Journal of Orthopedic and Spine Trauma

Kyphoplasty: A Comprehensive Review of Procedural Techniques, Patient Selection, and Clinical Outcomes in the Treatment of Vertebral Compression Fractures

Seyyed Mohammad Mousavi — 2026-07-12

Kyphoplasty is a minimally-invasive surgical technique designed to restore vertebral body height and reduce the associated kyphotic deformity. This intervention is typically performed following unsuccessful conservative therapy. Kyphoplasty must be conducted in the prone position under C-arm fluoroscopic guidance and usually employs local anesthetic techniques by trained practitioners. The procedure involves the percutaneous insertion of an inflatable balloon tamp within the fractured vertebral body in order to restore vertebral height, followed by the injection of polymethyl methacrylate (PMMA) bone cement to stabilize the fracture and increase vertebral stiffness by over 50%. Kyphoplasty is a practical therapeutic option for treating painful vertebral compression fractures (VCFs), considering its typically minor and infrequent complications. This study aims to review the best procedural techniques, as well as appropriate patient selection, to achieve the optimal outcome.

Management of Minimally Invasive Spine Surgery in Spinal Metastases: A Comprehensive Systematic Review and Meta-Analysis on Strategies, Treatments, and Outcomes

Daniel Encarnacion-Santos — 2026-07-12

Background: Minimally invasive spine surgery (MISS) represents an effective and increasingly adopted treatment strategy for spinal metastases. Over one million Americans are diagnosed with spinal metastases each year, and just 1.5 million are reported to be diagnosed; only 40-70 percent are spinal metastases. More advanced current percutaneous treatments such as kyphoplasty and vertebroplasty have improved the status of patients previously ruled out for surgery. Osteoblastic and osteolytic spinal metastases can be assessed and treated with percutaneous microwave ablation.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The comprehensive search involved several databases, including ScienceDirect and PubMed/MEDLINE, and was performed using the PRISMA guidelines, R software, and Excel. Search terms included “minimally invasive approach in metastatic lesions of the spine and spinal cord” combined with terms specifying surgical techniques, rehabilitation methods, and associated pathologies. Only studies published in English from January 2012 to February 2025 were included.

Results: Our study was based on a comprehensive systematic review and meta-analysis of 2380 patients with spinal metastases who were treated with minimally invasive and traditional open approaches, specifically vertebroplasty and kyphoplasty. We found 1090 patients (46%) with spinal metastases, where 509 cases (21%) were treated with the minimally invasive approach (MISS), while the traditional open approach [traditional open surgery (TOS)] was used for 432 patients (18%). 1611 patients (67%) were intervened by the leves of the fractures. Affected levels, whose cement breaches were 752 patients (31%) with metastases and CSF leaking.

Conclusion: New concepts were also employed in the minimally invasive, open approach which began with minimally invasive procedures such as vertebroplasty and kyphoplasty, and proceeded to treatments like percutaneous microwave ablation. Simple radiation therapy and chemotherapy, including the use of second-generation bisphosphonates such as pamidronate, are recommended, as well as steroids such as dexamethasone and methylprednisolone

Arthroscopic FiberWire Fixation for Anterior Cruciate Ligament Avulsion Fractures: A Case Series Report

Maziar Nafisi — 2026-07-12

Arthroscopic fixation using FiberWire sutures with a suture disc is a reliable, cost-effective, and minimally-invasive technique for managing anterior cruciate ligament (ACL) avulsion fractures, also known as tibial spine fractures (TSFs), which are uncommon but significant knee injuries that can lead to joint instability if left untreated. This retrospective case series evaluated the clinical outcomes of this approach in six patients (four men, two women; mean age: 22 years) with fractures classified using the modified Meyers and McKeever system. All patients underwent arthroscopic fixation and were followed for 9 months with serial radiographic and clinical assessments. Fracture union was achieved in all cases within three months, and five patients demonstrated negative Lachman and pivot shift tests, while one exhibited grade 1 positivity. The mean International Knee Documentation Committee (IKDC) score was 91.16 ± 4.61, with five patients graded as excellent and one as good. No complications were observed, highlighting the efficacy and safety of this technique across different age groups.

Isolated Bilateral Sacroiliac Joint Dislocation Managed by Closed Reduction and Internal Fixation: A Case Report

Ali Yeganeh — 2026-07-12

Background: Dislocations of the bilateral sacroiliac (SI) joint are serious injuries. It is extremely rare to experience SI joint dislocation without fracture or disruption of the anterior pelvic ring. Even though SI dislocations can be fixed via several different methods, the surgical technique should be tailored to everyone based on the patient's injuries. The treatment of these fractures with operative intervention remains difficult because of the possibility of other injuries associated with the fractures. Only three cases of this type of injury treated with open reduction and internal fixation (ORIF) have been reported in the literature.

Case Report: A 15-year-old girl presented with high-energy trauma. In the left hand, she had a fracture-dislocation of the wrist; in the right ankle, she had a pilon fracture and a calcaneus fracture. Her pelvis had a bilateral SI dislocation without a fracture in the pelvic ring. After hemodynamic stabilization, surgical management was performed for the wrist fracture-dislocation, as well as the pilon and calcaneus fractures. Four days later, the bilateral SI dislocations were fixed. We performed closed reduction and internal fixation (CRIF) due to the patient's situation and the high risk of infection. At the last follow-up, the fracture had united, and the patient experienced no discomfort in performing her daily activities.

