International Journal of Research in Orthopaedics

Is robotic-arm-assisted total knee arthroplasty less traumatic? A meta-analysis

Jeshwanth Netaji — 2025-04-25

Objective was to identify inflammatory responses that predict postoperative total knee arthroplasty (TKA) outcome. The robotic TKA has resulted decreased tissue trauma. This review aims to determine the level 1 evidence of inflammatory responses following robotic and conventional jig-based TKA as inflammatory markers provide an objective method for assessing the invasiveness of the surgery. A systematic search according to the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) of the existing literature was performed on the electronic databases PubMed, Scopus and Ovid until the 1^st of June 2023. Inclusion criteria were randomized controlled trials (RCTs), written in the English language and published in the last ten years, focusing on studies that evaluated the influence of inflammatory markers (O) on robotic TKA (I) and conventional jig based (C) TKA in end-stage knee osteoarthritis patients (P) were included in the study. The inverse variance method analyzed continuous outcomes as standard mean difference (SMD), random effect model and 95% confidence intervals (CI). In total, among the 557 articles, four studies were included. One hundred sixty-five patients were included, and various inflammatory markers and patient-reported outcome measures were analysed. This meta-analysis showed that R-TKA showed a decreased inflammatory response compared to C-TKA [interleukin (IL)-6 (Std. mean diff. {IV, random, 95 CI}=-1.22 {-1.78, -0.66}, C reactive protein (CRP) (-1.07 {-2.01, -0.13}, erythrocyte sedimentation rate (ESR)=-0.65 {-1.17,-0.12} with a significant p<0.05] with no significant changes in terms of patient-reported outcome measures Western Ontario and McMaster universities osteoarthritis index (WOMAC)=-0.25 {-0.59,0.09}, knee society score (KSS)=0.18 {-0.34, 0.70}, and functional outcome range of motion (ROM)=-0.22 {-0.62, 0.17} with a p>0.05. Robotic-arm-assisted TKA has decreased early postoperative inflammatory response. High powered studies assessing the predictive value of metabolic and inflammatory factors pre and post-surgery and the already evidenced risk factors with follow-up greater than one year after TKA are warranted.

Pure talonavicular subluxation

Youssef El Hassnaoui — 2025-04-25

Talon-navicular dislocation of the tarsus is a rare injury that can be easily overlooked in emergency settings. This report details the case of a 26-year-old man who experienced a right foot injury due to a fall resulting in plantar hyperflexion. Initially misdiagnosed as an ankle sprain, further evaluation revealed a plantar sub-dislocation of the navicular bone, confirmed by radiological imaging.

Comprehensive reconstruction and rehabilitation of explosive hand trauma: a case report

Stephane Jabre — 2025-04-25

Firework-related hand injuries can be devastating, resulting from a combination of blast forces, thermal impact, and penetrating trauma. These injuries result in extensive soft tissue damage, fractures, and partial or complete amputations, thereby posing complex challenges for surgical management and rehabilitation. We report the case of a 23-year-old male technician who sustained a severe explosive hand injury from fireworks. Initial treatment focused on thorough wound irrigation, debridement, skeletal stabilization, and prompt initiation of prophylactic antibiotics. Multiple staged procedures were performed, including open reduction and internal fixation of carpometacarpal dislocations, nerve and tendon repairs, and flap reconstructions to restore soft tissue integrity. Despite the complexity and extent of the injury, a staged approach facilitated optimal wound healing and partial functional restoration of the hand. This case underscores the multifaceted nature of blast-related hand injuries, where extensive tissue damage, compromised vascularity, and contamination necessitate a multidisciplinary approach. The hand surgery team collaborated to ensure appropriate skeletal stabilization, nerve and tendon repair, and soft tissue coverage. Early and intensive rehabilitation, encompassing both physical and psychological support, was critical in optimizing recovery. Although functional limitations persisted, the combination of modern surgical techniques and structured rehabilitation yielded a satisfactory outcome relative to injury severity. Successful management of severe hand trauma from fireworks requires coordinated, staged surgical interventions, and comprehensive rehabilitation. While advances in reconstructive surgery improve outcomes, complete recovery may remain elusive in profound blast injuries. Public awareness and preventive measures are paramount to reducing the incidence of such injuries.

Rare cause of neck pain and gait imbalance: a case report

Isam Sami Moghamis — 2025-04-25

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon cause of neck pain and radiculopathy that can be easily misdiagnosed. The lack of diagnostic criteria makes the diagnosis of such cases challenging. However, the correlation between clinical presentation with laboratory and radiological findings can help diagnose these patients. Surgical decompression is rarely indicated in the absence of any cause of neuronal compression. Medical treatment of CIDP is currently the main line of treatment. We are presenting a case of a 32-year-old male with no known medical conditions who presented to our spine clinic with a history of chronic neck pain associated with gradual and progressive left upper limb weakness and imbalance. Clinical imaging showed hypertrophied nerve roots of the cervical spine. The patient was treated with intravenous immunoglobulins and corticosteroids, which improved his symptoms significantly.

Knee arthrodesis with ring fixator for lower limb salvage after necrotizing fasciitis involving extensor apparatus

Paula Alves Sousa — 2025-04-25

Necrotizing fasciitis (NF) is a rare but severe infection with high morbidity and mortality, requiring urgent and aggressive intervention. This case describes a 64-year-old male who presented with septic arthritis of the knee complicated by NF and Streptococcal toxic shock syndrome. Despite early surgical debridement and empiric antibiotic therapy, the infection progressed, resulting in extensive necrosis of the knee extensor apparatus and exposure of the knee joint. Knee arthrodesis with a circular external fixator was performed, allowing for joint stabilization, soft tissue closure with skin grafts, and comprehensive functional rehabilitation. Six months post-discharge, the patient achieved pain-free, independent ambulation, avoiding amputation. This case underscores the feasibility of knee arthrodesis with a circular external fixator as a viable option for limb salvage in severe NF cases.

Management of fracture shaft femur with ipsilateral un-united neck femur fracture with femoral neck system in situ, with review of fixation options

Sankalp Chaudhary — 2025-04-18

Ipsilateral fractures of the femoral neck and shaft are rare but complex injuries that require meticulous planning and surgical execution. The presence of a previously fixed but ununited femoral neck fracture using a novel implant, such as the femoral neck system (FNS), further complicates management. We present the case of a 23-year-old male who sustained a mid-shaft femur fracture following a road traffic accident. Notably, the patient had undergone surgical fixation of an ipsilateral femoral neck fracture two months prior using FNS. Radiographs revealed non-union of the femoral neck with early signs of avascular necrosis, along with a fresh shaft fracture. Surgical management included removal of the FNS and closed reduction with internal fixation using a cephalomedullary (sirus) nail. Proximal femoral fixation was augmented using two locking screws through the nail and one additional screw outside the nail. The patient had an uneventful postoperative recovery. At four-month follow-up, radiographs showed progressive union of both femoral neck and shaft fractures, with no radiographic signs of implant failure or further head collapse. This case illustrates the surgical challenges in managing sequential ipsilateral femoral fractures with prior implant in situ. Timely revision of the FNS and stabilization with a cephalomedullary nail allowed for successful outcome. Such complex cases require individualized surgical planning, and the combination of appropriate fixation techniques can yield satisfactory healing and functional recovery.

