International Journal of Research in Orthopaedics <p>International Journal of Research in Orthopaedics is an open access, international, peer-reviewed journal that publishes original research work across all disciplines of orthopaedics and allied sciences. The journal's full text is available online at The journal allows free access to its contents. The journal aims to provide a platform for the exchange of information about all areas of orthopaedics and to promote the discipline of orthopaedics throughout the world. International Journal of Research in Orthopaedics is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new techniques. It is published every two months and available in print and online version. International Journal of Research in Orthopaedics complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email: <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></strong></p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix: 10.18203</strong></p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Research in Orthopaedics accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>About the Journal &gt; <a title="Online Submissions" href="" target="_blank" rel="noopener">Online Submissions</a></p> <p>Registration and login are required to submit items online and to check the status of current submissions.</p> <p>Please check out the video on our YouTube Channel:</p> <p>Steps to register and submit a manuscript:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>Problem Logging In-Clear cookies:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p> </p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Res Orthop.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The journal is indexed with </p> <p><a title="PubMed and PubMed Central (PMC)" href="" target="_blank" rel="noopener">PubMed and PubMed Central (PMC)</a> (NLM ID: 101775784, Selected citations only), </p> <p><a title="Scilit (MDPI)" href="" target="_blank" rel="noopener">Scilit (MDPI)</a>, </p> <p><a href=";journalId=44185" target="_blank" rel="noopener">Index Copernicus</a>, </p> <p><a title=";referer=brief_results" href=";referer=brief_results" target="_blank" rel="noopener">OCLC (WorldCat)</a>,</p> <p><a href="" target="_blank" rel="noopener">CrossRef</a>, </p> <p><a title="LOCKSS" href="http://localhost/index.php/ijoro/gateway/lockss" target="_blank" rel="noopener">LOCKSS</a>, </p> <p><a href="" target="_blank" rel="noopener">Google Scholar</a>,</p> <p><a href="" target="_blank" rel="noopener">ICMJE</a>, </p> <p><a href="" target="_blank" rel="noopener">J-Gate</a>, </p> <p><a title=";subAction=pub&amp;publisherID=3072&amp;journalID=37625&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" href=";subAction=pub&amp;publisherID=3072&amp;journalID=37625&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" target="_blank" rel="noopener">JournalTOCs</a>,</p> <p><a href="" target="_blank" rel="noopener">ResearchBib</a>.</p> Medip Academy en-US International Journal of Research in Orthopaedics 2455-4510 Revealing the therapeutic potential of teriparatide: a review <p>Teriparatide is an FDA-approved medication for osteoporosis that presents promising results in treating various musculoskeletal conditions. It helps in improving the bone mineral density and preventing fractures in individuals with osteoporosis. Its effectiveness in treating non-union and delayed union fractures, atypical femoral fractures, and spinal fusion procedures makes it valuable in improving bone healing and reducing complications. Teriparatide also improves bone density and strength in individuals with osteogenesis imperfecta, helps prevent and treat hypocalcaemia post-thyroidectomy, and helps in the management of hypoparathyroidism. In MRONJ, teriparatide improves lesion resolution and reduces bony defects. Furthermore, it potentially prevents bone metastasis in cancer patients without stimulating tumour growth. Nevertheless, teriparatide may cause short-term side effects like nausea and long-term concerns pertaining to the risk of osteosarcoma. Recent European alliance of associations for rheumatology guidelines have highlighted teriparatide's superior effectiveness in achieving bone mineral density thresholds and reducing fracture risks. Further clinical trials are necessary to determine optimal dosages and treatment durations of teriparatide. The off-label use of teriparatide should be considered only under the guidance of a healthcare professional when standard options are unavailable or inadequate.</p> Sushant Srivastava Arvind Kumar Vishal Kundnani Amit Ajgaonkar Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 704 710 10.18203/issn.2455-4510.IntJResOrthop20241128 Advances in stem cell therapy for articular cartilage lesions: clinical evidence and future directions: a systematic review <p>The significance of articular cartilage, an essential connective tissue, cannot be overstated in relation to joint health and functionality. Nevertheless, the human body might have adverse effects due to traumatic incidents, degenerative conditions, or repetitive stress, resulting in the manifestation of pain, inflammation, and impaired functionality. The primary objective of this study is to assess the effectiveness of stem cell therapy in the treatment of articular cartilage damage such as lesions. The systematic review was conducted adhering to the PRISMA principles. Boolean logic is employed in the search technique to integrate phrases pertaining to stem cell therapy, articular cartilage diseases, and biological processes. The research employs a range of databases and medical subject headings (MeSH) in order to facilitate a thorough examination. The stem cell therapy in the treatment of articular cartilage lesions has great potential. It enhances management and treatment outcomes for individuals afflicted with cartilage abnormalities. It is beneficial particularly those diagnosed with osteoarthritis (OA). Encouraging outcomes, such as alleviation of pain and improvement in functionality have been reported. Additional investigation is required to enhance therapy regimens, encompassing cell dosage, delivery techniques, and supplementary medicines. The use of stem cell therapies necessitates the imperative collaboration among researchers, doctors and regulatory agencies.</p> Kevin Miranda Suárez Claudia Anabel Pesantez Zea Mateo Daniel Fabara Vera Bryan Steven Pasquel Rodríguez Andrea Janet Zambrano Garces Erick Santiago Velastegui Jijón Angel Eduardo Romo Quintana Katherine Lizeth Bautista Suárez Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-06 2024-04-06 10 3 647 654 10.18203/issn.2455-4510.IntJResOrthop20240935 Calcaneus stress fracture: a case report <p>Calcaneal stress fracture is a rare clinical entity associated with diverse etiological factors such as high intensity training, female sex, smoking and poor nutrition. The authors present a case of a calcaneal stress fracture treated conservatively with immobilization, limited weight bearing and vitamin D supplementation.