Journal of Orthopedic and Spine Trauma

A Brief Review of Kyphoplasty Complications: Incidence, Risk Factors, and Prevention

Reza Yousefvand — 2026-02-24

Kyphoplasty is a minimally invasive procedure primarily used for the treatment of osteoporotic vertebral compression fractures (VCFs), traumatic fractures, and spinal involvement due to metastatic cancer. Even though kyphoplasty is generally regarded as a safe intervention, physicians should be aware of its potentially serious complications, although they are rare, especially considering the high number of patients who have the procedure done each year. This study aims to review the most significant complications related to kyphoplasty, along with their incidence, risk factors, and preventive strategies. We reviewed relevant articles from PubMed, Google Scholar, and credible sources to write this article. Cement leakage and adjacent vertebral fractures (AVFs) ‒the latter being the most frequent ‒are two of the most serious side effects. There are several ways that cement leakage can occur, including paravertebral (the most common), epidural, intradiscal, pulmonary embolism (PE), and foraminal leakage. It has been demonstrated that the eggshell technique, directional balloon placement, high-viscosity cement, and smaller cement volumes all lower the chance of cement leakage. Two important risk factors for AVFs are intradiscal cement leakage and preexisting osteoporosis in nearby vertebrae. Thus, managing these two elements could help avoid this issue. Achieving the best therapeutic results requires understanding the potential side effects of kyphoplasty and implementing effective management and prevention techniques.

Leukocyte Esterase Strip Test: The Game-Changer in Early Detection and Prevention of Prosthetic Joint Infections

Mohammad Ayati Firoozabadi — 2026-02-24

Background: This study aimed to assess the diagnostic performance and preventive utility of the leukocyte esterase (LE) strip test in periprosthetic joint infections (PJIs) associated with hip and knee arthroplasty.

Methods: A comprehensive literature search was performed in PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2024. Search terms included “leukocyte esterase”, “strip test”, “prosthetic joint infection”, and “synovial fluid biomarkers”. Relevant studies were reviewed to evaluate LE testing methodologies and diagnostic accuracy.

Results: The LE strip test is a rapid and inexpensive bedside tool that offers results within minutes. It demonstrates high specificity as a rule-out test preoperatively and reliable sensitivity for PJI confirmation postoperatively. The accuracy of the test is enhanced by sample centrifugation and glucose testing.

Conclusion: The LE strip test is a valuable tool for preoperative screening and postoperative diagnosis of PJI, especially when incorporated into comprehensive diagnostic algorithms.

Hip Rotation Arc

Sepand Heidari — 2026-02-24

Background: Rotational deformities of the lower extremity, such as altered femoral neck anteversion (FNA) and tibial torsion (TT), are common pediatric orthopedic conditions associated with intoeing gait. Accurate diagnosis is essential for effective treatment, yet the correlation between clinical examination and three-dimensional (3D) computed tomography (CT) measurements remains unclear. This study evaluates the agreement between clinical assessments and 3D CT in children with rotational deformities.

Methods: In a cross-sectional study at Imam Khomeini Hospital, Tehran City, Iran, 21 children (42 limbs) aged ≥10 years (girls) or ≥11 years (boys) with intoeing gait were assessed. Clinical measurements included hip internal rotation (HIR), hip external rotation (HER), and thigh-foot angle (TFA). Low-dose 3D CT (0.8-1.3 mSv) measured FNA and TT. Pearson correlation coefficients evaluated relationships between clinical and CT findings, with sliding threshold analysis to assess the impact of total hip rotation arc (HIR + HER) on correlations.

Results: Mean clinical measurements were: HIR = 63.54° ± 9.30°, HER = 42.11° ± 6.80°, and TFA = 9.60° ± 8.50°. CT measurements showed FNA 27.71° ± 6.60° and TT 16.11° ± 9.90°. Correlations were moderate (HIR vs. FNA: r = 0.41; HER vs. FNA: r = 0.57; TFA vs. TT: r = 0.483). At a total arc threshold of 98.5°, HIR-FNA correlation increased to r = 0.74 for arcs > 98.5°.

Conclusion: Clinical and 3D CT measurements show moderate correlation, suggesting complementary roles. Greater hip rotation arc enhances clinical reliability, supporting refined examination protocols to reduce imaging reliance in pediatric rotational deformity assessment.

