Iranian Journal of Orthopedic Surgery

Abstract Introduction: Non-specific chronic low back pain (NSCLBP) is a leading cause of disability and reduced quality of life, with multiple biomechanical factors contributing to its pathophysiology. Flatfoot (Pes Planus), as a structural abnormality, may play a role in the onset or exacerbation of this condition by altering the distribution of mechanical forces, increasing spinal stress, and inducing movement instability. This systematic review evaluates the existing evidence regarding the relationship between flatfoot and NSCLBP.
Methods: This study was conducted following the PRISMA guidelines. Articles published between 2004 and 2025 were searched in PubMed, Scopus, Medline, Embase, and Google Scholar using MeSH Terms. Studies were selected based on predefined inclusion and exclusion criteria, and their methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies and the PEDro scale for randomized controlled trials (RCTs). A total of 11 eligible studies were analyzed.
Results: Findings indicated that flatfoot may contribute to increased severity and persistence of chronic low back pain by inducing kinematic alterations in the lower limb, increasing internal rotation of the knee and hip, and affecting spinal biomechanics. However, some studies did not confirm this association definitively, possibly due to methodological differences and confounding factors.
Conclusion: Flatfoot may be considered a potential risk factor for NSCLBP. Altered mechanical force distribution and movement patterns could lead to functional spinal instability and increased lumbar stress. Further studies employing advanced biomechanical assessment methods are required to better understand this relationship and develop targeted interventions.

Abstract Background: Transcutaneous electrical nerve stimulation (TENS) is a common conservative treatment for knee osteoarthritis. However, no study has examined its effects on alleviating symptoms.
Objectives: This meta-analysis evaluated the effects of TENS on knee osteoarthritis symptoms.
Methods: Two investigators searched Pubmed, Embase, Scopus, Web of Knowledge, and the Cochrane database. They extracted the data and assessed them with the Cochrane risk-of-bias tool. Standardized mean difference (SMD) was analyzed by RevMan 5.4.1 with a 95% confidence interval. Subgroup analyses were based on control group, follow-up, TENS type, electrode location, number of sessions, combining TENS with exercise, sample size, and publication year.
Results: A total of 32 articles were included in the qualitative review, and 23 were included in the meta-analysis. TENS was more effective in reducing pain compared to sham TENS (I2: 76%; P<0.0001) and was as effective as an active intervention (I2: 70%; P=0.71). Active intervention improved function immediately (I2: 0%; P=0.04), compared to TENS. TENS significantly increased the active knee range of motion compared to sham TENS immediately (I2: 0%; P=0.002).
Conclusion: TENS reduces pain and increases active range of motion compared to sham TENS, but it does not have a significant effect on joint function and stiffness. TENS has similar effectiveness to active interventions in reducing pain. The duration of follow-up, the location of the TENS electrode, and combining TENS with other routine treatments can change the pain reduction rate.

Abstract Introduction& Purpose: Physical activity decreases at the beginning of adolescence, so organized physical activity at school plays an essential role in promoting the health and proper physical development of students. The purpose of this study was to investigate the effect of eight weeks of calisthenics training on core stability, muscle strength, static balance and trunk proprioception of male teenagers. Methods: In this semi-experimental study with a pre-test-post-test design, 40 male high school students aged 15 to 18 in Zavareh city were selected as a sample and randomly divided into two groups: calisthenics training (n=20) and control (n=20). The experimental group received calisthenics training for eight weeks, three times per week, for 60 minutes each session. Before and after the eight-weeks training, static balance, core stability, muscle strength and trunk proprioception were measured using the Stroke balance test, McGill test, chest press, leg press, rowing and error rate of the trunk reconstruction angle at 45° respectively. Results: The results of the independent t- test showed that eight weeks of calisthenics training increased the amount of static balance (p<0.0001), trunk proprioception (p<0.0001), core stability in trunk flexion (p<0.0001), and muscle strength in the rowing and leg press test (p<0.05) significantly.
Conclusion: Overall, the findings from the present study suggest that following an 8-week participation in calisthenics training, trunk proprioception, core stability in flexion, muscle strength and static balance improved in teenagers, therefore, this type of exercises can be used along with other types of exercises or as a suitable alternative in schools.

Abstract Background: Porous titanium structures have recently gained considerable popularity among researchers in studies examining bone ingrowth and osseointegration. Porous implants fabricated using triply periodic minimal surface design (TPMS) and designed through 3D printing techniques exhibited remarkable mechanical strength and cell viability compared to conventional implants. This study aimed to evaluate the effect of pore size of titanium implants with gyroid structure.
Methods: This study was conducted on Adult male Wistar rats weighing 350 and 450 g for the animal study by the calvarial defect model to investigate bone regeneration. Three disk-shaped implants were designed using a gyroid structure with pore sizes of 400, 500, and 600 micrometers. All implants were made by additive manufacturing (Selective Laser Melting) using Ti6Al4V medical-grade powder. Animals were sacrificed after 12 weeks, the skin was removed from the calvaria, and the implants were removed for histological examination.
Results: Gyroid structures had a high surface-to-volume ratio and pore connectivity, facilitating cell adhesion and ossification. A significant amount of bone ingrowth was observed in the 400 mm group, so that bone penetrated into pores significantly more than in the other groups. However, the vascularization was more pronounced in the 600 μm group than in the other groups.
Conclusion: According to the results, there was a positive effect of porosity in titanium implants in encouraging bone ingrowth. The porosity size of 400 μm was more suitable for the differentiation and proliferation of bone cells and thus the osseointegration in porous titanium implants with gyroid structure.
 