Conclusion: While the optimal method for fixing this injury is unclear, ORIF is the conventional approach for similar cases. However, in this case, CRIF was chosen due to disadvantages associated with ORIF, such as nerve damage, swelling, incomplete bone healing, increased pressure, blood clots, and our patient’s situation

Management of Ulnar Styloid Fractures Concomitant with Distal Radius Fractures: Case-Based Insights into the Decision between Fixation and Neglect

Hassan Zolghadr — 2026-07-12

Background: Ulnar styloid fractures are frequently associated with distal radius fractures; however, their optimal management remains controversial. In particular, the necessity of fixation in relation to distal radioulnar joint (DRUJ) stability continues to be debated.

Case Report: This article presents three representative clinical scenarios alongside a focused review of the current literature regarding ulnar styloid fracture management. The discussion emphasizes intraoperative assessment of DRUJ stability and its role in guiding treatment decisions. Conservative management is generally appropriate for minimally displaced or tip fractures, whereas selective fixation may be considered in displaced basal fractures associated with DRUJ instability.

Conclusion: Management of ulnar styloid fractures should be individualized based on DRUJ stability rather than fracture union alone. Selective fixation in cases of true instability yields favorable outcomes, while routine fixation is not recommended. Nonunion of the ulnar styloid is often clinically insignificant, and avoidance of unnecessary surgical intervention may reduce complication rates

Avascular Necrosis Following Pediatric Distal Humerus Fracture: A Report of 2 Cases and Follow-Up Strategies

Negin Bayat — 2026-07-12

Background: Supracondylar humerus fractures are the most common pediatric elbow injuries. Avascular necrosis (AVN) of the distal humerus is rare and may present months to years after injury, even when minimally displaced.

Case Report: Two children developed distal humeral AVN after supracondylar fractures, one treated in a cast and one with percutaneous pinning. Both later reported pain, motion loss, and deformity. Imaging confirmed AVN, with a fishtail deformity in one case and cubitus-varus deformity in the other. The first was observed with preserved function; the second underwent a lateral closing wedge extension osteotomy with good recovery.

Conclusion: Distal humeral AVN can follow both nondisplaced and displaced injuries. Young patients and higher-risk patterns warrant prolonged follow-up until trochlear ossification. Early recognition and a structured surveillance plan support timely intervention and better outcomes

Hidden Threats around the Knee When Cysts Are Not Just Cysts: A Case-Based Expert Review

Sadegh Saberi — 2026-07-12

Background: Soft tissue masses around the knee are commonly presumed to be benign cystic lesions. However, certain malignant tumors may mimic these entities, leading to delayed diagnosis and treatment. This case highlights the diagnostic challenges associated with malignant lesions presenting as common cysts.

Case Report: A 26-year-old woman presented with a painless mass in the posteromedial aspect of her left knee that had gradually enlarged over four months. Initial ultrasonography identified the lesion as a Baker’s cyst. Owing to atypical clinical and imaging features, further evaluation was pursued. The case was discussed at ORTHOBIT 2025 Congress (Tehran, Iran), where the diagnostic pathway, differential diagnoses, imaging findings, and management options were reviewed. Advanced imaging raised suspicion for a malignant soft-tissue tumor, emphasizing the limitations of relying solely on conventional imaging modalities.

Conclusion: Malignant tumors such as synovial sarcoma can closely resemble benign cystic lesions around the knee. Careful clinical assessment, recognition of atypical features, advanced magnetic resonance imaging (MRI) evaluation, and multidisciplinary collaboration are essential to avoid misdiagnosis and ensure timely management.

Strategies for Preventing Malreduction in Distal Femoral Comminuted Fractures: A Case Report

Hassan Zolghadr — 2026-07-12

Background: Comminuted distal femur fractures pose a significant challenge to achieving precise reduction and stable fixation. Achieving proper alignment is critical, as malreduction can lead to functional impairment and altered gait. Careful preoperative planning and precise intraoperative technique are essential to optimize fracture reduction and ensure favorable postoperative outcomes.

Case Report: A 39-year-old man sustained a comminuted distal femur fracture [AO Foundation/Orthopedic Trauma Association (AO/OTA) 33-C2] after a 9-meter fall. Surgical fixation was performed one week later using a precontoured anatomic lateral locking plate via minimally invasive plate osteosynthesis (MIPO). Postoperative imaging demonstrated a recurvatum deformity of the knee. At three months, fracture union was achieved with functional knee motion. This case underscores careful planning and implant positioning in complex distal femur fractures.

Conclusion: Optimal management of comminuted distal femur fractures requires precise anatomical reduction, careful plate positioning, and intraoperative verification to restore alignment, length, and rotation, while avoiding intercondylar notch violation. Immediate correction of malposition is essential to prevent postoperative deformity and preserve function, even if it modestly prolongs operative time