Functional and Radiological Outcomes of First Metacarpal Fractures Treated with Minimally Invasive Reduction and Osteosynthesis System

Ruchit Vyas — 2026-02-24

Background: First metacarpal base fractures, comprising 4% of hand fractures, pose treatment challenges due to the thumb’s functional importance. This study evaluates the functional and radiological outcomes of the Minimally Invasive Reduction and Osteosynthesis System (MIROS) for these fractures.

Methods: A prospective study was conducted on 30 patients with first metacarpal base fractures treated with MIROS at a single institute from June 2022 to October 2024, with a 6-month follow-up. Patients aged ≥≥18 years with closed fractures were included; open fractures were excluded.

Results: Functional outcomes, assessed by the Kapandji score, showed 80% of patients achieving a perfect score of 10 (mean: 9.85 ± 0.46). Radiographic union occurred at a mean of 5.13 ± 1.30 weeks. Extra-articular fractures had the best outcomes, while Rolando fractures showed reduced function.

Conclusion: MIROS demonstrated excellent results, with high functional scores, early mobilization, minimal complications, and faster union compared to traditional fixation techniques. It is a reliable, minimally invasive option for managing first metacarpal base fractures, particularly for extra-articular and Bennett types, although Rolando fractures may require more rigid fixation strategies.

A Dynamic Approach to Managing Unstable Proximal Interphalangeal Joint Fractures: The Suzuki Frame

Rasiq Rashid — 2026-02-24

Background: This study aimed to investigate the clinical and radiological outcomes in unstable proximal interphalangeal joint (PIPJ) fracture-dislocations using the Suzuki frame.

Methods: 21 patients (mean age: 33.14 years) with unstable fractures of the PIPJ were treated with a Suzuki frame. The mean interval between injury and surgery was 6.14 days. Early active range of motion (ROM) of all fingers was encouraged immediately after surgery. Patients were followed closely for the first two weeks, and clinical and radiological outcomes were measured at the final follow-up.

Results: Frames were removed at 6 weeks, with all fractures achieving union and stable, congruent PIPJ. One patient developed a pin-tract infection, resolved with antibiotics. Mean PIPJ ROM was -7.85° extension to 75.7° flexion; distal interphalangeal joint (DIPJ) ROM was -8.5° extension to 40.0° flexion. Mean grip strength was 13.5 kg, and mean visual analogue scale (VAS) pain score was 0.6. Early surgery (< 7 days) was associated with better DIPJ flexion (P = 0.008) and lower pain scores (P = 0.029).

Conclusion: The Suzuki frame is a convenient, inexpensive, and effective system to manage difficult unstable PIPJ fracture- dislocations

Titanium Elastic Nailing System in Adult Forearm Fractures: An Original Study

Punit Tiwari — 2026-02-24

Background: The present study aimed to evaluate the early functional and radiological outcomes of forearm fractures in adultstreated using the titanium elastic nailing system (TENS).

Methods: This study was conducted between 2022 and 2025 in the department of orthopedics at a tertiary care medical college. Atotal of 30 adult patients with radiologically confirmed forearm fractures (radius, ulna, or both) treated with TENS nail wereincluded. Exclusion criteria comprised pathological or open fractures, prior forearm surgeries, and systemic conditions affectingbone health. Follow-ups were scheduled at one week for aseptic dressing and follow-up check X-ray, two weeks for stitches andbackslab removal, six weeks, and three months. Outcomes assessed included functional recovery using the Disabilities of the Arm,Shoulder, and Hand (DASH) and Grace-Eversmann scores, radiological union via the modified Radiographic Union Score for Tibiafractures (mRUST) scoring, and surgical complications.

Results: The mean age of patients was 47 years, with a predominance of ulna-only fractures (56.67%). Most patients were dischargedwithin three days post-surgery. Functional recovery improved significantly over time, with 73.33% achieving "excellent" Grace-Eversmann scores and 66.66% having DASH scores < 20 by 12 weeks (P = 0.002). Radiological healing progressed steadily, with allpatients achieving mRUST scores ≥ 11 at 12 weeks. The mean time t0 union was 11.6 weeks. Complications were minor and managedconservatively.

Conclusion: TENS in adult forearm fractures demonstrated excellent functional outcomes, fast radiological union, minimal surgicalmorbidity, and early return to activity. Given its minimally invasive nature and low complication rate, TENS represents a safe andeffective treatment modality for adult forearm fractures.

Computational Modeling of Bone-Implant Construct Osseointegration: Advantages and Shortcomings

Yunus Rezvanifar — 2026-02-24

Background: Osseointegration (OI), the direct structural and functional connection between living bone and implants, remains poorly understood despite being critical for implant success. Current bone implant designs lack optimization due to limited understanding of the multifactorial mechanical, chemical, and biological processes which govern the OI process.