Implant fixation on myositis mass masquerading as distal humerus: an intraoperative error

Purushotham Lingaiah — 2025-04-25

Myositis ossificans is a non-neoplastic ossifying mass seen in association with a bony and soft tissue trauma. We present a case of myositis ossificans mass developed after a distal humerus fracture mimicking the shape of lateral humeral condyle which led to inappropriate fixation of implant over the mass. Preoperative planning, extensile surgical approach, complete excision of the mass and use of image intensifier are highlighted which will avoid complications like failure of fixation and recurrence.

Modular custom prosthetic reconstruction of proximal tibia giant cell tumor: a case report and review of literature

Vatsal A. Gupta — 2025-04-25

Giant cell tumors (GCTs) of bone are primary bone tumors that are benign in nature. They are biologically aggressive and have metastatic potential after malignant transformation. They occur in skeletally mature individual mainly in 3^rd decade of life. Here, we present a case of a 29-year-old female diagnosed with right proximal tibia GCT, managed with en bloc excision and custom mega prosthesis arthroplasty.

Osteoid osteomas around the ankle managed with cost-effective and clinically efficient percutaneous drilling resection: a case report of two cases in the talus and distal tibial epiphysis

Aashay Sonkusale — 2025-04-25

Osteoid osteoma (OO) is a benign bone tumour characterised by constant pain which is worse at night and relieved by NSAIDs. On imaging, it is seen as a well demarcated rounded osteolytic lesion with a central nidus. It is rarely seen around the ankle joint, and it is easy to miss on primary plain radiographs, especially in children, leading to mid- or delayed diagnosis which is highlighted in this case report. Conservative management with NSAIDs and immobilisation is usually the first line of management. Upon failure of medical treatment, there are various surgical options ranging from open resection to minimally invasive image guided procedures. We present 2 cases of sub-periosteal OO around the ankle- one in the talus and other one in the distal tibial epiphysis. The first case is of a 17-year-old girl, was initially misdiagnosed on plain radiographs and magnetic resonance imaging (MRI) as right ankle synovitis elsewhere and treated with open synovectomy and debridement. She presented to us 4 months after the procedure with incessant right ankle pain not allowing her to perform her routine activities. The second case describes OO in the distal tibial epiphysis of the left ankle in a 12-year-old male child presenting with typical left hind foot pain. We managed both the OO with percutaneous drilling resection (PDR) under computed tomography (CT) guidance with complete resolution of symptoms and full weight bearing within 48 hours. A six-month follow-up reported birth children back to schooling and routine activities with a completely pain free ankle joint. OO around the ankle requires a high index of suspicion. Early diagnosis is often obscured by vague symptoms and complex anatomical location around the ankle. CT scan is considered to be the gold standard; effusion and peri-lesional edema masks the lesion on MRIs. PDR is a cost effective and easy surgical option producing consistent results with low rates of recurrences.

Adenocarcinoma of humerus shaft treated with en bloc excision and long locking compression plate with fibular strut and iliac bone grafting: a case report

Gangadhar Bhuti — 2025-04-25

Adenocarcinoma of the humerus shaft is a rare malignant tumor, often secondary to metastasis from a primary site such as the lung, breast, or gastrointestinal tract. Management of these cases is challenging due to the complex anatomy, the need to preserve limb function, and the high risk of recurrence. This case report highlights a unique approach involving en bloc excision, long locking compression plate (LCP) fixation, fibular strut grafting, and iliac bone grafting. A 55-year-old female presented with persistent pain and swelling in the midshaft of right humerus, accompanied by reduced range of motion. Imaging revealed a lytic lesion, and biopsy confirmed metastatic adenocarcinoma. After a multidisciplinary evaluation, an en bloc excision of the tumor was performed. Reconstruction involved internal fixation with a long LCP, augmented by a vascularized fibular strut graft and autologous iliac bone grafting. Postoperative care included adjuvant chemotherapy and physiotherapy. Postoperative outcomes were favorable, with evidence of graft integration and functional recovery at six months, alongside significant pain reduction and absence of local recurrence at one-year follow-up. The combination of biological and mechanical reconstruction techniques provided durable outcomes and restored limb function. This report underscores the importance of a multidisciplinary approach and highlights the efficacy of autograft-based biological reconstruction in managing extensive diaphyseal defects. The chosen method demonstrates a viable alternative to endoprosthetic reconstruction, particularly in patients with long-term survival potential.

Large osteochondroma excision from distal radius

Lomesh P. Modi — 2025-04-25

Osteochondroma is a common benign bone tumor, originating within the periosteum as a small cartilaginous nodule. The distal femur, the proximal tibia, and the proximal humerus are the most common locations and the majority of these lesions cause no symptoms and are discovered incidentally. We present a rare solitary large (approx. 11 cm long) osteochondroma originating from the ventral aspect of the distal end of the radius with mechanical restriction of movement of the wrist joint in an 8-year-old female patient. The biopsy is suggestive of benign chondro-osseous neoplasm favoring the diagnosis of osteochondroma. Surgical intervention with the excision of the osteochondroma of the distal radius was performed and thereby the symptoms showed a complete resolution.

Multilevel spinal tuberculosis: a case report emphasizing the critical role of early diagnosis in mitigating neurological complications

Channappa T. S. — 2025-04-25

Tuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%–60% of cases 1. Spinal TB still occurs in both developed and developing countries. The diagnosis of spinal TB is difficult, and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity 2. We report a case of tuberculosis of the spine in a 23-year-old female patient who presented with complaints of lower back pain for 2 months and difficulty in standing and walking for 1 month. Pain had an insidious onset and gradually progressed over a period of 2 months. The patient gave a history of weakness of both lower limbs for 1 month. Plain X-ray The dorso-lumbar spine showed vertebral segmental bone destruction at the D11 vertebra. MRI of the dorsal spine showed wedging and collapse noted at the D11 vertebral body, forming a gibbus deformity causing thecal and cord compression. So, surgery was performed with debridement of debris and posterior stabilization and fixation at the D8, D9, and L1-L2 vertebrae, and also psoas abscess drainage was done on a later date. The patient was started on anti-tubercular therapy after confirming the diagnosis, and the patient recovered well and is currently under follow-up. For patients with spinal TB, debridement and autograft bone fusion with posterior fixation appear to be effective in arresting disease, correcting kyphotic deformity, and maintaining correction until solid spinal fusion.

Surgical management of chondromyxoid fibroma at meta-diaphyseal junction of proximal tibia: a case report

Umesh M. Shivanna — 2025-04-25

Chondromyxoid fibroma (CMF) is a rare, benign tumour of the bone. It represents less than 1% of all bone tumours. We present a case of a 20-year-old female who came with chief complaints of pain and swelling in right leg for 3 months. Radiograph showed features suggestive of large multiloculated osteolytic, radiolucent lesion with thinned out cortices in right proximal tibia. MRI showed exophytic lesion and features suggestive of osteosarcoma. USG guided biopsy reported as chondromyxoid fibroma. Patient underwent curettage of tumour followed by reconstruction with allograft and stabilized with internal fixation. Final histopathological report showed features suggestive of chondromyxoid fibroma. Patient made uneventful recovery with no signs of recurrence and good functional range of motion (ROM) of the knee joint after 2 years of follow up. Histopathology is the gold standard and mandatory for confirmation of the diagnosis. Curettage and filling the defect with polymethyl methacrylate (PMMA) or bone graft is the mainstay treatment of choice.

