Journal of Orthopedic and Spine Trauma

Tibia Plateau Fracture Down the Road: A Concise Review of Evolving Classifications

Pouya Tabatabaei Irani — 2025-08-23

Tibial plateau fractures (TPFs) are complex intra-articular injuries that demand precise classification for optimal surgical planning and outcomes. Traditional systems such as Schatzker and AO Foundation/Orthopedic Trauma Association (AO/OTA) classifications have been instrumental in categorizing these fractures based on plain radiographic findings. However, they often fall short in accurately identifying posterior column involvement and coronal plane fractures. The advent of computed tomography (CT) imaging and three-dimensional (3D) reconstructions has led to the development of more precise classification systems, notably Luo’s three-column model. This review provides a comprehensive review of the Schatzker, AO/OTA, and three-column classifications, highlighting their principles, clinical utility, and limitations. The updated three-column concept (uTCC) further incorporates injury mechanisms by assessing posterior tibia slope and medial plateau angles, offering enhanced guidance for surgical approaches. Studies comparing these systems suggest that the three-column model provides superior interobserver reliability and preoperative planning utility, especially in identifying and managing posterior column injuries. This review underscores the evolution toward 3D and mechanism-based classifications to improve treatment strategies for TPFs.

Discoid Lateral Meniscus in Clinical Practice: From Diagnosis to Treatment

Mohammad Ayati Firoozabadi — 2025-08-23

Discoid meniscus is the most common congenital anomaly affecting the lateral meniscus. Although many individuals remain asymptomatic, others may present with symptoms such as knee pain, swelling, and limited range of motion (ROM). Magnetic resonance imaging (MRI) is the diagnostic modality of choice, often supplemented by radiographic evaluation. The condition is classified into three types: complete, incomplete, and Wrisberg variants. In asymptomatic cases, surgical intervention is generally not indicated. However, for symptomatic individuals, arthroscopic surgery is typically recommended. The primary goals of treatment include stabilization of the meniscus, repair of any tears, and reshaping of the abnormal meniscus through a procedure known as saucerization, often performed using arthroscopy. Treatment options include partial meniscectomy, suture repair, and, in severe cases, total meniscectomy or meniscus allograft transplantation. Postoperative rehabilitation protocols are individualized, taking into account the patient’s age, activity level, and the specific surgical procedure performed.

Educational Corner: Step by Step Approach to Anterior Cruciate Ligament Revision Reconstruction

Pouya Tabatabaei Irani — 2025-08-23

In anterior cruciate ligament reconstruction (ACLR) revision, orthopedic surgeons are faced with many obstacles in decisionmaking and finding the best approach. Here we discuss these challenges and review a staged approach for better understanding and practical implications in ACL revision.

Clinical Outcomes of V-Shaped Lamina Osteotomy in Correction of Spinal Deformities: A Technical Report

Siamak Shabani — 2025-08-23

Background: Multiple osteotomy techniques have been developed to manage spinal deformities by alleviating symptoms, restoring spinal alignment, and halting progression. Techniques such as Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO), and vertebral column resection (VCR) vary in invasiveness and efficacy. Greater correction generally requires more extensive bone and soft tissue resection, which increases surgical complexity and the risk of complications. The V-shaped lamina osteotomy is a modified grade 1 posterior column osteotomy (PCO) designed to address multilevel deformities with reduced morbidity. This study evaluates its clinical safety and effectiveness.

Methods: In this retrospective analysis, 28 patients underwent multilevel V-shaped lamina osteotomy from 2005 to 2015. Diagnoses included idiopathic scoliosis (n = 7), degenerative scoliosis (n = 7), Scheuermann’s kyphosis (n = 4), and iatrogenic deformity (n = 10). Patients under 10 or over 80 years of age and those with traumatic, infectious, or malignant deformities were excluded.

Results: No intraoperative deaths, neurologic injuries, or major complications occurred. Two patients experienced superficial wound infections, which were resolved with debridement and antibiotics. All patients demonstrated significant sagittal and coronal alignment improvement. Mean blood loss was higher in patients undergoing four (or more)-segment osteotomies (350-500 ml) compared to those with two or three segments (200-300 ml). Surgical time ranged from approximately 4 hours for fewer segments to up to 6 hours for extensive procedures.

Conclusion: V-shaped lamina osteotomy is a safe, efficient technique for correcting multilevel spinal deformities. It offers comparable results to more invasive procedures while minimizing complications, making it suitable for long, smooth deformities.

