Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 4 2026 09 19 167 73 Omid Salkhori Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohammad Ayati Firoozabadi Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hesan Rezaee Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Hamed Naghizadeh Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Seyed Mohammad Javad Mortazavi Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2025 09 08 2026 06 28 Medial opening wedge high tibial osteotomy (MOWHTO) is a knee-preserving surgical option for selected patients with symptomatic medial compartment osteoarthritis (OA) and varus malalignment. Successful outcomes depend on appropriate patient selection, accurate radiographic assessment, individualized correction planning, stable fixation, and careful intraoperative protection of the lateral hinge and posterior neurovascular structures. This educational review summarizes the practical steps in the evaluation and surgical planning of MOWHTO, including clinical assessment, classification of varus deformity, imaging, indications and contraindications, correction target, osteotomy orientation, hinge position, fixation options, bone grafting, drain use, and postoperative considerations. The review also compares MOWHTO with lateral closing wedge high tibial osteotomy (LCWHTO) and discusses areas where evidence remains inconclusive. Rather than proposing a single universal technique, this article emphasizes individualized decision-making based on patient anatomy, severity of OA, ligament status, patellofemoral joint condition, planned correction, and surgeon experience. https://jost.tums.ac.ir/index.php/jost/article/view/710 https://jost.tums.ac.ir/index.php/jost/article/download/710/484

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 4 2026 09 23 174 8 Saeid Safaei Knee and Sport Medicine Research Center, Milad Hospital, Tehran, Iran Taravat Yazdanian Sean M Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Parisa Azimi Neurosurgeon, Department of Neurosurgery, Clinical Research Development Unit of Shahid Madani Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2026 07 03 2026 08 24 Background: Scheuermann’s kyphosis (SK), also known as juvenile kyphosis, is one of the most common causes of spinal deformity in adolescents. The objective of this study was to review the outcomes of posterior-only surgical correction for SK over 25 years. Methods: We retrospectively reviewed patients diagnosed with SK who underwent posterior spinal surgery. Health-related quality of life was assessed using the Oswestry Disability Index (ODI) and the Scoliosis Research Society 30-item questionnaire (SRS-30), and radiographic parameters were evaluated preoperatively and at follow-up. Results: A total of 210 patients with SKs underwent posterior-only surgical correction. The mean age at surgery was 17.5 years (range, 12–38 years), with a mean follow-up of 17.5 years. Significant improvements were observed in sagittal Cobb angle (85.9° to 43.2°, P < 0.001), coronal Cobb angle (32.5° to 11.5°, P < 0.001), L1–S1 lordosis (P = 0.001), and sagittal balance (P = 0.043). Clinical outcomes also improved significantly, with the ODI decreasing from 23.2 to 5.8 (P = 0.003) and the SRS-30 score increasing from 64 to 133.5 (P < 0.001). The mean pelvic incidence (PI) was 46°, with no significant correlation between pelvic incidence and either the preoperative sagittal Cobb angle (P = 0.46) or kyphosis correction (P = 0.7). However, kyphosis correction approximating PI was associated with more favorable postoperative outcomes. The overall complication rate was 4%, and the mean loss of correction at the final follow-up was 1.6°. Conclusion: A posterior-only approach is an effective and safe treatment for SK; however, whether correction approximating PI can optimize individualized outcomes remains a hypothesis requiring prospective evaluation. https://jost.tums.ac.ir/index.php/jost/article/view/829 https://jost.tums.ac.ir/index.php/jost/article/download/829/485