Hibernoma of the thigh: a case report and literature review

Youssef Elhassnaoui — 2025-04-25

Hibernoma is a rare benign tumor of brown fat. It presents as a voluminous slow growing mass in the regions where remnants of brown fat can remain in adults. We report a case of a hibernoma on the thigh and present the diagnostic and therapeutic elements of this type of tumor, whose differential diagnosis of liposarcoma.

Humeral lengthening by Ilizarov technique due post neonatal septic arthritis: a case report

Rosana Pinheiro — 2025-04-25

Septic arthritis is an acute infection that occurs more frequently in children, is monoarticular, and most frequently affects the knee and hip. The main long-term sequelae of shoulder septic arthritis is shortening of the humerus and deformity of the affected joint. Humeral lengthening, whether unilateral or bilateral, is a valid method that improves the outcome following arm shortening and deformity correction. We presented the case of a teenager with sequelae of septic arthritis of the shoulder. He had dysmetria of the upper limbs of 120 mm, with shortening of the left humerus and humeral head subluxation. He underwent humerus osteotomy and humeral lengthening according to the Ilizarov technique. Currently, he presents some dysmetria, but have normal mobility. Radiologically we achieved 80 mm lengthening and reduce the humeral head, which was initially dislocated. Diagnosis of neonatal septic arthritis requires a high index of clinical suspicion. Humeral lengthening in post-septic shortening with the application of Ilizarov fixator is an effective, safe, reliable method.

Inpatient temporal trends in open and minimally invasive sacroiliac joint fusions

Kanwar Parhar — 2025-04-25

Background: Lower back pain is a leading cause of disability worldwide, with sacroiliac joint dysfunction implicated in 15-30% of chronic cases. For this a sacroiliac joint fusion (SIJF) may be performed using either open or minimally invasive surgery (MIS) techniques. Prior to the introduction of unique ICD-PCS codes in 2015, there was limited data on the surgical variables for the different techniques. This study aims to evaluate open and MIS inpatient case trends from 2016-2020.

Methods: A retrospective analysis of the national inpatient sample database from 2016 to 2020 was conducted. Patients were identified using ICD-10 PCS codes for open and MIS SIJF procedures. Temporal trends and geographic distribution were analyzed, with demographic and procedural data compared using statistical tests including Mann-Kendall, t-tests, and Chi-square.

Results: Among 38,660 inpatient SIJF procedures, 34,590 were open and 3,890 were MIS. The procedures were primarily performed on females, identifying as white, Medicare payers and in urban teaching hospitals (p<0.001). No significant temporal trends in procedural volume were observed for open (p=0.807) or MIS (p=0.462) SIJF from 2016-2020. However, regional analysis revealed majority of the procedures taking place in the Southern region of the United States (p<0.001).

Conclusions: Inpatient SIJF volumes remained stable from 2016-2020, with most procedures performed in the South. These findings align with the increasing shift toward outpatient MIS SIJF, as inpatient volumes did not rise despite greater MIS adoption. Future studies should examine outpatient trends to further characterize this shift.

Incidence and risk factors of adjacent segment disease following short segment posterior instrumentation in Bahraini patients: a five-year retrospective analysis

Noor M. AlAnsari — 2025-04-25

Background: Despite advances in spinal surgery, adjacent segment disease (ASD) and adjacent disc degeneration (ADD) remain notable postoperative complications following spinal fusion, mainly due to suspected increased biomechanical stress that leads to adjacent disc degeneration. This research focuses on the Bahraini population, utilizing MRI to compare pre-op and post-op Adjacent disc conditions to identify the incidence and risk factors of ASD and ADD after short segment spinal fusion.

Methods: A retrospective cohort study conducted over a five-year period at Salmaniya Medical Complex, the largest tertiary care center in the Kingdom of Bahrain. Reviewing pre-operative and post-operative MRI scans of 41 symptomatic patients who underwent short segment spinal fusion between 2014 and 2019. Patients were selected based on specific pre-operative and post-operative criteria developed by the orthopaedic team and were followed up to October 2023. Statistical analyses were performed using R software.

Results: The analysis of 41 patients revealed a significant incidence of adjacent segment changes and the main risk factor that showed significance was advancing age. While other reported risk factors like level of fusion and number of fused segments did not significantly correlate with advancing ADD or ASD. There was no statistically significant association between hypertension, diabetes or multiple comorbidities and worsening conditions for either ASD or ADD post operation.

Conclusions: The findings from our study contribute to the understanding of ASD and ADD after lumbar fusion surgeries, particularly in highlighting the significance of age. These insights can aid surgeons in better anticipating the risks associated with specific demographic and clinical profiles. More controlled studies on larger populations will help delineate more concrete risk factors.

A comparative study between closed interlocking intramedullary nailing and locking plate by minimally invasive plate-osteosynthesis in diaphyseal fracture of tibia

Mohammad Musa — 2025-04-25

Background: Tibial shaft fractures are common and often lead to significant complications. This study aims to compare the efficacy of interlocking intramedullary nailing (IMN), and minimally invasive plate osteosynthesis (MIPO) in treating these fractures. The aim of the study was to compare the outcome between closed interlocking intramedullary nailing and locking plate by MIPO in diaphyseal fracture of tibia.

Methods: This prospective, comparative observational study was conducted at the Department of Orthopaedic Surgery, M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh, from October 2019 to March 2021, enrolling 30 patients with closed diaphyseal tibial fractures. Participants were randomly assigned to group A (interlocking intramedullary nailing) or group B (locking plate by MIPO). Data were analyzed using statistical package for the social sciences (SPSS) version 25, with p<0.05 considered significant.

Results: In a study of 30 patients with tibial fractures (group A: 15, group B: 15), group A had significantly shorter surgery times (105±17 versus 119±18 minutes, p=0.043) and achieved full weight-bearing earlier (93.3% versus 46.7% at 12 weeks, p=0.014). Both groups showed similar radiological union rates (93.3% versus 80.0%, p=0.598). Group A had more anterior knee pain (73.3% versus 0%, p=0.001), while group B had more wound infections (20.0% versus 6.7%, p=0.224). Functional outcomes were better in group A (93.3% excellent versus 66.7%, p=0.16).

Conclusions: Closed interlocking intramedullary nailing and locking plate by MIPO both are equally effective procedures for treating tibial diaphyseal fractures.

Assessing the efficacy of doppler ultrasound in determining the level of amputation amongst diabetic foot patients: a 2-year retrospective study

A. B. Oladiran — 2025-04-25

Background: Diabetic foot complications leading to amputation represent a significant healthcare burden, particularly in elderly populations. Understanding the patterns, procedures, and outcomes of these amputations is crucial for improving patient care.

Methods: A retrospective observational study of 33 patients who underwent diabetic foot amputation was conducted. Data collected included demographic characteristics, clinical parameters, surgical procedures, and outcomes. Doppler ultrasound was requested for all the patients to confirm the level of amputation that had been determined clinically.