Abstract Background: Distal radius fractures are among the most common fractures. They can happen at any age group, and there are several treatment options and several classification systems for these fractures. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment of distal radius fractures by bridging external fixator and percutaneous pinning.
Methods: In a cross-sectional study, 72 patients with Fernandez type 3, 4 and 5 that underwent external fixation and percutaneous pinning for comminuted distal radius fractures were followed and assessed after 3 and 6 months.
Results: The 72 patients had mean age of 44.2 years. 55% were male. The most common cause of fractures was vehicle accidents. 4 cases of malunion, 4 radial nerve injuries, 2 fixator loosening and 6 cases of infection were encountered.
Conclusion: External fixator supplemented by percutaneous pinning is an efficient technique for treatment of unstable distal radius fractures. It has low rate of complication and high rate of patient's satisfaction.

Abstract Abstract
Introduction: Humeral shaft fractures are highly prevalent. These fractures can lead to complications and significantly impact quality of life. Choosing the appropriate surgery type presents challenges of high cost, and economic burden. We are investigating and comparing the outcome of Intramedullary Nailing (IMN) surgery with reaming and nailing without reaming as a treatment method for humeral shaft fractures and its outcomes.
Materials & Methods: This study was a prospective cohort study that examined patients with humerus shaft fractures in 2023. The study was conducted on nailing humeral fractures in a teaching hospital. The patients were randomly divided into two groups: One group was treated with intramedullary nailing with reaming, and the other group without reaming. The patients were monitored for pain, delayed union, non-union, infection, radial nerve palsy, and healing status at intervals of two weeks, one, three, and six months after surgery.
Results & Discussion: Sixty-nine patients including 29 in non-reamed and 40 in the reamed cases were studied. Union was observed at 11.1±3.5 weeks in non-reamed and 8.2±1.9 in reamed group, delayed union was observed in 3 of non-reamed and 2 of reamed cases. One case of non-union was in non-reamed group. In the second week of the follow-up, the reamed group reported significantly higher pain levels; however, no significant difference was observed in the 4th and 12th weeks of follow-up. There was no significant difference between the two groups regarding complications.
Conclusion: Reamed IMN of humeral fracture can reduce the union time, and helps to lower the occurrence of delayed union and non-union. However, the patients would experience more pain in few first post-surgery weeks and reaming.

Abstract Background: Total Hip prosthesis replacement is one of successful invasive procedures in medical history. Hip joint replacement started by Sir John charnley by using of low friction artificial joint on 1960s. Subsequently bearing material, fixation methods and new designs were defined and modified. The main concerns about THA are biological response due to particles produced by bearing surfaces that lead to Osteolysis and prosthesis loosening. Modern THA biomaterials were developed to remedy this problem.
Methods: A journal research strategy was performed using different terms. The highest quality technical articles and reports were selected that included the best and newest related contents. Key search words were hip, biomaterial, wear, titanium, zirconia, alumina, UHMWPE and CO-Cr. Finally 69 sources were chosen and used in this review.
Results: Recent advances in hip prostheses have focused on mechanical strength, biocompatibility, bioactivity, increasing wear resistance and reliability using new technologies, as well as structure modification and nanotechnology hybridization. A hybrid design in nano-ceramics has increased resistance up to four times that of alumina, allowing for a smaller femoral head. The prosthesis stability, longer life, and reliability are needed due to the increase in young patients who need hip arthroplasty with higher activity levels, which can be achieved with scientific methods and newly improved materials.
Conclusion: This study introduces the biomaterials used in hip joint prostheses and discussed them from different aspects. In addition, more advanced biomaterials for THA have also been investigated to further reduce wear and increase the life of the prosthesis in the future.
 

Abstract Background: Essex-Lopresti injury (ELI) is one of the rare injuries of the elbow area, which includes fracture of radius head, disruption in the interosseous membrane of the forearm (IOM), and distal radio-ulnar joint dislocation. This happens as a result of transverse pressure on the elbow and forearm when falling down or when high energy is applied.
Methods: In this study, we introduced a 40-year-old patient who suffered both bone forearm fracture in addition to the above injuries. First, the patient underwent both bone forearm ORIF surgery, and then fixation of radius head and distal radio-ulnar joint reduction and fixation.
Results: After six months, the patient has 20 degrees of motion limitation only in the pronation state, and the joint’s motion range in other joints is complete.
Conclusion: In general, the Essex-Lopresti injury (ELI) is one of the rare hand injuries that are difficult to diagnose with simple radiographs and requires great care.
 
 

Abstract Abstract Introduction: In some cases of major lower limb trauma, either amputation or limb preservation is performed. The aim of this study was to compare the quality of life in patients undergoing amputation versus limb preservation. Materials & Methods: In a cross-sectional comparative study, patients with major lower limb trauma who underwent either lower limb amputation or limb preservation were evaluated at least six months post injury. Quality of life was assessed and compared between the two groups using SF-36 questionnaire. Results & Discussion: A total of 94 patients, including 80.9% male and 0.9% female, with mean age of 41.5 years (range 18 to 64), with the mean study period of 6 months, were included in the study. There was no statistically significant difference between the two study groups regarding age, gender, marital status, number of children, education level, smoking, or substance and alcohol abuse. The sub-scales of general health (P = 0.001) and vitality (energy) (P = 0.002) were significantly higher in the amputation group in comparison with the limb-preservation group within the six- months post injury. Conclusion: In patients with major trauma, attempts to preserve the limb, instead of immediate amputation results into longer hospital stays, increased incidence of infections, and higher rates of re-operation. Amputation, within a minimum of six months, leads to improved quality of life, particularly in the domains of general health and vitality.