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 4 2026 09 23 204 11 Prerna Walia Assistant Professor, Department of Oncopathology, The Gujarat Cancer and Research Institute, Ahmedabad, India Dhruv Patel Fellowship in Orthopedic Oncology, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India Vikas Warikoo Professor, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India Abhijeet Salunke Assistant Professor, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India Nandlal Bharwani Fellowship in Orthopedic Oncology, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India Shashank Pandya Professor, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India 2025 11 18 2026 06 14 Background: Pulmonary tuberculosis (TB) is routinely encountered in developing countries such as India. However, osteoarticular TB is rarely seen and frequently presents with an atypical clinical-radiological presentation that may mimic bone tumors. For such lesions involving the bones, we need to be more vigilant in both clinical and radiological terms. The aim of this study was to bridge the gap between diagnosis and management for achieving good outcomes. Methods: This retrospective study analyzed five cases referred to the orthopedic oncology unit with suspected bone sarcoma, based on clinical, radiological, and histopathological examinations (HPE). Results: A total of five cases (three male and two female patients) with the suspicion of bone sarcomas were included in this study. The mean age of the study group was 20.6 years. The mean values of blood parameters were as follows: hemoglobin (Hb) 9.88 g/dl, white blood cell (WBC) count 10820/μl, erythrocyte sedimentation rate (ESR) 85 mm/h, and C-reactive protein (CRP) 48.8 mg/l. Two patients (40%) had infections as one of the differential diagnoses. Radiological evaluation suggested infection in four of the five patients (80%). A biopsy was planned and sent for both HPE and culture. HPE was positive in all cases (100%), whereas culture was positive in 60% of cases. Conclusion: For all the aggressive bony lesions, a multidisciplinary team is of utmost importance for the diagnosis. The role of the oncopathologist is crucial in differentiating atypical presentations of osteoarticular TB from malignant bone tumors. https://jost.tums.ac.ir/index.php/jost/article/view/738 https://jost.tums.ac.ir/index.php/jost/article/download/738/490

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 4 2026 09 23 212 4 Hassan Zolghadr Orthopedic Surgeon, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Monir Najafi Pirasteh Assistant Professor, Department of Orthopedics and Trauma Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohamad Ehsan Shapourgan Resident, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran 2026 04 12 2026 05 25 Background: Supracondylar humerus fractures are the most common pediatric elbow injuries, and maintaining stable reduction is essential to prevent late complications such as cubitus varus. Medial column comminution is an often underrecognized factor that can compromise stability, even in fractures that appear minimally displaced. This report highlights the clinical importance of medial column comminution in pediatric supracondylar fractures and emphasizes surgical strategies to prevent varus deformity. Case Report: Two pediatric cases with supracondylar humerus fractures were evaluated. The first case involved a minimally displaced fracture initially treated non-operatively, which subsequently developed cubitus varus due to medial column collapse. The second case presented with medial column comminution and was managed with closed reduction and percutaneous pinning. Stable fixation and maintenance of alignment successfully prevented postoperative collapse and deformity. Conclusion: Medial column comminution is a key determinant of stability in pediatric supracondylar humerus fractures. Early identification and a tailored surgical approach, including valgus reduction and selective medial pinning when indicated, are critical to prevent collapse, maintain alignment, and avoid late varus deformity. https://jost.tums.ac.ir/index.php/jost/article/view/793 https://jost.tums.ac.ir/index.php/jost/article/download/793/491

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 4 2026 09 23 179 84 Reza Zarei Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Manafi Rasi Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mojtaba Baroutkoub Assistant Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mehdi Ghasemi Nik Resident, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Shahab Aldin Vaziri Researcher, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ali Pourmojarab Assistant Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2026 02 26 2026 08 10 Background: Unstable pelvic ring fractures are high-energy injuries with complex anatomy and significant morbidity. Surgical fixation is the standard treatment; however, there is still controversy over the optimal sequence of anterior and posterior stabilization. An anterior-first fixation may help stabilize the pelvis, facilitate posterior reduction, and improve functional outcomes. Methods: We retrospectively reviewed patients with unstable pelvic ring injuries using a standardized “anterior-first” fixation protocol. Radiographic reduction was assessed using Matta and Tornetta criteria on anteroposterior (AP), inlet, and outlet views. Functional outcomes at a minimum of 12 months were measured using the Iowa Pelvic Score (IPS) and Majeed Pelvic Score (MPS). Clinical complications, including bleeding requiring transfusion, hematuria, and limb-length discrepancy (LLD), were recorded. Results: The study included 20 patients with a mean age of 40.7 ± 16.3 years. Excellent or good reductions were achieved in most patients, with 45% and 60% of cases rated as “Excellent” on the AP and inlet views, respectively. Outlet views showed greater variability, with 40% fair reduction. Mean IPS and MPS scores were 84.2 ± 16.7 and 78.9 ± 16.0, respectively, and were strongly correlated with each other (r = 0.82, P < 0.001). Older patients (> 50 years) achieved functional outcomes comparable to younger cohorts. Clinically, bleeding requiring transfusion occurred in 45%, hematuria in 35%, and LLD > 1 cm in 35%. No catastrophic complications were observed. Conclusion: In this small retrospective case series, anterior-first fixation was associated with acceptable radiographic reduction and favorable functional outcomes in selected patients with unstable pelvic ring injuries. Given the limited sample size and the absence of a comparator group, these findings should be interpreted with caution. Larger prospective comparative studies are needed to clarify the optimal fixation sequence. https://jost.tums.ac.ir/index.php/jost/article/view/781 https://jost.tums.ac.ir/index.php/jost/article/download/781/486