</p> <p> </p> Sonia M. Rodrigues Raquel P. Marques Ricardo C. Teixeira Pedro Chaves Catarina Rodrigues Amilcar Valverde Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-12 2024-04-12 10 3 665 667 10.18203/issn.2455-4510.IntJResOrthop20240946 Extra skeletal chondroma a rare presentation in the big toe of a pediatric patient: a case report <p>Extra-skeletal chondroma is a rare benign tumor of juxta-articular soft tissues rarely seen in pediatric cases. It is formed mainly of hyaline cartilage and presented as a painless swelling. It is not well evident on conventional X-rays radiography. MRI is the preferred diagnostic modality. Surgical excision is the recommended form of treatment for symptomatic cases. We are reporting a case of this rare tumor in the big toe of a child.</p> Maged Mostafa Ahmed R. Khamis Omar Aljeeran Waleed Yusuf Saqer Mohamed Almasry Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 668 671 10.18203/issn.2455-4510.IntJResOrthop20241119 Chondral lesion of the patella in a junior football player: chondral-only fragment fixation <p>Chondral lesions of the patella are a relatively common pathology that can cause pain and impairment in active young individuals. These lesions can have lifelong consequences, with increased risk of osteoarthritis in some cases. Surgical excision of medium to large fragments is associated with poor long-term outcomes. There is a general belief that fixation of purely chondral lesions in the absences of subchondral bone is associated with low integration rates, however recent case reports and basic science studies have been challenging this belief. In this case report, we describe a young patient with a chondral lesion of the patella and a fragment without subchondral bone, who underwent open fragment reduction and fixation using bioabsorbable pins. The patient had a successful outcome with significant fast improvement in pain and function and full return to practice. This case highlights the potential benefits of conservative surgical management with preservation of the native cartilage, even in the absence of subchondral bone, especially in the young active patient.</p> <p> </p> Emanuel C. Seiça Lucas Armada Joana Canhoto Hugo Vaz dos Santos Rui Viegas Luís Barbosa Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 672 675 10.18203/issn.2455-4510.IntJResOrthop20241120 Floating total knee: periprosthetic fracture of the distal femur combined with tibial plateau fracture in primary total knee arthroplasty <p>We are currently witnessing an increasing number of complications associated with arthroplasty, both due to its greater prevalence, whether primary or revision, and to the population's longer average life expectancy. Periprosthetic fractures associated with a floating knee, in the context of total knee arthroplasty, are rare and their treatment is challenging. We present a case of ipsilateral periprosthetic fracture of the distal femur combined with fracture of the tibial plate in total knee arthroplasty. The 80-year-old female patient was admitted to the emergency department after falling from her own height at home. She reported diffuse pain in her right knee and associated functional incapacity. The limb was stabilized and immobilized in a posterior long leg splint. Initial X-rays showed an ipsilateral periprosthetic fracture of the distal femur and medial tibial plate. The patient's only previous surgery was a total right knee arthroplasty performed in 2020. She underwent surgical treatment with osteosynthesis of the distal femur with a locked anatomical plate and arthroplasty revision of the tibial component. Periprosthetic fractures associated with knee arthroplasty typically involve the distal femur. Fractures involving the tibia are rare and usually occur in the medial tibial plate, in the presence of detachment of the tibial component. There is little published literature on this type of fracture in elderly patients. Periprosthetic fractures in total knee arthroplasty require individualized and planned treatment according to the personality of each fracture and the existence or not of prosthetic detachment.</p> Goncalo Modesto João Pires João Mendes João Seixas Carlos Alegre João Oliveira Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 676 679 10.18203/issn.2455-4510.IntJResOrthop20241121 Case report of a new technique for with posterior cruciate ligament avulsion fractures treated with a mini transverse incision <p>Posterior cruciate ligament (PCL) is a strong stabilising ligament of the knee joint originating from posterior part of Intercondylar eminence oof tibia and attaches to the anterior part of medial surface of lateral condyle of femur. The PCL plays a major role in knee stabilization, and are statistically one of the rarest injuries around the knee. Due to the surrounding neurovascular elements in the popliteal space, very few open approaches to repair such injury were performed. The ‘‘safe transverse mini-incision approach’’ to PCL avulsion fracture is a simple approach, does not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients.</p> Bhaskar Shetty Kuknadu Anvith S. Shetty Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 680 684 10.18203/issn.2455-4510.IntJResOrthop20241122 A case of primary skeletal muscle lymphoma mimicking cellulitis <p>Primary skeletal muscle lymphoma is a rare entity. Their presentation can be easily confused with a wide variety of inflammatory conditions, neoplasia as well as infectious diseases. We came across a 65-year-old lady who presented to us with complains of pain and swelling in the right thigh, leg and foot and fever-on and off for 20 days. She was initially managed elsewhere on the line of cellulitis with incision and drainage of right leg 15 days back but there had been no clinical improvement. We took her detailed history and examined her thoroughly. Relevant blood investigations were sent. However, the clinical examination findings and history were suggestive of an infective cause, blood investigations were suggestive of an acute inflammatory pathology, whereas radiological investigations (NCCT and X-ray) and cytological investigations (FNAC) which were performed at the previous place of treatment were inconclusive. We then did a CE-MRI of the right lower limb which showed centrally necrotic, enhancing mass lesion involving peroneal muscles with multiple enlarged inguinal and popliteal lymph nodes. Based on this finding, biopsy was performed and specimen was sent for histopathological examination which revealed “malignant small round cell tumor”. Immunohistochemistry was then done and tumor cells were found to be positive for vimentin, LCA, CD20 and negative for PANCK and CD3. Based on the above findings it was diagnosed as “non-hodgkin’s lymphoma (NHL) B-cell type” of right leg. Considering the confusing clinical presentation of this entity and inconclusiveness of blood and basic radiological investigations, lesions of extremities presenting with features of cellulitis must be carefully assessed.