Results: The mean age was 68.8±8.9 years, with a slight male predominance (51.5%). Most patients (78.8%) belonged to the low socioeconomic class, and 63.6% had only primary education. Below knee amputation was the most common procedure (81.9%), and 66.7% of patients presented with grade 4 diabetic foot. Doppler ultrasound was requested for all patients, but only 18.2% underwent the investigation. Comorbidities were present in 69.7% of cases, with hypertension being the most prevalent (45.5%). The mean HbA1c was 9.742±4.9267. A significant improvement in PCV was observed post-operatively (31.6±4.9% versus 26.3±6.7%, p=0.001).

Conclusions: The correlation between Doppler USS and intra-op findings is statistically significant. Doppler USS remains important investigation in determining level of amputation following clinical assessment of diabetic foot patients.

Functional outcomes following total hip and knee arthroplasty

Prem Kumar Sah — 2025-04-25

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective treatments for advanced osteoarthritis (OA) and other joint disorders. Despite their efficacy, many patients experience residual functional limitations postoperatively. This study evaluates functional outcomes following unilateral THA and TKA, integrating patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs) over 12 weeks.

Methods: This prospective observational study, conducted at B. P. Koirala Institute of Health Sciences, Nepal, included adults scheduled for unilateral THA or TKA. Participants completed preoperative questionnaires assessing demographics, health status, joint disabilities, and baseline functional tests, including the 30-second chair stand test (30-s CST) and the HOOS/KOOS. Postoperative follow-ups were conducted at 2, 6, and 12 weeks, assessing functional outcomes, satisfaction, pain, and quality of life (QoL). Paired t-tests and repeated measures ANOVA was used for data analysis in SPSS version 26.0.

Results: The study included 38 patients; 24 THA and 14 TKA, with both groups showing significant postoperative improvements in all outcomes (HOOS/KOOS, 30-s CST, pain, and QoL). TKA patients demonstrated better early improvements in pain, symptoms, and physical function at 2 weeks. In contrast, THA patients had greater improvements in sports and recreation scores by 12 weeks. Self-reported QoL showed significant improvements, with no significant differences in age or BMI affecting outcomes. Pain catastrophizing decreased significantly in both groups. Gender differences were found in the THA group, where men improved better in most functional measures.

Conclusions: Both THA and TKA result in significant improvements in pain, physical function, and QoL, with PROMs and PBOMs playing complementary roles in tracking recovery highlighting the importance of integrating subjective and objective measures for holistic post-surgical evaluations and personalised rehabilitation strategies.

A comparative analysis between the proximal femoral nail and dynamic hip screw in the management of unstable trochanter fracture of the femur

Nazmul Huda Shetu — 2025-04-25

Background: Trochanteric fractures are a growing public health concern, particularly as the population ages. This study aims to assess recovery and functional outcomes following treatment of trochanteric femoral fractures using either PFN or DHS. The aim of this study was to compare the effectiveness of proximal femoral nail (PFN) and dynamic hip screw (DHS) in managing unstable trochanteric fractures of the femur.

Methods: This quasi-experimental study at the emergency and outpatient department of the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka (July 2005-June 2007), included 30 patients with unstable trochanteric fractures, treated with proximal femoral nail (n=14) or dynamic hip screw (n=16). Surgeries were performed under spinal anesthesia, and outcomes, including union rate, complications, and functional results, were assessed and analyzed using SPSS (p<0.05).

Results: Out of the 33 patients initially included, 2 died and 1 were lost to follow-up, leaving 14 patients in the PFN group and 16 in the DHS group. The mean operation time was significantly longer for PFN (117.4 minutes) compared to DHS (72.3 minutes). A higher percentage of DHS patients required blood transfusions. Follow-up results showed that PFN patients experienced less pain, better hip movement, and higher Harris hip scores, with statistical significance in pain relief and functional outcomes.

Conclusions: The proximal femoral nail (PFN) is an effective treatment for unstable trochanteric femoral fractures, offering biomechanical stability, early weight-bearing, and a lower risk of wound infection compared to traditional methods.

Functional outcomes of arthroscopic rotator cuff repair: transosseous technique versus single-row with anchors

Julio Solis Kronthal — 2025-04-25

Background: Transosseous repair (TO) has declined in popularity since the introduction of suture anchors and arthroscopic methods in 1985. Nevertheless, failure rates remain significant, at 12% to 40% and the cost of these devices is considerable. Consequently, interest has revived in arthroscopic transosseous technique, the aim of this study was to evaluate whether anchorless transosseous arthroscopic fixation achieves similar or better functional outcomes than single-row fixation with anchors in patients with rotator cuff tears.

Methods: 60 shoulders with complete rotator cuff tears were evaluated, divided into two groups based on fixation technique: Group 1 (transosseous) and Group 2 (single row with anchors). All patients had a minimum 12-month follow-up, including clinical assessments (VAS, range of motion) and functional questionnaires (ASES, Constant scores).

Results: No significant differences were found in VAS scores at 6 months (t=0.244, p=0.404) and 12 months (t=0.220, p=0.413). Additionally, there was no superiority of either group in motion ranges at 12 months (forward flexion t=0.732, p=0.234; external rotation t=1.608, p=0.057; abduction t=0.583, p=0.281). Both groups reported high postoperative satisfaction, with no differences in ASES (t=0.153, p=0.439) and constant scores (t=0.572, p=0.285) at 12 months.

Conclusions: The transosseous repair technique is as effective as single-row anchor repair for rotator cuff repair, achieving similar clinical and functional outcomes.

Complications and associated risk factors of open reduction and internal fixation among adult patients with tibial plateau fractures

M. Ali Haider — 2025-04-25

Background: Tibial plateau fractures are complex injuries that often require open reduction and internal fixation (ORIF) for optimal recovery. However, complications and risk factors associated with ORIF can significantly impact patient outcomes. This study aimed to evaluate the complications and associated risk factors of open reduction and internal fixation and their effect on functional recovery in adult patients with tibial plateau fractures.

Methods: This prospective observational study was conducted in the Department of Orthopaedics and Traumatology, Chittagong Medical College Hospital, Chattogram, Bangladesh, from January 2018 to December 2019. This study included 50 adult patients of both genders with high-energy tibial plateau fractures through a consecutive sampling technique. Functional outcomes were assessed over six months and statistical associations with risk factors were examined.

Results: The mean age of patients was 43.95±10.89 years, with a male predominance (76%). The most common fracture type was Type VI (72%) and the majority were closed fractures (84%). The average time from injury to surgery was 11.05±3.203 days, with a mean operative duration of 107±12.074 minutes. At six months, 82% of patients achieved excellent functional outcomes, while 10% had good and 4% each had moderate and poor outcomes. The mean fracture union time was 15.39±1.614 weeks. Infection significantly affected recovery (p=0.008), with 92.7% of infection-free patients achieving excellent results, whereas 33.3% of those with superficial infections had moderate outcomes and all patients with deep infections had poor outcomes. Gender also had a significant impact (p=0.047), with 80.4% of males achieving excellent outcomes compared to 19.5% of females.

Conclusions: The findings show that ORIF in tibial plateau fractures generally results in favorable outcomes, but factors like gender and post-operative infections significantly influence recovery. Effective infection control and individualized patient management may enhance surgical success and functional outcomes.

