50 years of age and were women (66%). 12% of participants faced severe burden and 32% faced moderate to severe burden. Coping strategies involved avoidant, problem-focused, and emotion-focused strategies. Avoidant strategies were associated with moderate to severe burden. Active coping strategies were significantly associated with little or no burden. Greater use of positive coping strategies was related with less amount of caregiver burden. The caregivers with highest burden were found to engage in self-distraction, denial, and behavioral disengagement. The utilization of problem-focused coping strategies, emotional support, and religious practices was most prevalent in caregivers where there was minimal or no burden. Conclusion: The study highlights that coping style plays a significant role in determining caregiver burden, with avoidant coping strategies being associated with higher burden, while active and positive coping strategies were associated with reduced burden. These findings emphasize the importance of promoting adaptive coping mechanisms and providing psychosocial support interventions to reduce caregiver burden and improve caregiver well-being. https://jost.tums.ac.ir/index.php/jost/article/view/716 https://jost.tums.ac.ir/index.php/jost/article/download/716/469

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 96 101 Pranav Kothiyal Associate Professor, Department of Orthopedics, Sri Guru Ram Rai University, Dehradun, India Kunal Vij Professor, Department of Orthopedics, Sri Guru Ram Rai University, Dehradun, India Pranjal Khatri Junior Resident, Department of Orthopedics, Sri Guru Ram Rai University, Dehradun, India 2025 09 25 2026 05 18 Background:  Displaced intra-articular calcaneal fractures (CFs) pose significant challenges in management. This prospective comparative study aimed to evaluate and compare the clinicoradiological and functional outcomes of the sinus tarsi approach (STA) versus the extensile lateral approach (ELA) in Sanders type II and III fractures. Methods: Between February 2022 and August 2024, 120 patients aged 18-65 years with closed displaced intra-articular CFs (Sanders type II/III) were prospectively enrolled and randomly allocated to undergo open reduction and internal fixation (ORIF) via STA or ELA (60 patients each). Outcomes included time to surgery, operative duration, restoration of Böhler’s and Gissane’s angles, complications, and functional scores [American Orthopedic Foot and Ankle Society Score (AOFAS) and Maryland Foot Score (MFS)] at 6, 12, and 24 weeks. Results: The STA group had significantly shorter time to surgery (mean 4 vs. 6 days, P = 0.01) and operative time (65.5 ± 10.2 vs. 85.3 ± 12.4 minutes, P = 0.001). Both approaches achieved good radiological restoration, with ELA showing marginally better postoperative Böhler’s (28.5° ± 3.2° vs. 27.8° ± 3.1°) and Gissane’s (130.2° ± 3.8° vs. 128.5° ± 3.6°, P = 0.001 for Gissane’s) angles. Complication rates were low and comparable. At 24 weeks, STA demonstrated superior AOFAS (91.0 ± 4.9 vs. 90.0 ± 5.5, P = 0.001) and MFS (90.0 ± 4.3 vs. 89.0 ± 5.2, P = 0.001). Conclusion: Both approaches yield satisfactory outcomes, but STA provides advantages in operative efficiency and long-term functional recovery with similar complication rates. STA may be preferred for most Sanders type II and III fractures, reserving ELA for complex cases requiring greater exposure.  https://jost.tums.ac.ir/index.php/jost/article/view/717 https://jost.tums.ac.ir/index.php/jost/article/download/717/470

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 102 6 Atharva Sharma Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Bibhas DasGupta Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Mihir Patel Additional Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Mahesh Shinde Assistant Professor, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Sanket Jethliya Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Shreyas Revankar Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Deepanshu Garg Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Rohan Bahl Senior Resident, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Patil Yogeshwari Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Siddharth Mitra Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Samreen Chunawala Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Yash Singh Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India Singh Akanksha Medical Student, Department of Orthopedics, H.B.T Medical College and Dr R.N. Cooper Hospital, Mumbai, India 2025 10 02 2026 05 18 Background: Proximal humerus fractures are common, especially in the elderly, and often result from low-energy falls or high energy trauma in younger patients. These fractures pose a management challenge due to varied patterns and complex anatomy. While many are treated conservatively, displaced or comminuted fractures often require surgical fixation. Locking plates, particularly the proximal humeral internal locking system (PHILOS), offer stable fixation and improved outcomes, especially in osteoporotic bone. This study aims to assess the functional outcome of displaced proximal humerus fractures treated with PHILOS plating at a tertiary care teaching hospital in Mumbai, India. Methods: This prospective observational study involved 30 adults with displaced proximal humerus fractures treated with PHILOS plating. After informed consent, patients underwent surgery and standardized postoperative rehabilitation. Shoulder function was assessed using the Constant-Murley score (CMS) at 6 weeks, 3 months, and 6 months. Data were analyzed using t-tests and chi-square tests. Results were expressed as mean ± standard deviation (SD) and percentages, with significance set at P < 0.05. Results: This study included 30 patients (mean age: 52.5 years); 70% were men. Most injuries were due to road traffic accidents (RTAs) (70%), with two-part fractures being most common (60%). Radiological union occurred at 6-8 weeks in 80%, 9-12 weeks in 16.7%, and after 12 weeks in 3.3% of patients. The CMS improved significantly over 6 months (P < 0.0001). Functional outcomes were good to fair in most patients. Postoperative complications occurred in 36.67%, mainly shoulder stiffness (23.33%), followed by impingement (10%) and malreduction (3.33%). Conclusion: The PHILOS plate offers stable fixation and favorable functional outcomes in proximal humerus fractures, with timely union and improved CMS, making it an effective option despite minor complications. https://jost.tums.ac.ir/index.php/jost/article/view/721 https://jost.tums.ac.ir/index.php/jost/article/download/721/471