Evaluation of the Functional Outcome in Intra-Articular Distal Humerus Fractures Treated by Dual Plating

Vinod Bhuktar — 2025-08-23

Background: The complex anatomy of the elbow joint, multiple displaced fragments, and intra-articular extension of the fracture make these cases challenging to treat and prone to complications. Several methods of limited internal fixation, such as Kirschner wires (K-wires), screw fixation, and single plates, have been described. However, these methods do not provide sufficient stability for early mobilization and often yield unpredictable results. The latest generation of pre-contoured anatomical compression locking distal humerus plate systems offers angular stability and rigid fixation for intra-articular distal humerus fractures. This study aims to evaluate the clinical outcomes of distal humerus fractures using dual plate fixation.

Methods: After ethics committee approval, this prospective observational study was conducted over a period of 26 months on 20 patients with intra-articular distal humerus fractures. Functional outcome was measured by using the Mayo Elbow Performance Score (MEPS) system. Radiological union was checked at regular intervals.

Results: Olecranon osteotomy (65%) showed better outcomes than the paratricipital approach (35%), with 60% of patients achieving excellent MEPS scores at 24 weeks. Radiographic union was observed in 60% of patients by 12-14 weeks, 25% by 16-18 weeks, and 15% by 18-20 weeks [mean ± standard deviation (SD) = 15.00 ± 2.83 weeks]. Mean range of motion (ROM) improved significantly from 65.83 ± 14.89 degrees at 6 weeks to 102.50 ± 15.88 degrees at 24 weeks (P < 0.01). Complications included one case each of wound infection, hardware protrusion, and stiffness, managed with antibiotics or physiotherapy.

Conclusion: The dual locking plating for intra-articular humerus fracture may be a better option in terms of stable and rigid fixation, functional outcome, and fewer complications.

Simple Suture vs. Vertical Mattress: Choosing the Best Suture for Palmar Incision Based on a Randomized Clinical Trial

Abbas Abdoli Tafti — 2025-08-23

Background: Despite the prevalence of palmar injuries and surgeries, no consensus exists regarding the type of wound closure. The present study compares simple sutures and vertical mattresses sutures in carpal tunnel release (CTR), trigger finger release (TFR), and trigger thumb release (TTR).

Methods: A total of 89 surgeries were randomized to either simple or vertical mattress sutures. Outcomes including pain, infection, Patient and Observer Scar Assessment Scale (POSAS), satisfaction level, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were evaluated on postoperative day 3, week 3, and month 3. Month 3 assessments were mostly performed remotely due to coronavirus disease 2019 (COVID-19).

Results: The mean pain was higher in the vertical mattress sutures group compared with simple sutures, though the pain difference was statistically significant only on day 3. No significant mean difference was found between the two groups regarding POSAS items. Some patients underwent bilateral CTR with simple sutures on the one hand and vertical mattresses sutures on the other. The results of their investigation were consistent with the other findings.

Conclusion: Vertical mattress suture in palmar surgeries is associated with greater short-term pain. Other variables did not differ between the two groups at different times. Hence, conclusively, regardless of the short-term pain associated with simple suture, both types of sutures can be used in hand surgeries with similar long-term results.

Posterior Fusion in a Case of Lenke Type 2 Adolescent Idiopathic Scoliosis with Severe Factor VII Deficiency: A Case Report

Siamak Shabani — 2025-08-23

Background: Congenital factor VII (FVII) deficiency is a rare autosomal recessive coagulation disorder that poses significant challenges during major surgeries, particularly high-risk procedures like instrumented spinal fusion for adolescent idiopathic scoliosis (AIS).

Case Report: We present the case of a 15-year-old girl diagnosed with Lenke type 2 AIS and severe congenital FVII deficiency. She was referred to Imam Khomeini Hospital Complex, Tehran, Iran, for corrective spinal fusion. Preoperatively, a single dose of recombinant activated FVII (rFVIIa) at 20 mcg/kg was administered to maintain hemostasis. The instrumented spinal fusion was performed under general anesthesia using meticulous surgical techniques. Notably, no additional doses of rFVIIa were required during the procedure.

Conclusion: This case demonstrates that with appropriate preoperative factor replacement and careful intraoperative hemostatic management, patients with severe FVII deficiency can safely undergo corrective spinal fusion. It underscores the critical importance of sustaining hemostasis in managing high-risk surgical patients with coagulopathies.