Clinical benefits of undenatured chicken collagen type II Unstergen® as a nutritional therapy in the management of osteoarthritis: a double-blind, placebo controlled clinical study

Sriraam V. T. — 2025-03-27

Background: Osteoarthritis (OA) is a degenerative joint disease affecting millions globally, often leading to pain and reduced mobility. Nutraceuticals like undenatured chicken collagen are gaining attention for their potential in symptom relief. This proof-of-concept study evaluates the clinical efficacy of Unstergen® of Titan Biotech Limited in the management of OA.

Methods: This randomised, double-blind, placebo-controlled study studies 48 adults with OA. Subjects received 40 mg/day of Unstergen® (n=32) or placebo (n=16) once a day for 90 days. Outcomes were assessed using WOMAC score, pain scale, quality of life questionnaire (QoL) for all and global rating of change scale (GROC) using X ray of target joint for a cohort of 12 subjects.

Results: Unstergen group demonstrated statistically significant reduction of 20.39% in Western Ontario and McMaster universities osteoarthritis index (WOMAC) scores and 37.77% in pain numerical rating scale (Pain NRS) compared to 7.24% and 8.70% reduction in the placebo arm, respectively. The 90.32% subjects reported improvement in QoL compared to placebo (p<0.05). The 87.50% subjects were deemed to have marked improvement on their X ray while no subject in the placebo arm showed improvement after 90 days. No adverse event was attributed to Unstergen and was deemed clinically safe.

Conclusions: Unstergen® demonstrated significant improvement in pain, function and QoL; highlighting its role as a novel nutraceutical supplementation therapy for OA.

Functional outcome of medial patella femoral ligament reconstruction: a prospective study of novel hamstring sparing technique without patella anchors

Jithin Mohan — 2025-04-25

Background: A composite graft made of medial retinaculum and quadriceps tendon can be used instead of hamstring graft for medial patellofemoral reconstruction in recurrent dislocation of patella. Our study aims at determining the functional outcome of MPFL reconstruction with this composite graft.

Methods: This is a unicentric, prospective observational study conducted in 60 patients with recurrent dislocation of patella with normal Q angle and without trochlear dysplasia. A composite graft composed of medial patella retinaculum and quadriceps was harvested, one end was sutured at medial superior 2/3rd junction of patella with ethibond. The other end of graft fixed at schottles point with a bio screw. Patients were followed up at 6 weeks, 3 months, 6 months and then yearly. A preoperative and post operative Lysholm score and Kujala score were used for comparison.

Results: There was a significant improvement in Kujala and Lysholm scores. Only 3 out of 60 patients developed further instability that was managed non surgically. There was no statistically significant association with ligamentous laxity and the outcome.

Conclusion: Considering the donor site morbidity and patella fracture this novel hamstring sparing MPFL reconstruction is superior, and outcomes are comparable with previous techniques.

A study on functional outcome of cemented bipolar hemiarthroplasty and proximal femoral nailing for intertrochanteric fractures of femur in elderly patients 60-90 years

Nasneem M. — 2025-04-25

Background: Intertrochanteric fractures are common in elderly patients, often resulting from low-energy falls and exacerbated by osteoporosis. Procedures like bipolar hemiarthroplasty (BHA) and proximal femoral nailing (PFN) present unique benefits and challenges. The aim of the study was to compare the functional outcome of intertrochanteric fracture treated with proximal femoral nail and cemented bipolar hemiarthroplasty.

Methods: A longitudinal observational study was conducted among patients with complaint of an intertrochanteric fracture between March 2021 and August 2022. A total of 24 patients were selected based on particular inclusion and exclusion criteria and divided into two groups of 12. After the respective procedure, patients were monitored for a duration of 5 months, both preoperatively and postoperatively at 1, 3, and 5 months. The collected data included demographic data, clinical data as well as Harris hip score which was then entered into excel sheets and then analyzed using EZR version 1.54 software.

Results: The present study included 24 patients of which 37.5% were males and 62.5% were females with a mean age of 78.17±9.13 years. The mean blood loss observed was 203.75±65.99 ml, mean surgery time was 96.42±26.02 minutes, and mean number of days needed to bear full weight was 28.21±20.42 days. Of the fracture patterns, 31-A2 was the most common encountered (54.2%). The mean amount of blood loss among participants in the PFN group was 152.50±24.17 ml and in the bipolar group the mean blood loss was 255±52.83 with this difference being statistically significant (p<0.05).

Conclusions: This study found significant intraoperative blood loss differences between PFN and CBH in older intertrochanteric fracture patients. The statistically significant reduction in blood loss makes PFN a safer surgery for this sensitive group.

Evaluating functional recovery post-total knee replacement, a WOMAC based comparison of synovectomy versus non-synovectomy approaches in a tertiary care hospital in South India

Abhilash Pillai — 2025-04-25

Background: Synovectomy is commonly performed during total knee arthroplasty (TKA) for patients with osteoarthritis (OA) and inflammatory arthritis to address synovial inflammation. However, its impact on long-term functional outcomes remains unclear. Objective of this study was to evaluate the effect of synovectomy during TKA on postoperative pain, stiffness, and functional outcomes in patients with OA and inflammatory arthritis.

Methods: A hospital-based retrospective cohort study was conducted with 86 patients who underwent TKA one year prior (43 with synovectomy, 43 without). The Western Ontario and McMaster osteoarthritis index (WOMAC) was used to assess pain, stiffness, and physical function at follow-up.

Results: The mean age of patients was 65.4 years. No significant differences were found in pain (p=0.638) and stiffness (p=0.647) between the two groups. However, physical function was significantly better in the group without synovectomy (p=0.004), with significantly fewer difficulties in activities such as standing, bending, and getting in/out of bed (p<0.05). The mean total WOMAC score was significantly lower in the group without synovectomy (p=0.045).

Conclusions: Synovectomy during TKA had no impact on postoperative pain or stiffness and was associated with poorer functional outcomes compared to TKA without synovectomy. These findings suggest that synovectomy may not offer additional benefits for patients with OA and inflammatory arthritis. Further research with larger samples is recommended to better understand its role in TKA.

Holistic approach to managing acute soft tissue injury: PEACE and LOVE protocol-observational research

Arif Rizvi — 2025-04-25

Background: Soft tissue injuries such as sprains, strains and contusions are common in football and the initial response to these injuries plays a crucial role in recovery. Traditional methods like R.I.C.E. (rest, ice, compression, elevation) have been widely used since their introduction in 1978. However, recent evidence suggests that these methods may not support optimal tissue healing, leading to the development of the P.E.A.C.E. (protection, elevation, avoid anti-inflammatories, compression, education) & L.O.V.E. (load, optimism, vascularization, exercise) protocol, which emphasizes natural healing processes without the use of anti-inflammatory treatments. This study aims to analyze the recurrence of injuries and the remedial management strategies used by footballers, promoting awareness of the P.E.A.C.E. & L.O.V.E. principle for better injury outcomes.

Methods: This was a survey-based observational study involving 200 footballers aged 18 to 35, playing at different levels in Lucknow football academies and clubs. Data were collected using a self-made questionnaire comprising questions about football-related injuries and their management. Statistical analysis was performed using MS Excel (v2019) and SPSS (v26.0).