</p> <p> </p> Alok Sahu Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 685 688 10.18203/issn.2455-4510.IntJResOrthop20241123 Tibial tuberosity fracture in adult as an unusual pattern of injury <p>Tibial tuberosity avulsion is an uncommon fracture in adults, such lesions typically seen in adolescent male with well-developed quadriceps, ligaments when they are stronger than growth plate. We described a case of 51-year-old gentlemen had direct trauma to left knee, no risk factors were identified, not able to walk, difficulty in straight leg raise test, radiograph of left knee showed tibial tuberosity avulsion fracture. The fracture was treated with open reduction and internal fixation, f/u with successful rehabilitation which results in good range of motion and excellent function at knee joint. The aim of study is present unusual and rare case of tibial tuberosity Avulsion fracture in adult, early diagnosis, surgical mode of treatment, post-surgery rehabilitation and possible complications.</p> Mohit H. Jain Kartik P. N. Nandhini Iyer Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 689 692 10.18203/issn.2455-4510.IntJResOrthop20241124 One year old misdiagnosed penetrating injury of sacrum with a retained knife: a case report and review of literature <p>Penetrating injuries to the spine, although less common than blunt trauma from motor vehicle accidents, are important causes of injury to the spinal cord. They are essentially of two varieties-gunshot or stab wounds. Gunshot injuries to the spine are more commonly described and are associated with a higher incidence of neurological damage. On the contrary, the prognosis is better in stab wounds where surgery plays a greater role. Here we report a case of a 31 year old male with a history of penetrating injury with knife in lower back 1 year ago comes with complaints of pain and pus discharge since 2 weeks. On detailed history taking, clinical examination and investigations it was found that knife was left <em>in situ</em> which was causing symptoms. Surgical exploration was done. Foreign body (knife) was removed keeping all the neurovascular complications in check. Post operatively patient is doing good with no neurological deficits. A timely intervention in removing foreign body is necessary for preventing for complications.</p> Anand Kumar Umesh Kumar Meena Ram Prasad Meena Ekaansh Karir Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 693 696 10.18203/issn.2455-4510.IntJResOrthop20241125 Functional outcome in case of surgically and conservatively treated bilateral distal end radius and scaphoid fracture: a rare case report <p class="Body" style="text-align: justify;">Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Proper preoperative evaluation is a must to know the orientation of the fracture. Treatment must be based on displacement of the fracture. If fracture is displaced, internal fixation is needed but if its stable with minimal displacement, we can conserve it. A patient with displaced distal radius fractures and displaced scaphoid fracture on one side, along with displaced distal end radius fracture and undisplaced scaphoid fracture on the other side, was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating on the right side and below elbow cast in cup holding position on the left side which was non-dominant. The approach to treating fractures hinges on several factors: the specific location and alignment of the fracture, the patient's characteristics, and the surgeon's expertise. For fractures in the distal radius and scaphoid, employing a rigid internal fixation method allows for the early initiation of active wrist rehabilitation, eliminating the necessity for wrist immobilization using a plaster cast or external skeletal fixation. On the other hand, a conservative treatment approach involving a below-elbow cast offers certain advantages, such as minimal blood loss and fewer complications related to wound healing, particularly for undisplaced fractures, especially when they occur in the non-dominant hand.</p> <p class="Body"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif';"> </span></p> Amey Sadar Mainak Roy Deepanjan Das Suhas Aradhya Bhikshavarthi Math Samir Dwidmuthe Saurabh Sah Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 697 699 10.18203/issn.2455-4510.IntJResOrthop20241126 Chondroblastoma of the anterior process of calcaneus: a case report <p>Chondroblastoma of the calcaneus is a fairly uncommon tumour. Despite being a benign and indolent lesion, chondroblastoma of the calcaneus can lead to functional limitations, due to its location in such a weight-bearing bone. This report presents a rare case of chondroblastoma affecting the anterior process of the calcaneus, which was successfully treated with extended curettage and synthetic bone graft substitute, resulting in favourable functional outcomes at 13 months post-surgery. This case underscores the importance of timely recognition and appropriate management of this uncommon tumour to achieve optimal patient outcomes.</p> Manjunath Nishani Tarkik Thami Tarvinder Singh Siddhartha Singh Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 700 703 10.18203/issn.2455-4510.IntJResOrthop20241127 Functional outcome of patients presenting with isolated medial condyle fractures of femur in a tertiary care hospital <p>Isolated medial condyle fractures of the femur with an intact lateral condyle are a rare entity. These fractures require prompt diagnosis and anatomical restoration of joint surface to prevent post traumatic arthritis. Till date no suitable implant is available for fixation of these fractures. In this study we have used 4.5 recon plates and CC screws to fix these fractures. We aim to study the functional outcome of these fractures in a group of patients fixed with the above implants. The study was conducted in a group of patients presenting with isolated medial condyle fractures of femur in a tertiary care hospital. An ORIF was done and fractures were fixed with recon plates and lag screws and various parameters were evaluated such as range of motion of knee, average time to weight bearing, Lysholm knee scores, pain perception etc 20 patients were evaluated in the age group of 20-70 in a 5 year period. Majority of the patients had a very good functional range of motion of the knee and nearly 75% achieved union by 12-16 weeks. 