Methods: This systematic review analyzed studies published in English using numerical/mathematical methods to model OI. A PubMed search was conducted up to July 2025, and full-text articles were screened for keywords including "osseointegration," "healing," "bone generation," "computer simulations," "finite element models," and "mechanobiological model." The selected studies encompassed various species, tissue types, and computational procedures. Articles were categorized by modeling approach: mechanical, biological, and compound models.

Results: Seventeen articles met the inclusion criteria. Ten studies had employed mechanobiological algorithms simulating bone formation around implants, focusing on mechanical factors. Four studies had developed bioregulatory algorithms, targeting biological aspects. Three studies had created compound models integrating both mechanical and biological factors. Current models successfully predicted key mechanical influences but showed limitations in capturing complete biological complexity.

Conclusion: Mathematical models of OI face significant challenges in accurately considering both biological and mechanical factors simultaneously, often oversimplifying one aspect, while focusing on the other. Their key limitations include unrealistic boundary conditions, computational constraints, and incomplete understanding of biophysical signal translation. Moreover, most models rely on animal studies with interspecies differences and adapt bone healing algorithms rather than developing OI-specific approaches. Despite these challenges, mechanobiological models offer promising insights for optimizing implant design, though developing comprehensive models requires substantial experimental investment and computational resources

Custom Three-Dimensional-Printed Implants for Tibial and Femoral Segmental Defects: A Systematic Review and Meta-Analysis

Seyed Hadi Kalantar — 2026-02-24

Background: Segmental bone defects of the lower extremity, particularly involving the femur and tibia, remain a major reconstructive challenge. Traditional techniques such as the Ilizarov method, Masquelet’s induced membrane, and vascularized fibular grafts are effective but often associated with prolonged treatment duration and significant morbidity. Recent advances in additive manufacturing have introduced patient-specific three-dimensional (3D)-printed implants as a promising alternative.

Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was conducted to collect current knowledge on 3D-printed implants of the tibia and femur. Databases including PubMed, Scopus, Embase, and Web of Science were searched from January 2000 to April 2025 for studies reporting outcomes of treatment of tibial or femoral segmental bone defects. Primary outcomes included bone union rate and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, and pooled data were analyzed using a random-effects model.

Results: Seventeen studies involving 174 patients were included. The mean bone defect length was 12.3 cm, and the mean follow-up was 27.2 months. The pooled union rate was 92.4% [95% confidence interval (CI): 89.0%-94.8%], with no statistically significant heterogeneity (I² = 0%). The mean time to radiological union was 7.66 months. The pooled complication rate was 23.5% (95% CI: 15.6%- 33.8%), with reoperation, deep infection, and device-related events being the most common. Assessment of publication bias revealed no statistically significant effect.

Conclusion: Custom-made 3D-printed implants represent a highly effective and safe option for the reconstruction of segmental bone defects in the lower extremity. The high union rate and acceptable complication profile support their utility in managing complex cases. Further prospective studies are needed to confirm these findings and define optimal indications.

Factors Predicting Intensive Care Unit Admission in Trauma Patients: A Multicenter Study Based on the National Trauma Registry of Iran

Mohammadreza Golbakhsh — 2026-02-24

Background: Caring for trauma patients is a paramount international concern. Delays in diagnosing patients in need of intensive care have unredeemable consequences. Identifying predicting factors of intensive care unit (ICU) admission in trauma patients is not without merit regarding this matter. This study aimed to investigate the underlying factors associated with ICU admission in trauma patients.

Methods: A retrospective study was designed based on data from the National Trauma Registry of Iran (NTRI) from 2016 to 2021. ICU admission was considered the primary endpoint. Relationships between demographic variables, injury site, injury mechanism, vital signs, and trauma scores with the outcome were evaluated by univariate analyses. ICU risk factors and their specific odds ratio (OR) were determined by multivariate analysis.

Results: Following univariate and multivariate analyses, age > 55 years, widowhood, injuries due to road accidents, falling from a height, penetrating objects, and gunshot, underlying cardiovascular disease (CVD), injury to head, thorax, abdomen, spine, and lower extremities, hypotension, hypertension (HTN), tachycardia, bradycardia, hyperpnea, low oxygen saturation, high body temperature, Glasgow Coma Scale (GCS) ≤8, and Injury Severity Score (ISS) > 15 were introduced as independent risk factors of ICU admission. Nonetheless, transport to the hospital (personal car) and upper extremity injury reduced the outcome incidence.