Results: Injury recurrence: 76.5% experienced more than one recurrence, while 24.5% had a single recurrence. Immediate treatment strategies: 59.5% followed R.I.C.E., 30.5% used P.R.I.C.E. and 9.5% followed P.O.L.I.C.E. Awareness of P.E.A.C.E. & L.O.V.E.: 88% were unaware, while only 12% were aware of the principle. Perceived study impact: 96.5% of participants found this study informative.

Conclusions: The study revealed that 88% of footballers lacked awareness of the P.E.A.C.E. & L.O.V.E. principle, which highlights the need for educating athletes about its benefits for optimal recovery and injury prevention. Incorporating these updated guidelines can reduce the recurrence of injuries and enhance long-term outcomes.

Impact of anxiety, depression, and stress among knee osteoarthritis patients: a percentage-based study

Aavrati Rastogi — 2025-04-25

Background: Mental health challenges play an important role in pain and progression of knee osteoarthritis (KOA). Two prevalent psychological comorbidities that affect patients' quality of life (QoL) are anxiety and depression. The functional condition of patients with KOA may be influenced by feelings of depression and anxiety.

Methods: The study was conducted on 108 individuals diagnosed with osteoarthritis knee according to European League Against Rheumatism (EULAR) classification knee OA. Age, gender, and body mass index (BMI) were recorded, pain and functional activities were assessed using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and depression, anxiety and stress scales-21 (DASS-21) was used for stress, anxiety, and depression.

Results: The 108 patients with osteoarthritis knee were included in the study. The mean age of patients was 55.92±0.8 years, and the mean BMI was 27.24±0.4 kg/m². The majority of patients with knee OA had typical levels of stress (64.75%), anxiety (39.57%), and depression (50.36%). There was mild to severe degrees of stress (17.27–10.79%), anxiety (9.35–22.30%), and depression (20.14–22.30%). Anxiety had a higher prevalence of severe to extremely severe cases (28.78%) than depression (11.52%) and stress (7.19%), indicating the psychological load experienced by a subgroup of patients.

Conclusions: According to the findings, to maximize patient care and rehabilitation, psychological support, especially for anxiety, should be incorporated into the treatment of KOA.

Functional outcome of postero-medial condyle fractures of proximal tibia treated using posteromedial locking compression plate

N. Krishna Prasad — 2025-04-25

Background: Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. They comprise approximately 8% of all fractures among those aged over 55 years. Surgical intervention for tibial plateau fractures is essential to achieve articular congruity, proper joint alignment, mechanical stability and support ligamentous integrity, as well as to enable prompt rehabilitation

Methods: A 12 months prospective study was conducted from July 2023 to June 2024 at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh. The study included 30 patients with Schatzker Type IV, V and VI proximal tibial fractures. Fractures involving the medial condyle were treated using a posteromedial locking compression plate.

Results: The study included participants aged between 23 to 62 years with the mean age being 36 years (22 males and 8 females). Schatzker classification Type IV fractures being the most prevalent (14 cases) followed by Type V fractures (10 cases) and Type VI fractures (6 cases). Right-sided fractures were more common, with 20 cases reported, compared to 10 cases of left-sided injuries. The functional outcome was measured using the Lysholm Knee Score according to age, fracture and gender. It was excellent results in 19 patients, good results in 8 and fair results in 3 at six month follow up.

Conclusions: Fixation of the tibial plateau fractures using locking compression plates allows for early rehabilitation of the patient and has an excellent functional outcome. Restoring stability, articular congruity and alignment ensures long-term joint health and minimizes complications. A well-planned approach to the tibial plateau fracture with importance to the posteromedial fragment has excellent functional outcomes.

The effect of decompression with posterior spinal fusion on back and leg pain in lumbar canal stenosis

Kushagra Kaushik — 2025-04-25

Background: Lumbar canal stenosis, characterized by pain, numbness and neurological claudication, causes gradually worsening back and leg pain, which can lead to neurologic compromise and patient distress. Posterior lumbar interbody fusion (PLIF) has been used for spinal fusion, with any of the decompression procedures. We aimed to examine the effects of decompression with PLIF on back pain, leg pain and neurological claudication in patients with lumbar canal stenosis.

Methods: In this observational study, total of 50 patients with lumbar canal stenosis who underwent PLIF at Bharati Hospital were included from January, 2020, to April, 2022. Selected patients had LS spine X-rays and MRIs. Neurological claudication, VAS scores for back and leg pain and Oswestry Disability Index were assessed at 3 months, 6 months, 9 months and 12 months post-op.

Results: The majority (19 (38%)) of the patients were between the ages of 50 and 60, with 23 men and 27 women in total. 50% of study participants had pain in both legs. Neurologic claudication decreased significantly from pre-op to post-op and at 3, 6, 9 and 12 months' follow up, none of the patients reported it. A significant decrease in the mean of VSB and VSL was reported at post-op, 3, 6, 9 and 12 months. The ODI score also decreased significantly at post-op, 3, 6, 9 and 12 months.

Conclusions: PLIF with interbody fusion and local graft with posterior instrumentation gave significantly improved clinical and functional outcomes by significantly reducing pain, as determined by the VAS scores for back and leg pain.

Clinical and radiological outcome of minimally invasive plate osteosynthesis in distal tibial fractures: a retrospective analysis

Mahantesh Magadum — 2025-04-25

Background: Distal tibial fractures are a common injury that poses challenges in terms of treatment and outcomes. Minimally invasive plate osteosynthesis (MIPO) has emerged as a promising technique, reducing the need for large incisions while promoting faster recovery and fewer complications compared to traditional open reduction and internal fixation (ORIF). This study evaluates the clinical and radiological outcomes of MIPO in patients with distal tibial fractures.

Methods: A retrospective analysis of 40 patients who underwent MIPO for distal tibial fractures between November 2022 and November 2024 at a Tertiary healthcare center, was conducted. Fractures were classified according to the AO/OTA system. Outcomes such as fracture healing, functional recovery (measured using the AOFAS score), pain relief (assessed via the VAS), and complication rates were evaluated. Statistical analysis was performed using SPSS version 25, with p<0.05 considered significant.

Results: The mean age of the patients was 42.5±12.3 years. The majority of fractures were classified as type 43-A (70%). Fracture healing was achieved in 95% of cases by 24 weeks, with a mean time to union of 14.3±3.2 weeks. The AOFAS scores improved significantly from 72.5±13.1 at 6 weeks to 85.2±10.3 at 12 weeks (p<0.05). Pain reduction was also significant, with VAS scores decreasing from 6.25±2.14 at 6 weeks to 1.56±1.26 at 24 weeks (p<0.05). Complications were noted in 10% of cases, including superficial infection and delayed union.

Conclusions: MIPO offers favourable outcomes in the treatment of distal tibial fractures, with significant improvements in fracture healing, functional recovery, and pain reduction. The technique is associated with a low complication rate, making it a viable option for managing these fractures.

Clinical and radiological outcome of wide enbloc laminectomy with subaxial lateral mass screw fixation in patients of cervical spondylotic myelopathy with ossification of posterior longitudinal ligament: a prospective observational study

Lokendra Singh Chauhan — 2025-04-25

Background: Data evaluating the clinical and radiological outcome of wide enbloc laminectomy with sub-axial lateral mass screw fixation in patients of cervical spondylotic myelopathy with ossification of posterior longitudinal ligament (OPLL) is scanty in the literature.

