Iranian Journal of Orthopedic Surgery

Abstract Abstract Introduction: Intra-articular pilon fractures of the distal tibia are complicated fractures with far-reaching long-term functional consequences. Despite improved surgical methods, the ideal management protocols and resulting recuperation patterns continue to be topics of recent investigation. This study aims to compare functional outcome, and rates of complications after surgical management of pilon fractures by open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO) and also to compare the effect of age on recovery and modes of complications. Materials & Methods: This is a prospective observational cohort study of 183 type B or C pilon fracture patients treated at a single trauma center. The level of functional recovery 2 weeks, 6 weeks, 3 months, 6 months, and 12 months post-injury was measured by the Foot Function Index (FFI). Postoperative complications were noted, and the time to return to normal activities. Repeated-measures ANOVA was employed in the assessment of temporal changes in FFI scores. Results & Discussion: There was significant improvement on all subscales of FFI during 12 months of time (P<0.001), with most improvement in the first 6 months. The mean duration of time to return to activity was 25.5±7.5 weeks. Complications were malunion (23.0%), nonunion (30.6%), deep infection (15.8%), loosening of implant (14.8%), and reoperation (36.6%). Age was correlated with increased complications. Compared with ORIF, MIPO achieved comparable 12-month functional recovery (FFI improvement) while demonstrating a lower, though not statistically significant, rate of deep infection, suggesting similar efficacy with a potential advantage in soft-tissue preservation. Conclusion: Operative management of pilon fracture yields significant functional improvement, although complications are common. Prognosis depends on age. Preoperative planning should be meticulous, close observation necessary, and individualized rehabilitation in order to maximize outcome.

Abstract Abstract Introduction: Dual mobility (DM) implants have been increasingly adopted in total hip arthroplasty (THA) to reduce the risk of postoperative instability. However, evidence comparing DM and conventional THA in Middle Eastern populations remains limited. Materials & Methods: In a retrospective case-control study the patients who had undergone primary unilateral THA in one year at two major medical centers were evaluated. The case-group received DM implants, and the control- group had conventional THA. Within a one-year follow-up, the pain (Numeric Rating Scale), hip function (Harris Hip Score), and quality of life (EQ-5D), and Postoperative complications were compared. Results & Discussion: The 86 patients studied included 42 DM and 44 conventional THA cases. Both groups experienced significant improvement in pain, function, and quality of life at one-year follow-up. The DM group demonstrated greater improvements in EQ-5D scores and higher postoperative HHS compared to the conventional group. The only dislocation (4.6%) in the conventional-group had no statistically significance. Other postoperative complications, including infection and DVT, were comparable between the groups. Conclusion: DM hip arthroplasty was associated with more favorable postoperative functional recovery and quality of life outcomes, without a significant increase in complications, in short-term follow-up. These findings support the broader application of DM implants in primary THA, although further prospective studies are needed to assess the long-term outcomes and also cost-effectiveness.

Abstract Abstract Introduction: Intra-articular pilon fractures of the distal tibia are complicated fractures with far-reaching long-term functional consequences. Despite improved surgical methods, the ideal management protocols and resulting recuperation patterns continue to be topics of recent investigation. This study aims to compare functional outcome, and rates of complications after surgical management of pilon fractures by open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO) and also to compare the effect of age on recovery and modes of complications. Materials & Methods: This is a prospective observational cohort study of 183 type B or C pilon fracture patients treated at a single trauma center. The level of functional recovery 2 weeks, 6 weeks, 3 months, 6 months, and 12 months post-injury was measured by the Foot Function Index (FFI). Postoperative complications were noted, and the time to return to normal activities. Repeated-measures ANOVA was employed in the assessment of temporal changes in FFI scores. Results & Discussion: There was significant improvement on all subscales of FFI during 12 months of time (P<0.001), with most improvement in the first 6 months. The mean duration of time to return to activity was 25.5±7.5 weeks. Complications were malunion (23.0%), nonunion (30.6%), deep infection (15.8%), loosening of implant (14.8%), and reoperation (36.6%). Age was correlated with increased complications. Compared with ORIF, MIPO achieved comparable 12-month functional recovery (FFI improvement) while demonstrating a lower, though not statistically significant, rate of deep infection, suggesting similar efficacy with a potential advantage in soft-tissue preservation. Conclusion: Operative management of pilon fracture yields significant functional improvement, although complications are common. Prognosis depends on age. Preoperative planning should be meticulous, close observation necessary, and individualized rehabilitation in order to maximize outcome.