70% of the patients had a low VAS score. Overall early diagnosis and prompt anatomical restoration of joint surface in isolated medial condyle fractures of femur led to favourable range of motion of knee, early radiological healing and low VAS score.</p> Gourab Bose Rahul Roy Saptarshi Mukherjee Sunandan Datta Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 655 658 10.18203/issn.2455-4510.IntJResOrthop20241117 The study of outcome in fractures of proximal third of tibia in adults treated by expert tibia nail <p>This study aims to evaluate the clinical, functional outcome and complications of fracture proximal third of tibia treated with expert tibia nail in terms of radiological union, functional outcomes by short form -36 (SF-36) score, Johner and Wruhs criteria, visual analogue score and patient satisfaction score. Twenty-five patients with fracture proximal third of tibia treated with expert tibia nail in SNMC and HSK hospital and research centre, Bagalkot were enrolled in this study. The radiological union was assessed by plain radiograph and functional outcome by SF-36 score, Johner and Wruhs criteria, visual analogue score and patient satisfaction score. The radiological union was achieved in all the patients between 14 to 26 weeks duration (mean of 19.6±2.82 weeks). The mean SF-36 score was 84.9±4.06 and the mean visual analogue score was 2±1.78 at the 22<sup>nd</sup> week of follow-up. Results based on Johner and Wruhs criteria, 17 patients had excellent, 6 had good, 1 had fair and 1 had poor results. The average patient satisfaction score was 8.88 out of 10. There were 8 cases of post-operative knee pain, 5 cases of infection, 2 cases of malunion, 1 case of shortening and 1 case of the delayed union in our study. Intramedullary fixation with expert tibia nail for fracture proximal third tibia is a safe and less invasive technique. The radiological union was achieved in all the cases. This technique ensures excellent functional outcomes and a low incidence of complications.</p> Darshan B. Abhijeet Vijayanand Bedge Naveen M. Belaval Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 659 664 10.18203/issn.2455-4510.IntJResOrthop20241118 Current status of graft choice in adults for anterior cruciate ligament reconstruction: a systematic review and meta-analysis <p>The anterior cruciate ligament (ACL) is a frequently performed surgical procedure in the field of sports medicine, and graft selection is an essential aspect of ACL reconstruction (ACLR) that has been shown to optimize post-operative rehabilitation, facilitate return to full sporting function and reduce the risk of complications. However, there needs to be more agreement regarding optimal graft choice. The present study aims to identify the optimal graft choice in the adult population undergoing ACLR. The current systematic review explores the electronic database of online libraries of academic institutions from 2011 to 30 September 2022 and compared the clinical outcomes of autograft and allograft for ACLR, which provides an evidence-based approach for graft selection. The findings of our present study delineate that ACLR in adult populations with autograft is the most promising choice for ligament tear over allograft based on lower failure rate, reduced complications, and high cost-effectiveness. However, there was no significant difference in overall IKDC, pivot shift, Lachman test, and Tegner activity. This critical analysis recommends that for an adult population, ACLR with autograft can provide better clinical results than an allograft, but further studies carried out about other parameters affecting the long-term stability, quick return, and physical therapy adopted outside the supervision of the respective surgeon would be required.</p> Mahantesh Magadum Joshua Smith Karl J. New Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-03-08 2024-03-08 10 3 639 646 10.18203/issn.2455-4510.IntJResOrthop20240673 The use of arthroscopy in diagnosing and treating sports-related cartilage lesions <p><strong>Background:</strong> Sports-related cartilage lesions pose challenges for athletes. Cartilage, vital for smooth joint movement, can be damaged. Arthroscopy, a minimally invasive procedure, allows precise diagnosis and treatment of joint issues, offering quicker recovery and minimal scarring, enhancing orthopedic interventions. This study aimed to assess the use of arthroscopy in diagnosing and treating sports-related cartilage lesions.</p> <p><strong>Methods:</strong> This prospective observational study was conducted at the department of orthopaedics and traumatology, Life Line Hospital Moulovibazar, Mount Adora Hospital Sylhet, MAG Osmani Medical College Hospital Sylhet, Bangladesh from January 2022 to December 2023. As the study subjects, a total of 58 patients with non-surgically treated acute or chronic sports-related cartilage lesions were enrolled by using a purposive sampling technique. After 6 months, a follow-up report was recorded. Data were analyzed by using Microsoft Office tools.</p> <p><strong>Results:</strong> In this study, 72% of participants underwent cuff repair, with the remaining 28% opting for loop repair. The arthroscopic assessment revealed anterior medial cartilage lesions in 34% and anterior lateral lesions in 28%. Posterior medial, posterior lateral, and mid-talus dome cartilage lesions were observed in 17%, 5%, and 16%, respectively. Capsule repair was employed in 86% of cases. Significant improvement in hip range of motion, as well as radiological parameters like lateral center-edge angle, alpha angle (anteroposterior), and alpha angle (Dunn), was observed 6 months postoperatively (p&lt;0.001).</p> <p><strong>Conclusions:</strong> In detecting and treating sports-related cartilage lesions, arthroscopy is an effective method. This minimally invasive less painful treatment approach contributes to faster rehabilitation and a quicker return to normal activities.</p> Abdullah Al Mamun Abdullah Al Muti M. Moniruzzaman Monir Abdul Hannan M. Mofizur Rahman Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 497 501 10.18203/issn.2455-4510.IntJResOrthop20241099 Functional outcome of diaphyseal fractures of forearm in children treated with titanium elastic nailing system <p><strong>Background: </strong>Forearm fractures are common injuries in children, with diaphyseal fractures of the forearm being among the most frequent injuries treated in the pediatric population. This study aimed to assess the functional outcome of diaphyseal fractures of the forearm in children treated with the titanium elastic nailing system.</p> <p><strong>Methods:</strong> This prospective observational study was conducted at the Department of Orthopaedics, Mainamoti Medical College, Cumilla, Bangladesh from January 2020 to December 2022. The study included 67 patients aged 6-15 with diaphyseal forearm fractures treated with the titanium elastic nailing system, selected through purposive sampling. MS Office tools were used for data analysis.