Methods: This is a prospective observational study aimed to know the clinical and radiological outcome of wide enbloc cervical laminectomy with sub-axial lateral mass screw fixation in patients of cervical spondylotic myelopathy associated with OPLL. A total of sixty patients were included in our study who underwent wide enbloc cervical laminectomy and sub axial lateral mass screw fixation and were followed up to 1 year postoperatively. Modified Japanese orthopedic association (MJOA) score was used for functional outcome calculation, which was done at 1 month, 3 months, 6 months and 1 year postoperatively. We used C2-C7 Cobb’s angle as parameter of cervical alignment on lateral radiograph of cervical spine, modified Singh’s grading was used to asses cord compression on cervical spine MRI.

Results: There was significant improvement in MJOA score from preoperative (12.2) to one year postoperative (15.7). The mean improvement in MJOA was 3.5 points. The average neurological recovery rate was 60.34%. Overall, 90% patients showed improvement in MJOA score. Cervical alignment is maintained from preoperative 15 degree to postoperative 14.3 degree. The average decrease in cobb’s angle was 0.7 degree and cord compression value improved from preoperative 2.7 to postoperative 0.4 according to modified Singh’s grade.

Conclusions: Wide enbloc cervical laminectomy with sub-axial lateral mass screw fixation is a safe and effective treatment of multilevel cervical spondylotic myelopathy associated with OPLL providing a good functional outcome, maintaining adequate cervical alignment postoperatively.

Study of functional and radiological outcome of percutaneous bridge plating of extra articular fibula fracture for management of distal tibia type III open fracture

Abhishek R. — 2025-04-25

Background: Fractures of the distal tibia account for 7 to 9% of lower extremity fractures, with the fibula fractured in about 85% of these cases. Management of fibula fracture in the distal third fracture setting is essential as it facilitates the reduction of tibia fracture. The management of distal third tibia and fibula fracture vary from intramedullary nail in the tibia fracture and plating for the fibula fracture to dual plating with minimally invasive percutaneous plate osteosynthesis (MIPPO) in the Tibia and fibula and depending on local tissue condition. This study aimed to evaluate the outcome of percutaneous bridge plating of fibula fracture in the setting of concomitant open type III distal tibia fracture.

Methods: A prospective clinical study of patients with distal tibia type III open fractures with extra-articular fibula fractures at the department of orthopaedics, SMS medical college, Jaipur, Rajasthan, India from June 2023 to May 2024 were subjected to percutaneous bridge plating for the fibula with appropriate management for the tibia fracture, Outcomes assessed using the lower extremity functional scale (LEFS), proportional length difference, talocrural angle, and fracture healing. Complications post-surgery was also evaluated.

Results: Studies have shown that appropriate fixation of the fibula aids in the reduction and stabilization of tibial fractures, improving overall outcomes. The use of percutaneous bridge plating offers benefits in terms of soft tissue preservation and mechanical stability.

Conclusions: The treatment chosen and the outcomes after a fracture seem to be satisfactory. Further studies and detailed analyses are required to establish long-term benefits and compare with other fixation methods.

Evaluation of the Ganga Hospital score in predicting outcomes of open tibial fractures

Patil Manoj Mantesh — 2025-04-25

Background: Open tibial fractures, commonly caused by high-energy trauma, are associated with significant morbidity due to the bone’s subcutaneous location and role as a weight-bearing structure. The Ganga Hospital open injury severity score (GHOISS) is a tool used to assess the severity of open fractures and predict outcomes such as limb salvage or amputation, especially in resource-limited settings. Aim of the study was to evaluate the effectiveness of the GHOISS in predicting the outcomes of open tibial fractures.

Methods: This cross-sectional analytical study included patients with open tibial fractures admitted to the hospital. GHOISS was used to assess injury severity and predict the need for limb salvage or amputation. Functional outcomes were evaluated using the lower extremity functional score (LEFS). Data on injury mechanisms, fracture classification, treatment methods, and outcomes were collected and analysed.

Results: The GHOISS was found to be highly reliable in predicting outcomes. Lower GHOISS scores were associated with better functional outcomes and higher rates of limb salvage, while higher scores correlated with increased likelihood of amputation. LEFS scores correlated well with GHOISS, supporting its clinical validity.

Conclusions: The GHOISS is an effective tool for predicting the outcomes of open tibial fractures, improving clinical decision-making and patient management. It can lead to better functional outcomes and more efficient allocation of healthcare resources, particularly in resource-limited settings.

Functional and radiological outcomes of Madelung and Madelung-like deformities corrected with corrective osteotomies of radius with or without ulnar shortening

Parakh Dhingra — 2025-04-25

Background: Madelung deformity results from a bony and ligamentous dysplasia at the wrist, leading to palmar displacement of the hand on a shortened, bowed forearm. It is commonly associated with dorsal subluxation and prominence of the ulnar head, which collectively contribute to restricted wrist range of motion.

Methods: This study included 15 patients diagnosed with Madelung and Madelung-like deformity, with a mean age of 15 years (range: 10–21 years). All patients underwent clinical and radiographic evaluations. Various surgical techniques were employed, including dorsolateral closed-wedge osteotomy, open-wedge osteotomy, and dome osteotomy. Functional outcomes were assessed using the Modified Mayo wrist score, both pre- and post-operatively.

Results: Postoperative analysis revealed statistically significant improvements in wrist range of motion, pain relief, grip strength, radial inclination, and carpal slip. The modified Mayo wrist scores also demonstrated significant postoperative improvement.

Conclusions: Our findings suggest that surgical intervention plays a pivotal role in restoring wrist function by enhancing range of motion, increasing grip strength, and alleviating pain, ultimately contributing to improved functional outcomes and patient quality of life.

Mid-term functional and structural analysis arthroscopic single-row repair in full thickness rotator cuff tear

Jaimeen P. Jesalpura — 2025-04-25

Background: Purpose is to analyse functional scores and structural integration of cuff in Full thickness cuff tear patients treated with single row Arthroscopic rotator cuff repair (SR-ARCR) making it cost effective surgery in developing countries. Additionally, evaluation of Fatty atrophy, Glenohumeral arthritis, importance of subscapularis repair and role of biceps tenotomy was done.

Methods: 60 rotator cuff repairs with minimum 12 months follow-up and all treated by SR-ARCR. Functional Assessment by Constant Murley Score (CMS), UCLA score and structural assessment by Sugaya grading.

Results: Mean follow-up 35.93± 26.24 months with post operative mean constant murley (CMS) was 94.83±7.78 (p<0.001), mean UCLA 33.82±6.7 (p<0.001). Active forward flexion (AFF) 166.5±11.62(p<0.001), External rotation 79.17±10.13 (p<0.001), Muscle strength (0-25) 22.78±3.32(p<0.001), VAS 1.2±0.75(p<0.001), restoration of Acromio-humeral-distance (AHD) to 8.8±1.79(p<0.001). Sugaya 1(85%) having CMS 97.06±5.21 (p<0.001), Sugaya 2(10%) having CMS 82.67±9.42(p<0.001), Sugaya 3 (5%) having 81.33±6.35 (p<0.001).