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 4 2026 09 23 215 9 Fardis Vosoughi Assistant Professor, Department of Orthopedics and Trauma Surgery, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Hassan Zolghadr Orthopedic Surgeon, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Ali Akhoondi Resident, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Arash Sherafatvaziri Knee Surgeon, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran 2026 01 03 2026 05 25 Background: Revision anterior cruciate ligament reconstruction (rACLR) remains one of the most technically demanding procedures in orthopedic sports medicine, particularly in patients with generalized joint laxity (GJL), unrecognized medial collateral ligament (MCL) injuries, and meniscal pathology. Successful outcomes require meticulous diagnostic assessment, individualized graft selection, and simultaneous management of associated ligamentous and meniscal injuries. Case Report: We report the case of a 23-year-old man with a history of failed primary anterior cruciate ligament reconstruction (ACLR), who presented with recurrent instability, medial knee pain, and episodes of giving way. Clinical and imaging evaluation revealed GJL, a previously unrecognized MCL rupture, meniscal tears, and tibial tunnel widening. A single-stage rACLR using a quadriceps tendon (QT) autograft, combined with concurrent MCL reconstruction and meniscal repair, was performed. Conclusion: This case highlights the importance of comprehensive evaluation of medial laxity, GJL, and meniscal pathology in all anterior cruciate ligament (ACL) injuries. rACLR in such complex cases requires anatomy-based, patient-specific planning, careful graft selection, and concurrent management of associated injuries to optimize stability and functional outcomes. Hamstring autografts should be used with caution in patients with joint laxity, and double hamstring harvest is discouraged in combined ACL- MCL reconstruction. https://jost.tums.ac.ir/index.php/jost/article/view/766 https://jost.tums.ac.ir/index.php/jost/article/download/766/492

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trerefore, this study was designed to evaluate the effects of using Penrose drain in order to reduce the operation site hematoma and improve the results of surgery. Methods: Patients with a diagnosis of carpal tunnel syndrome (CTS) were randomly divided into intervention and control group and then were evaluated by pain with Visual Analog Scale (VAS) and Pinch power. Penrose drain was placed for the intervention group and removed after two days. Three months after surgery, all patients were re-evaluated by VAS and pinch power, and then the collected data were analyzed statistically using the Wilcoxon Signed Ranks Test by SPSS. Results: Out of 46 patients, Penrose drain was placed for 21 patients. According to the results, the VAS and Pinch power evaluations were better in patients with Penrose drain (P-value = 0.001) but in patients without Penrose drain, only the VAS evaluation results were improved, but a decrease in Pinch powers was detected. Conclusion: The results showed that CTR surgery with or without the Penrose drain decreases pain in patients after three months of operation. CTR with Penrose drain improve Pinch power and also decreases the pain, but in patients without Penrose drain, Pinch power was reduced after this period. https://jost.tums.ac.ir/index.php/jost/article/view/464 https://jost.tums.ac.ir/index.php/jost/article/download/464/361

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 31 4 EN Arash Sherafat Vaziri Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Sina Javidmehr Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Fardis Vosoughi Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Erfan Babaei Nejad Department of orthopedics and trauma surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Kaveh Same Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran 2022 09 16 2023 10 10 During the past two decades, the use of robotic arms in knee arthroplasty has changed from a concept to a reality. These systems promise precision and accuracy while shortening the required learning curve. Although still largely in the early stages, there are currently several commercially available platforms with varying degrees of flexibility. The available models can be classified into several categories based on their mode of operation (whether the system requires imaging input) and degree of autonomy. The present study aimed to review the existing body of literature and provide an outlook of the current landscape. The strengths and weaknesses of the implementation of such systems in knee arthroplasty are also discussed. https://jost.tums.ac.ir/index.php/jost/article/view/404 https://jost.tums.ac.ir/index.php/jost/article/download/404/353