</p> <p><strong>Results:</strong> According to the functional outcome criteria described by Price et al., it was observed that in the highest number of patients (86.56%), the functional outcome was excellent, followed by good, fair, and poor outcomes found in 8.96%, 2.99%, and 1.49% of the cases, respectively. As the postoperative complications, the delayed union was found among 4%, and skin infection was found among 3% of cases.</p> <p><strong>Conclusions:</strong> Considering the excellent outcomes and lower complication rate, the titanium elastic nailing system may be considered a very effective and safe treatment method for the management of diaphyseal fractures of the forearm in children.</p> Kazi Shahadat Hossain Abdullah Al Rafi Qaisur Rabbi M. Shoeb Mia M. Abdur Rouf Kawchar Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-06 2024-04-06 10 3 502 506 10.18203/issn.2455-4510.IntJResOrthop20240934 Outside in and all inside approach for repair of meniscal tears: post-operative subjective evaluation: a retrospective study <p><strong>Background:</strong> Assess clinical outcomes after using outside-in, all-inside or combination of both approaches for meniscal repair.</p> <p><strong>Methods:</strong> 86 patients with diagnosed meniscal tears, operated between January 2017 and January 2019 by one surgeon in Northway Clinic, Vilnius and Vilnius Clinical Hospital were surveyed. The meniscal repair techniques used included all-inside, outside-in, or a combination. Clinical outcomes were evaluated using the International Knee Documentation Committee Subjective Knee Evaluation Form, with meniscal retear indicating failure. Ethical approval was deemed unnecessary for this project. Descriptive statistical analyses were performed using IBM SPSS Statistics 29.01.</p> <p><strong>Results:</strong> Patients undergoing the outside-in approach scored 89.4±12.5 on the IKDC questionnaire, compared to 88.5±16.6 for all-inside and 82.8±20.3 for both techniques combined (p=0.194). Kaplan–Meier analysis showed a 5.6-year survival rate of 80.9% with the all-inside approach. Subjective knee function assessment indicated scores of 8.50±1.9 for outside-in, 8.49±1.4 for all-inside, and 8.16±1.95 for both techniques. Cox proportional hazards model analysis suggested that older age and higher BMI trended towards reduced reoperation risk (hazard ratio, 0.93 and 0.98; p=0.246 and p=0.832, respectively).</p> <p><strong>Conclusions:</strong> Self-reported outcomes in this study evaluated by IKDC questionnaire and subjective function assessment emphasize that both all-inside, outside-in or combination of the techniques provide similar results. All adverse outcomes defined as meniscal retears were observed using all-inside technique.</p> Barbora Dauderytė Gintarė Lukoševičiūtė Kęstutis Bliznikas Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 507 513 10.18203/issn.2455-4510.IntJResOrthop20241100 Complications of Ilizarov method treatment for infected nonunion femoral shaft fracture <p><strong>Background:</strong> Infected non-union of the femur is complicated by the involvement of soft tissue and bone, long-term resistant multi-bacterial infection, limb length discrepancy, deformities, joint stiffness, and multiple draining sinuses, and poses a challenge for orthopedic surgeons. This study aimed to analyze the complications of Ilizarov method treatment for infected non-union femoral shaft fracture.</p> <p><strong>Methods: </strong>This prospective observational study was conducted at the national institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh, from May 2018 to August 2020. A total of 20 patients were selected as study subjects by purposive sampling technique. All data were collected using a pre-formed questionnaire. Data were processed and analyzed using computer software program SPSS version 22.0.</p> <p><strong>Result: </strong>The mean bone gap created during the operation was 2.7±1.7 cm of them, in 12 (60%) patients, it was 0 to 2 cm, and in 8 (40%) patients it was more than 2 cm. The mean time needed for radiological union was 7.85±2.1 months ranging from 5 months to 11 months. In 10 (50%) patients, union was achieved within 4 to 7 months, and in 10 (50%) patients it was 8 to 11 months. Regarding limb length discrepancy, in 5 (25%) cases there was no limb length discrepancy (LLD). Twelve patients had 1 cm to 2.4 cm LLD and 3 (15%) patients had ≥2.5 cm LLD. The mean LLD was 1.2±0.9 cm. Regarding complications, in 10 (50%) cases, there was no complication and 10 (50%) patients had complications. The complications were pin tract infection in 7 (35%) patients and wire loosening in 3 (15%) patients.</p> <p><strong>Conclusions: </strong>The study concludes that while the Ilizarov ring fixator proves to be a dependable and successful method for stabilizing, correcting length discrepancies, and eliminating infections, it is not without its share of complications. The findings of this research indicate a 50% complication rate among the patients undergoing this treatment.</p> M. Zakir Hossain Manash Chandra Sarker M. Jahangir Alam Naima Ferdousi M. Abdul Gani Mollah Nazmul Huda Setu Raquib Mohammad Manzur Devolina Bhowmik Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 514 519 10.18203/issn.2455-4510.IntJResOrthop20241101 Characterization of the knee joint phenotype in the Portuguese population <p><strong>Background: </strong>Neutral constitutional alignment and neutral joint line obliquity has been the standard alignment strategy for total knee arthroplasty. This one-for-all measure may negatively impact gait pattern and knee biomechanics. Novel alignment strategies surged, considering the variability in phenotypes found across the literature, as different populations may present different phenotype distributions. The Portuguese population has a distinct genetic origin, with no phenotype distribution data. Our objective was to characterise the population’s knee morphology, searching and analysing adjacent joint osteoarthrosis, and calculating the pre-disease coronal alignment.</p> <p><strong>Methods: </strong>A retrospective cohort study was conducted. Full-length X-rays performed between 2016-2023 were analysed. Five alignment parameters were measured (LDFA, MPTA, JLCA, TJLA, HKA), and two parameters were calculated (aHKA, JLO). Knees were classified according to the CPAK classification.</p> <p><strong>Results: </strong>For the arthritic cohort, CPAK-I (23%) II (20%) were most common, aHKA increases as KL increases (r=0.8352; p&lt;0.001). For the healthy, Type-II (42%) and Type-I (15%) were most common. For paediatric, Type-II (43%) and Type-V (21%) were most common. CPAK Types-VII/VIII/IX were rare. Differences between genders for healthy and arthritic cohorts were statistically significant. The arthritic had higher prevalence of adjacent joint osteoarthritis.