Proximal Humerus Open Fracture in Pediatrics: A Case Report and Literature Review

Reza Zandi — 2025-08-23

Background: Proximal humerus fracture (PHF) in pediatrics is managed with different options: nonoperative or operative. However, proximal humerus open fractures are sparse in the literature.

Case Report: We present a 9-year-old boy who presented to our institution with proximal humerus open fracture (type IIIA of Gustilo classification). After irrigation and debridement, reduction was satisfactory. We preferred to immobilize the fracture using slingand-swathe and U-slab splint.

Conclusion: Satisfactory union, angulation, and range of motion (ROM) were achieved.

Lumbopelvic Stabilization Outcome in Renshaw Type IV Sacral Agenesis: A Case Report and Review of the Literature

Siamak Shabani — 2025-08-23

Background: Caudal regression syndrome (CRS), also known as sacral agenesis (SA), is a rare congenital disorder characterized by malformations of the caudal spine, lower limbs, urogenital, and anorectal systems. While the exact etiology remains unknown, a strong association with maternal diabetes mellitus (DM) has been observed.

Case Report: This retrospective study includes two patients diagnosed with Renshaw type IV CRS who underwent spinopelvic fusion. Both patients presented with back pain, severe thoracolumbar (TL) kyphotic deformity, and difficulty in sitting. Postoperative outcomes demonstrated improved sitting ability, enhanced mobilization, increased self-esteem, and better overall quality of life.

Conclusion: Orthopedic, neurological, and visceral anomalies are prevalent in patients with SA. Spinopelvic instability in type IV CRS significantly impairs sitting and mobilization. Surgical fusion can facilitate sitting and improve functional outcomes and cosmesis.

A Novel Case of Multi-Level Lumbar Spine Injury

Michael O’Neal — 2025-08-23

Background: Fractures involving several posterior arch elements of lumbar vertebrae are rare and usually associated with highenergy axial loading (e.g., burst fracture) or hyperflexion and distraction (e.g., Chance fracture) resulting in displacement and neurological sequelae. This report explains the mechanical and biomechanical factors and treatment options for a novel fracture pattern involving multi-level posterior arch vertebral fractures and imparts optimism for timely recovery and return to play in high-level athletes.

Case Report: We report a case of a 21-year-old male elite football player with an acute, traumatic two-level lumbar pedicle, pars, and lamina fractures without failure of the vertebral body nor neurological complications. Treatment was conservative with relative rest, movement restrictions, non-narcotic analgesics, and a bone growth stimulator. After four months, the patient was pain-free with corresponding radiographic evidence of healing. He returned to training with special attention given to core strength and lumbopelvic mobility. A computed tomography (CT) scan 2.5 years after the injury showed no evidence of pars, lamina, or pedicle fractures. To date, this patient has played in the National Football League (NFL) as a starter for three years without any complaint of low back pain.

Conclusion: This unique fracture pattern could represent a harbinger to a more severe injury. We discuss mechanical and biomechanical factors, management, and return to play expectations for a collision sport athlete with this particular spine injury.

Clinical Outcome of Partial Spondylectomy and Adjuvant Therapy of a Metastatic Leiomyosarcoma to the Thoracic Spine: A Case Report

Siamak Shabani — 2025-08-23

Background: Leiomyosarcoma (LMS) is a rare malignant tumor of smooth muscle origin, most commonly arising in the uterus. Spinal metastases from uterine LMS are extremely uncommon and represent diagnostic and therapeutic challenges. Due to its relative resistance to radiotherapy and chemotherapy, surgical management remains the cornerstone of treatment.

Case Report: A 42-year-old woman, with a history of uterine myomectomy 12 years earlier, presented with progressive thoracic back pain. Imaging [computed tomography (CT) and magnetic resonance imaging (MRI)] revealed a destructive extradural lesion at T5-T6. CT-guided biopsy confirmed LMS. She underwent partial spondylectomy with spinal stabilization, followed by postoperative adjuvant chemotherapy and radiotherapy. Serial follow-up with MRI, positron emission tomography (PET)-CT, and technetium-99m scintigraphy at 6, 12, and 24 months ‒ and again at 7 years ‒ showed no evidence of residual or recurrent tumor. She remained disease-free.

Conclusion: This case demonstrates that combined surgical cytoreduction and adjuvant therapy can achieve long-term disease control in patients with rare spinal metastases of uterine LMS. Reporting such extended follow-up cases provides valuable insights into treatment strategies and prognosis.