Abstract Abstract Introduction: Knee dislocation has potential for complex injury to blood vessels nerves and ligaments. It requires prompt diagnosis and treatment. Radiological assessments aid in guiding appropriate orthopedic and surgical interventions. This study aims to assess the treatment outcomes of knee dislocations. Materials & Methods: A cross-sectional study of patients admitted to an orthopedic center within 4 years with knee dislocation was conducted. Demographic data, initial treatments, correlated injuries, pain severity, and post-surgery outcomes were collected. The initial management which was with external fixation or bracing were conquered. Statistical analysis was performed using SPSS v25. Results & Discussion: Sixty-two patients (11 female, 51 male) were enrolled. Motor vehicle accident, car accident, and falls were common causes. Co-occurring injuries included ligamentous, vascular, and nerve injuries, with the first one being predominant. The initial treatments were by either bracing or external fixation. No re-dislocation was reported in the external fixator group, while 5 occurred in the bracing group. Pain severity scores were lower in the external fixator group at 1 and 3 months post-surgery. Time to return to work and duration of rehabilitation were, non-significantly, shorter in brace treatment group. Conclusion: Both brace and external fixator show promise as initial knee dislocation treatments, offering distinct benefits. Definitive conclusions warrant comprehensive clinical trials.

Abstract Abstract Introduction: Considering the importance of growth plate fractures in quality of life and the complications caused by it and the lack of information about the prevalence of this type of fracture in the target society, this study was conducted with the aim of evaluating the prevalence of this type of fracture in an Iranian society. Materials & Methods: The information of 41 patients with fracture of growth plate including; age, gender, open and closed fracture, single and multiple fractures, type of fracture, location of fracture and presence of fracture on the right or left side of the limb were extracted from the operating room records, radiographs of the patients and their files. After collecting the data, the data were subjected to statistical analysis. Results & Discussion: 32 boys and 9 girls with an average age of 8.24±2.48. 32 years were included the distal radius fracture was the most common (26 cases) and the medial malleolus and distal metatarsal (1 person) were the least common sites of fracture. Most of the fractures were on the left side (22 people), closed (33 people) and single injury (29 people) and Salter-Harris type 2 physeal fractures were the most common fracture patterns (35 people). Conclusion: the growth plate fracture in children was more common in boys, left side, single fracture, and the majority of those were Salter-Harris type 2 fractures.

Abstract Abstract Performing total knee arthroplasty (TKA) in patients with extra-articular deformities presents complex and significant surgical challenges that can have both direct and indirect impacts on treatment outcomes. These deformities often require more meticulous planning and tailored surgical strategies to maintain biomechanical alignment of the joint and ensure optimal patient function. Among these strategies are intra-articular corrections and extra-articular osteotomies, with the choice depending on the specific characteristics of the patient and the severity of the deformity. In this context, advanced technologies such as computer-assisted surgery and robotic systems have emerged as innovative tools that enhance accuracy in surgical planning and execution, minimize the risk of surgical errors, and facilitate improved clinical outcomes. This article provides a comprehensive review of current best practices and emerging trends in managing TKA for patients with extra-articular deformities, while also emphasizing the importance of multidisciplinary preoperative planning, advanced imaging assessment, and patient-specific risk evaluation. It further discusses structured decision-making algorithms to guide the selection of appropriate corrective techniques, with careful attention to soft-tissue balance, implant positioning, and long-term stability. Collectively, these considerations aim to optimize functional outcomes, reduce complications, and improve implant longevity in this challenging patient population.

Abstract Abstract 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. 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. Findings suggested that flatfoot may contribute to increased severity and persistence of chronic low back pain by inducing kinematic alterations in the lower limb by increasing internal rotation of the knee and hip, and affecting spinal biomechanics. However, some studies did not confirm this association definitively. Flatfoot may be considered a potential risk factor for NSCLBP., by altered mechanical force distribution and movement patterns leading to increased lumbar stress. Further studies employing advanced biomechanical assessment methods are required to better understand this relationship and develop targeted interventions.

Abstract Abstract Infected nonunion of both forearm bones presents significant therapeutic challenges. Conventional methods often involve prolonged stabilization or complex grafting techniques with variable functional outcomes. A 49-year-old diabetic female presented with purulent drainage and failed union after two prior surgeries for open forearm fractures. Radiographs confirmed infected nonunion with retained hardware. A staged protocol was performed as such: (1) Radical debridement, ulnar plating, and antibiotic-cement spacer placement in the radial defect; (2) After interim antibiotics, spacer wasremoved and radius reconstructed with tricortical iliac crest autograft, fixed with screws, and augmented by cancellous grafting. At 24-week follow-up, radiographic union was achieved with no infection recurrence. Approximately 90% of contralateral forearm range of motion was restored, with no donor site complication. This approach—combining immediate ulnar stabilization with staged radial reconstruction using the Masquelet technique—effectively resolved infection and restored function in complex both-bone nonunion. It represents a strategic balance of mechanical and biological principles for challenging upper limb reconstruction.