</p> <p><strong>Conclusions: </strong>The Portuguese population presents a similar knee phenotype comparing with other populations, some differences have been found regarding the Asian continent. The most common phenotype was a neutral alignment if either healthy or paediatric, or a varus alignment if knee OA. Coronal alignment may not have a major impact in the prevalence of ankle and hip osteoarthritis; however, higher prevalence is observed in patients with knee OA.</p> Emanuel Cortesao de Seica Lucas Armada Ana Marreiros Ana Paula Fontes Maria Miguel Carvalho Joao Paulo Sousa Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 520 528 10.18203/issn.2455-4510.IntJResOrthop20241102 Supervised machine learning to predict non-home discharge following surgical treatment of pelvic fractures <p><strong>Background:</strong> Decision-tree-based machine learning (ML) algorithms such as random forest (RF) are useful for their ability to predict outcomes and rank variables according to their utility in the decision-making process. This study utilizes RF to identify important predictors of discharge to facility following surgical stabilization of pelvis fractures, a traumatic injury that often precludes mortality and diminished quality of life.</p> <p><strong>Methods:</strong> The American College of Surgeons national surgical quality improvement program (ACS-NSQIP) database was queried for patients aged 16 to 70 undergoing surgical fixation of pelvis fractures between 2008 and 2018. Outcome of interest was discharge home versus to facility. RF was trained with surgical variables, comorbidities, and other patient factors and tasked with predicting discharge location. Permutation feature importance (PFI) was then generated to identify important variables.</p> <p><strong>Results:</strong> Out of 492 patients, 184 patients were discharged to facility, and 308 patients were discharged home. RF identified age, American Society of Anesthesiologists (ASA) classification, and preoperative hematocrit as top predictors for discharge to facility. Patients being discharged home were younger, had lower ASA scores, and had higher preoperative hematocrit.</p> <p><strong>Conclusions:</strong> RF identified age, ASA classification, and preoperative hematocrit as top predictors for discharge destination following pelvic surgery. Knowledge of the impact of these variables can inform preoperative planning for both patients and their care team, while highlighting the opportunity to address preoperative hematocrit to both reduce cost and improve quality of care.</p> David Chung Richard Rice Brittany McPhee Mikayla Kricfalusi Trevor Case Olumide Danisa Rebecca Rajfer Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 529 533 10.18203/issn.2455-4510.IntJResOrthop20241103 Does patient-specific instrumentation in primary total knee arthroplasty improve long-term satisfaction or function? A randomized trial with a 9-year follow-up <p><strong>Background:</strong> Patient-specific instrumentation (PSI) aims to increase the accuracy of total knee arthroplasty (TKA). However, the long-term benefit compared to conventional instrumentation (CI), is still controversial. This randomized controlled trial compares the long-term outcomes between PSI and CI in TKA.</p> <p><strong>Methods:</strong> Patients submitted to PSI or CI TKA with a minimum follow-up of 8 years were evaluated. Satisfaction levels, forgotten joint score (FJS) and Western Ontario and McMaster university osteoarthritis index (WOMAC) scores were compared. Regarding descriptive statistics, mean, standard deviation and frequencies were obtained. For inferential statistics we used the t test for independent samples the Mann-Whitney test and the Wilcoxon Test.</p> <p><strong>Results:</strong> A total of 50 TKA were included (48% CI; 52% PSI) with an average follow-up time of 9.3 years. At the final follow-up the WOMAC score was similar between groups (p=0.846; CI:26.8±22.5; PSI:26.8±25.3). Similarly, no differences were seen for the FJS (p=0.785; CI:59.6±35.1; PSI:57.1±36.2) or satisfaction (p=0.486; CI:8.1±2.8; PSI:9.1±1.4). However, at the final follow-up, the total WOMAC score had worse results when compared to the previous evaluations (p=0.013 for CI group; p=0.009 for PSI group). No significant differences in the satisfaction levels were detected regarding the initial and final evaluations (p=0.581 for CI group; p=0.936 for PSI group).</p> <p><strong>Conclusions:</strong> Nine years after TKA, PSI and CI patients reported similar levels of satisfaction and functioning. Both groups achieved similar results concerning the WOMAC, FJS scores and satisfaction levels. This study suggests that long-term satisfaction and functioning levels are similar in both PSI and CI.</p> Sofia Caldeira-Dantas Marta Gonçalves Gonçalo Vaz-Pinto Pedro Dias Ana Marreiros Ana Paula Fontes João P. Sousa Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 534 539 10.18203/issn.2455-4510.IntJResOrthop20241104 Physical examination, magnetic resonance imaging and the arthroscopy of the shoulder: a correlation of diagnostic tests <p><strong>Background:</strong> Shoulder pathology is the third cause of consultation for musculoskeletal disorders; it is a cause of disability and economic losses. The gold standard for its diagnosis and treatment is arthroscopy. However, arthroscopy is an invasive diagnostic technique. Therefore, clinical and imaging methods may be useful as diagnostic techniques before considering arthroscopy. Nevertheless, these non-surgical diagnostic methods may present a poor correlation in diagnostic accuracy when compared to the arthroscopic diagnostic method in the context of shoulder pathology.</p> <p><strong>Methods:</strong> A retrospective study including 123 patients who presented shoulder complains, underwent physical examination and a shoulder magnetic resonance imaging (MRI) study prior to a shoulder arthroscopy. A clinical correlation was made using the kappa index, sensitivity and specificity of the clinical and imaging tests were also calculated.</p> <p><strong>Results:</strong> The correlation between arthroscopy and the clinical assessment showed a kappa index of 0.25 for rotator cuff injuries, 0.41 biceps pathology, 0.51 sub acromial impingement, 0.51 acromioclavicular arthrosis, 0.28 for SLAP injury. MRI diagnostic method showed a kappa correlation of 0.24 for rotator cuff injuries, 0.59 biceps pathology, 0.39 sub acromial impingement, 0.46 acromioclavicular arthrosis and 0.34 for superior labral anterior posterior (SLAP) injury.