Conclusion: Numerous contextual variables were significantly associated with ICU admission, each with its own matter. When entering the emergency room, paying attention to these factors can help diagnose people in need of ICU care sooner.

Functional Outcomes of Measured Resection vs. Gap Balancing in Total Knee Arthroplasty

Fenil J. Shah — 2026-02-24

Background: Total knee arthroplasty (TKA) is the gold standard surgical intervention for treating end-stage knee osteoarthritis (OA). Measured resection (MR) and gap balancing (GB) are the primary surgical techniques that are employed to achieve these outcomes. Each of these procedures has its own distinct principles and advantages; MR is completely based on predetermined bone cuts and femoral rotation whereas GB is truly based on native knee anatomy. Their comparative impact on short-term recovery, implant alignment, and long-term outcomes remains debated, highlighting the need for evidence-based guidance. This study was conducted to compare the functional outcomes, complications, and patient-related outcomes of these two different techniques in the hands of a single surgeon.

Methods: A prospective randomized study was carried out with 60 patients undergoing TKA. They were categorized as the MR group (Group MR) or the GB group (Group GB). Functional recovery was the primary outcome and was assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Secondary outcomes included tourniquet times, postoperative visual analogue scale (VAS) score, and postoperative knee flexion at various intervals.

Results: The GB subset demonstrated statistically significant improvement one month following surgery in both KSS Part 1 (P < 0.001) and KSS Part 2 (P = 0.004) and larger reduction in WOMAC score (P < 0.001), suggesting rapid and comprehensive functional recovery and early improvement in pain and joint stiffness. However, the difference between the two groups was not statistically significant at 12 and 24 months post-operatively.

Conclusion: GB offers superior short-term outcomes, but the choice of surgical technique should take into account individual patient profile or patient-specific factors, the surgeon’s operative experience, and implant survivorship.

Clinical Profile and Outcomes of Total Hip Replacement in Qatar

Abdullah Murshid — 2026-02-24

Background: Total hip replacement (THR) is a common surgical procedure that improves the functional outcomes and health- related quality of life (HRQOL) in patients with severe hip joint pathology, particularly those with osteoarthritis (OA) and avascular necrosis (AVN). This study evaluates the clinical profile and outcomes of THR in Qatar.

Methods: We conducted a retrospective cohort study of 123 patients who underwent primary THR at Hamad General Hospital, Qatar, between January 2011 and August 2021. Data on demographics, clinical characteristics, and preoperative and postoperative scores were collected and analyzed. Functional outcomes were measured using the Oxford Hip Score (OHS) and 12-Item Short-Form Health Survey (SF-12). Linear regression analysis was performed to identify factors influencing postoperative outcomes.

Results: The primary indications for THR were OA (37.4%) and AVN (25.2%). Significant improvements were observed in both OHS and SF-12 scores postoperatively. However, these scores tended to decrease over time. Age and alcohol consumption were found to affect functional outcomes negatively, as well as mental and physical health, postoperatively.

Conclusion: THR significantly improves functional outcomes and HRQOL in patients with severe hip joint pathology. However, age and alcohol consumption are associated with poorer long-term outcomes, highlighting the need for targeted preoperative counseling and postoperative management in these populations.

Anterior Cervical Discectomy and Fusion: A Two-Case Series and Literature Review on Management and Outcomes

Daniel Encarnacion-Santos — 2026-02-24

Background: Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for cervical spine pathologies, including disc herniation and spinal stenosis. Despite its efficacy, complications such as paraplegia can occur, often due to hematomas or iatrogenic injuries.

Case Report: A 42-year-old man presented with persistent pain in his cervical spine radiating to his left arm, numbness in his fingers, and limited movement in his cervical spine. Magnetic resonance imaging (MRI) revealed a C6-C7 disc herniation and C5-C6 spinal canal stenosis. ACDF was performed at C6-C7 with a cage and bone autograft, achieving decompression and stabilization. A 47-year- old female patient presented via the emergency department complaining of severe, recurring pain in the cervical spine radiating to the right shoulder and scapula region and headaches. According to the patient, she has been suffering from severe pain, considered a real nuisance, for several months. MRI showed intervertebral disc herniation and foraminal stenosis at the C5-C6 vertebrae. Anterior microsurgical decompression and fusion with a cage were performed at C5-C6.

Conclusion: ACDF effectively restores cervical alignment and dynamics in single-level cervical pathologies, with transient postoperative complications such as dysphagia resolving during recovery. It remains the preferred approach for anterior cervical disc herniation