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 03 31 35 8 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. Shahin Talebi Orthopedic Surgeon, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shirin Sheibani Student Research Committee, School of Medicine, Mazandaran University of Medical Science, Sari, Iran. Abolfazl Ghadiri Assistant professor of orthopedic surgery, Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran 2023 05 18 2024 03 31 Background: After the spine, the hip is the most common site that can be infected with extrapulmonary tuberculosis (TB). In the early stages, patients present with complaints of pain around the hip, and after a while, they might experience deformities, shortening, and limited movements. Because hip TB mimics the symptoms of other hip diseases like rheumatoid arthritis (RA) and osteoarthritis, diagnosis is difficult. Here, we aimed to report a rare case of hip TB secondary to pulmonary TB and the result of the total hip arthroplasty (THA). Case Report: A 41-year-old man presented to the orthopedic clinic with a complaint of progressive pain in the right hip. After laboratory tests, imaging, and sputum culture, active TB infection and advanced arthritis of the hip joint were detected. A subluxation/ dislocation stage of arthritis and an acetabular protrusion were present, leading to the restriction of movements. After receiving medical therapy, we performed THA for the patient. Conclusion: The patient’s right hip reached a normal range of motion (ROM) without pain in the 18-month follow-up. Since TB can mimic the symptoms of many common diseases, considering hip TB along with other diagnoses can aid in reducing possible complications and improving patients' lives. https://jost.tums.ac.ir/index.php/jost/article/view/497 https://jost.tums.ac.ir/index.php/jost/article/download/497/348

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 39 41 Farzad Amouzadeh Omrani ssociate Professor, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Kourosh Kharkan Ghamsari Orthopedic Surgeon, Joint, Bone, Connective tissue, and Rheumatology Research Center (JBCRC), Department of Orthopedics, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran Mojtaba Baroutkoub Assistant Professor, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sina Afzali Orthopedic Surgeon, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Kookly Assistant Professor, Joint, Bone and Connective Tissue, Rheumatology Research Center (JBCRC), Department of Orthopaedics, 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran 2022 11 14 2024 03 13 Background: Only 3% of all proximal tibial fractures result in an avulsion fracture of the tibial tuberosity. It is often seen in youngsters between the ages of 3 and 6 and is less frequent after puberty. Case Report: A 15-year-old boy was presented with severe left knee pain following a high jump. X-ray and computed tomography (CT) scan showed a tibial tuberosity fracture with joint surface involvement. The damaged part was fixed with a 4.5mm cannulated screw and washer, reinforced with 2 SwiveLock anchors. In the sixth week, full weight bearing and full range of motion (ROM) were obtained. Conclusion: The primary objective in managing tibial tubercle fractures is the restoration of both the extensor mechanism and the integrity of the joint surface in cases where they have been compromised. https://jost.tums.ac.ir/index.php/jost/article/view/437 https://jost.tums.ac.ir/index.php/jost/article/download/437/351

Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 10 1 2024 04 01 42 4 Prem Kothimbakkam Chettinad Academy of Research & Education Arun Kumar Indira Medical College and Hospital Anantharamakrishnan Ganesh Chettinad Academy of Research and Education Vijayashankar Murugesan Chettinad Academy of Research and Education 2023 04 11 2024 03 13 Background: The commonest benign bone tumors, osteochondromas, which can be solitary or multiple involving the metaphyseal region of long bones, rarely present in the axial skeleton, such as pelvic girdle, which warrants surgical excision in case of symptoms arising out of pressure effects. Case Report: In this study, we are herewith reporting an unusual case of pubic tubercle osteochondroma, which is solitary and pedunculated in a 37-year-old woman. She has had the swelling for the past 15 years, which was asymptomatic except for mild hydroureteronephrosis, which was an incidental diagnosis; however, we managed the patient with surgical excision of the tumor with elaborate pr