</p> <p><strong>Conclusions: </strong>After comparing arthroscopy with clinical assessment and the MRI diagnostic method we found that clinical assessment is useful to diagnose biceps pathologies, subacromial impingement, and acromioclavicular arthrosis. On the other hand, MRI studies and diagnosis made by a radiologist showed to be a valuable tool for the diagnosis of biceps pathology and acromioclavicular arthrosis.</p> Jose E. Canchan Felipe Camara Felipe Martinez Guillermo Bobadilla Eduardo Trujillo Ramon Esperon Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 540 546 10.18203/issn.2455-4510.IntJResOrthop20241105 Evaluation of optimizing Monteggia fracture-dislocation care: surgical innovations, radiological insights, and functional rehabilitation in adult patients <p><strong>Background:</strong> Monteggia fractures, rare in adults, involve proximal ulna fracture and radial head dislocation. Managing these injuries poses challenges, fueling historical debates and driving advancements in internal fixation. Watson Jones' frustration highlights the ongoing pursuit of effective surgical approaches for optimal outcomes and functional limb restoration. his study aims to evaluate Monteggia fracture-dislocation treatment by analyzing radiological outcomes for structural insights and alignment post-surgery.</p> <p><strong>Methods:</strong> This prospective observational study, conducted at Swapno general hospital, Mirpur-2, Dhaka, Bangladesh from 1<sup>st</sup> January 2021 to 31 January 2024, enrolled 30 patients with radiologically confirmed Monteggia fracture-dislocation. Surgical procedures involved creating an interval, anatomical reduction, and fixation, with regular follow-ups assessing outcomes, including range of motion, X-rays, and VAS scores, while statistical analysis utilized SPSS version 23.</p> <p><strong>Results:</strong> The highest frequency percentage in the age distribution was observed among individuals aged 41-45, constituting 20% of the total sample, while the lowest frequencies were recorded in the 31-35 and &gt;51 age groups, each representing 10% of the sample. Physical assault emerged as the leading cause of injury, accounting for 40% of cases, followed by road traffic accidents at 36.66% and falls at 23.33%. In terms of final outcomes, the majority of patients (43.33%) achieved a good outcome, while the lowest percentage (10%) resulted in poor outcomes.<strong> </strong></p> <p><strong>Conclusions:</strong> In conclusion, addressing Monteggia fracture-dislocation in adults requires navigating inherent complexities. Modern internal fixation methods prove impactful, emphasizing the need for precise classification and stable anatomical reduction.</p> M. Abdullah Al-Maruf Shahidul Islam M. Asaduzzaman M. Mainul Hasan M. Zahidul Hoque Raju Mollick Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 547 551 10.18203/issn.2455-4510.IntJResOrthop20241106 A multicentre, retrospective and observational study to evaluate safety and functional outcomes of arthroscopic shoulder ligament repair using Sironix suture anchor <p><strong>Background: </strong>Arthroscopic shoulder ligament repair is one of the most performed procedures in the orthopaedic specialty. Suture anchor devices are used in arthroscopic surgeries to reattach ligaments or other soft tissues to bone. The goal of this study was to evaluate the safety and functional outcomes after shoulder ligament repair.</p> <p><strong>Methods: </strong>This is a multicentric, retrospective, observational study conducted on patients who underwent primary arthroscopic shoulder ligament tear repair between April 2018 to July 2022, using Sironix suture anchors at Kumaran Hospital and Rela Institute, Chennai, Tamil Nadu, India, and DNV Ortho Care Hospital, Dharmapuri, Tamil Nadu, India. A total of 75 patients were included. Post-surgery measurements of functional outcomes were performed using the PENN shoulder score, simple shoulder test questionnaire, shoulder pain and disability index, and single assessment numerical evaluation. Adverse events were recorded.</p> <p><strong>Results: </strong>At post-surgery follow-up visits, there was a significant improvement in the functional outcomes of all the patients. The PENN shoulder score had a mean (SD) pain score of 92.04 (7.50), a satisfaction score of 91.87 (8.00), and a function score of 93.18 (6.16), respectively. The mean (SD) SST score and SPADI score was 88.9 (9.7), and 2.8 (2.79) respectively. The SANE mean (SD) values of the operated joint and opposite joint were 91.0 (7.31) and 98.1 (4.26) respectively with a p value of 0.0001.</p> <p><strong>Conclusions: </strong>Based on the study results, arthroscopic shoulder ligament repair with Sironix suture anchor resulted in good and desirable functional outcomes with no major adverse events and improved quality of life.</p> K. Vijayaraj V. Rathika Ashok Kumar Moharana Sachin Angrish Deepak T. S. Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-03-05 2024-03-05 10 3 552 558 10.18203/issn.2455-4510.IntJResOrthop20240658 A comprehensive comparative study on mid-term clinical and functional outcomes in Indian patients following bilateral total knee arthroplasty: assessing the impact of body mass index on post-total knee arthroplasty results <p><strong>Background:</strong> Limited research exists on Indian obese patients undergoing simultaneous bilateral total knee arthroplasty (bTKA), necessitating a comprehensive and comparative analysis with non-obese counterparts. This study presents an observational and prospective assessment of Indian patients who underwent cruciate retaining/posterior stabilized (CR/PS) metal-backed implant surgeries from 2016 to 2019.</p> <p><strong>Methods:</strong> The study encompassed 190 patients (380 knees) undergoing bTKA, classified by World Health Organization (WHO) weight stratification: normal weight (cohort 1, n=51), overweight (cohort 2, n=85), and obese (cohort 3, n=54). Primary endpoints were implant survivorship and revision rates, with secondary endpoints including range of motion (ROM), knee society score (KSS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and SF-36 scores.</p> <p><strong>Results:</strong> Female representation dominated all groups (88.24%, 87.06%, and 90.74%). End-stage osteoarthritis occurred in 94.12%, 96.47%, and 98.15%, respectively. Over the 3-year follow-up, four fatalities occurred, with 186 patients completing the study. ROM showed significant improvement after three years, with baseline values increasing from 93.29°±18.29° (cohort 1) to 123.97°±2.28°, 122.86°±5.03°, and 122.67°±4.77°, respectively (p&lt;0.001). KSS demonstrated substantial improvement (cohort 1: 89.87±6.48, cohort 2: 90.47±8.40, cohort 3: 90.52±8.07) after three years. A 100% success rate and no revisions indicated implant durability. WOMAC and SF-36 questionnaires exhibited significant improvements in pain, stiffness, and overall well-being (p&lt;0.001) after bTKA.