Conclusion: Single row arthroscopic rotator cuff repair offers excellent outcomes cost effectively by reducing number of anchors and with supervised physiotherapy and rehabilitation protocols. Good structural integration of rotator cuff ensures better functional outcomes. Repair of Subscapularis to balance force couple, biceps tenotomy to decrease pain and medialised repair to decrease tension of repaired cuff improves functional scores. Restoration of acromio-humeral-distance decreases progression of gleno-humeral arthritis.

Comparative analysis of proximal humerus internal locking system plating and external fixation in proximal humerus fracture management: a prospective study on functional outcomes

Chetan Kothari — 2025-04-25

Background: The management of proximal humerus fractures presents challenges due to their intricate anatomy and varied fracture patterns in NEER’S type 3,4. This prospective study aimed to compare functional outcomes between proximal humerus internal locking system (PHILOS) plating and external fixation ((UMEX).

Methods: Fifteen patients in each group, classified as NEER type 3 and 4 fractures were included. Patient demographics showed no significant age or gender differences between the groups. Patients’ selection was randomized.

Results: Functional assessment using disabilities of the arm, shoulder, and hand (DASH) scores revealed superior outcomes in the external fixator group at 6 weeks (55.54±6.50 vs. 50.50±6.10), 3 months (66.91±5.34 vs. 61.67±7.08), and 6 months (77.83±2.79 vs. 65.29±5.15), with significant differences observed (p=6 weeks: 0.0370, 3 months: 0.0299, 6 months: <0.0001). Similarly, visual analogue score (VAS) scores demonstrated lower postoperative pain levels in the external fixator group at 6 weeks (2.85±1.21 vs. 4.14±1.10) and 6 months (0.33±0.52 vs. 1.00±0.58), with significant differences noted (p=0.0049 and p=0.0024). Furthermore, regarding range of motion, the external fixator group consistently outperformed the PHILOS group across all measured shoulder movements at 3 and 6 months, showing significant differences (abduction: p=0.0127, extension: p<0.0001, external rotation: p=0.0004, internal rotation: p=0.0002, flexion: p<0.0001).

Conclusions: These findings underscore the potential superiority of external fixation in achieving better clinical outcomes, lower pain levels, and improved range of motion compared to PHILOS plating in proximal humerus fracture management.

A comparative study of plating versus interlocking nail in fracture shaft humerus

Priyanka Mise — 2025-04-25

This study is to compare the outcomes of each method of fixation i.e. plating and interlocking nailing for the patients with fracture shaft of humerus and to analysis statistically significant difference in the results of these two methods conducted during October 2020 to September 2022 among 20 patients who satisfied the inclusion criteria and exclusion criteria, follow up was done up to 9 months. The study of 20 patients of humerus shaft fracture fixed either with plate or interlocking nail showed postoperatively in the plating group there were 2 complications and in the interlocking group there were 6 cases with complications, healing rate is found to be good in the plating maximum time taken is ≤17 weeks and while interlocking more than half cases took ≥17 weeks, the average disabilities of the arm, shoulder and hand (DASH) score in the plating group was 19.8 and in the interlocking group it was 44.6, among the 20 patients 5 had excellent results, 8 had good results, 5 had fair results, 2 had poor results. We conclude that both the modalities of treatment i.e., plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the functional outcome and rate of complications, we are of the opinion that plating offers better result than interlocking nailing with respect to pain and function of the shoulder joint.

Reviving mobility: conversion arthroplasty as a solution for failed proximal femur fixation

Utkarsh Tiwari — 2025-04-25

Proximal femur fractures are very common both in young and old age group and are usually managed surgically. In case of failed fixations, young patients are managed with subsequent attempts of osteosynthesis to achieve union and maintain integrity of femoral head. However, in case of elderly patients, arthroplasty of hip joint may be considered keeping in mind the poor bone quality, loss of bone or injury to the articular cartilage. This study is aimed to assess the outcomes and consequences of conversion arthroplasty following unsuccessful fixation of intertrochanteric fractures. We report 3 cases of proximal femur fixation, who were initially managed with intramedullary nailing subsequent to trauma. But patients post operatively developed complications like implant failure, non-unions and post traumatic arthritis of hip for which conversion arthroplasty was done as a rescue procedure following failed fixation.

Low back pain: shifting the paradigm from non-specific to specific

Oluwasegun A. Aremu — 2025-04-25

Low back pain is a leading cause of disability worldwide and it imposes huge economic burden on affected individuals and the government. It can be broadly classified into specific and non-specific low back pain. Non-specific low back pain constitutes about 90% of all low back pain, and it is now a leading cause of years lived with disability. The present review aims to describe the evolution of the term non-specific low back pain, to show that the term may no longer be appropriate and to propose hypothesis that can explain low back pain in general. A review of the literature shows that several terms have been used to describe non-specific low back pain. Examples of such terms are mechanical low back pain, and idiopathic low back pain with few inconsistencies in the usage of the term. The term, non-specific low back pain, became widely accepted after introduction of the concept “diagnostic triage” by Waddell in 1994. The concept classified low back pain into specific, radicular syndrome and non-specific. As explained by Waddell, only radicular syndrome and specific types of low back pain require further diagnostic evaluation. This has been the practice ever since. Recent evidence from MRI findings of symptomatic and asymptomatic individuals however, suggest that diagnostic evaluation, coupled with specific provocation tests can lead to specific diagnosis of low back pain in majority of the cases. Based on these recent evidences and others, it can be hypothesized that low back pain is a spectrum of disease with a specific cause.

The role of matrix rhythm therapy in managing and breaking tissue adhesions

Arif Rizvi — 2025-04-25

This article explores the potential of Matrix Rhythm Therapy (MRT) in addressing tissue adhesions, focusing on its relevance as a non-invasive and effective treatment modality. A systematic review of current literature was conducted using databases such as PubMed, Scopus, and Web of Science. Search terms included "Matrix Rhythm Therapy," "tissue adhesions," "non-invasive treatments," and "mobility improvement." MRT demonstrates promising results in breaking tissue adhesions, improving mobility, and reducing pain by restoring cell matrix dynamics and tissue elasticity. MRT represents a viable adjunct or alternative to conventional treatments for tissue adhesions. Further research is required to standardize protocols and validate its efficacy across diverse clinical scenarios.

The hidden integration: J-sign patella as a predicting indicator for knee osteoarthritis and its therapeutic implications

Aavrati Rastogi — 2025-04-25

The J-sign patella is an erroneous movement or tracking of the patella during knee movement, particularly when moving laterally during knee flexion, which can be symptomatic of patellar malalignment or instability, essential in developing and progressing knee osteoarthritis (KOA). The study aimed to determine the clinical significance of the J-sign patella as a diagnostic and prognostic tool in patients with KOA. The objective of this study was to comprehensively evaluate the clinical and pathophysiological importance of the J-sign patella in the onset, progression, and management of KOA, with a particular emphasis on its diagnostic, prognostic, and therapeutic implications. A systematic search was conducted to discover all relevant studies on the J-sign patella and its relation to the OA knee. Databases such as PubMed, Cochrane Library, and Scopus were used. A few research studies show the clinical significance of addressing J-sign patella in treating KOA.