</p> <p><strong>Conclusions:</strong> This mid-term CR/PS knee survival analysis underscores 100% implant functionality, improved knee function, and enhanced quality of life for all patients, irrespective of their body mass index (BMI). Simultaneous bilateral TKA with CR/PS implants demonstrates favourable outcomes, affirming its efficacy as a viable treatment option.</p> Karineravanda Machaiah Ponnanna Ravi Teja Rudraraju Supreet Bajwa Kunal Aneja Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-03-19 2024-03-19 10 3 559 566 10.18203/issn.2455-4510.IntJResOrthop20240687 Age wise comparative analysis of patients undergoing total knee arthroplasty: a multicenter indigenous experience <p><strong>Background: </strong>This study assesses the mid-term clinical and functional outcomes, implant survivorship and impact of age on patients implanted with either cruciate retaining/posterior stabilized (CR/PS) total knee system (TKS).</p> <p><strong>Method: </strong>This is an ongoing, prospective, multicentre, real-world study enrolling 300 patients: younger adults (&lt;55 years; n=69), older adults (55 years to &lt;65 years; n=92) and elders (≥65 years; n=139). Primary safety endpoints: implant survivorship and cumulative revision rate. Secondary endpoints: Knee Society Score (KSS), Western Ontario and McMaster universities osteoarthritis (WOMAC) score, range of motion (ROM), SF-36 questionnaire for assessment of quality of life (QoL), radiographic analysis, and any adverse events at 6 weeks, 6 months, 1-3 years. </p> <p><strong>Results: </strong>Primary endpoint demonstrated absence of any revision across all age categories during the 3 years study period. Secondary outcomes KSS (clinical and functional) showed non-significant difference among elderly (91.13±7.90 and 98.18±4.62, respectively) in comparison to young adults (91.03±8.61 and 98.91±3.75, respectively). All three age-groups showed significant improvement in ROM (p&lt;0.001) till 3 years 121.05°±7.74°, 123.22°±4.26°, and 122.43°±5.8° respectively, with no differences among the age groups. We observed that WOMAC and SF-36 QoL scores improved with each follow-up (p&lt;0.001) across all age groups. Radiographs showed no implant wear or osteolysis during the investigation.</p> <p><strong>Conclusions: </strong>Age seems to play no notable role on the post-TKA outcomes. Over a 3-year period, we observed marked enhancements in patient measures such as ROM, KSS, WOMAC, and QoL indicating and strongly affirming the safety and efficacy of CR/PS TKS prostheses.</p> <p><strong> </strong></p> Ravi Teja Rudraraju Supreet Bajwa Kunal Aneja Karineravanda Machaiah Ponnanna Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-12 2024-04-12 10 3 567 575 10.18203/issn.2455-4510.IntJResOrthop20240947 The role of diabetes in low back pain compared to non-diabetics <p><strong>Background: </strong>Type 2 diabetes is a prevalent non-communicable disease, affecting significant proportion of the global population, with an estimated 382 million individuals affected. There exists a correlation among diabetes and low back pain. The objective of this investigation was to examine the potential association linking diabetes and low back pain by utilising the Oswestry disability Index as a gauge of the intensity of persistent lower back pain.</p> <p><strong>Methods: </strong>The study was conducted by cross sectional method in which 200 patients with low back pain were included from period of October 2020 to September 2022. Oswestry disability index questionnaire was used for the intensity of lower back pain. Statistical package for the social sciences was used for data analysis.</p> <p><strong>Results: </strong>In this study, out of 200 patients, 59 (29.5%) had diabetes and 141 (70.5%) were without diabetes, with a average age of 53.61±15.07 years. Overall, according to gender, patients were equally distributed, while female and male predominance was seen in diabetics and non-diabetics, respectively.</p> <p><strong>Conclusions: </strong>The distribution of patients as per gender and ODI score did not differ, although more diabetics had a significantly higher ODI score than non-diabetics. A significant increase in blood glucose, HbA1c, microalbuminuria, and ODI score was noted in diabetics compared with non-diabetics, with significant positive associations of ODI with age, blood glucose, and HbA1c. The increased levels of the diabetic profile parameters and their association with the ODI indicate the possible role of diabetes with low back pain.</p> Denish S. Aghara Sanjay N. Patil Nishant Mirchandani Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 576 581 10.18203/issn.2455-4510.IntJResOrthop20241107 Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study <p><strong>Background:</strong> Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score.</p> <p><strong>Methods:</strong> The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score.</p> <p><strong>Results:</strong> Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2).</p> <p><strong>Conclusions:</strong> Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection.</p> Chrisphin C. Christhudasan Acksen Thangaraja Hany Hameed Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 582 587 10.18203/issn.2455-4510.IntJResOrthop20241108 Quantification of anterior translation of tibia over femur using Lachmeter in anterior cruciate ligament reconstruction with hamstring tendon autograft <p><strong>Background:</strong> The anterior cruciate ligament (ACL) is an important restraint on anterior tibial translation of the knee. Arthroscopic ACL reconstruction using hamstring tendon autograft is the most widely accepted surgical procedure for ACL insufficiency. This study is assessing the effect of ACL reconstruction by hamstring tendon autograft on the anteroposterior stability of the knee joint by measuring the side-to-side difference of anterior tibial translation using the Lachmeter. We are also assessing the functional outcome of the same surgery using international knee documentation committee (IKDC) score.</p> <p><strong>Methods:</strong> The study included 30 patients who were admitted for ACL reconstruction with hamstring tendon autograft. The side-to-side difference of anterior tibial translation was assessed by using Lachmeter preoperatively and postoperatively at the end of the 1<sup>st</sup>, 3<sup>rd</sup>, and 6<sup>th</sup> months. The IKDC score was assessed preoperatively and postoperatively at the end of 6<sup>th</sup> month.</p> <p><strong>Results:</strong> The mean Lachmeter value of respondents in the current study was 4.31±0.56 mm during the preoperative period. Lachmeter values were 2.79±0.42 mm, 2.09±0.42 mm, and 1.29±0.39 mm, respectively, at the end of the first, third, and sixth months postoperatively. Mean preoperative and postoperative 6<sup>th</sup> month IKDC scores were 55.83±7.7 and 89.20±5.3 respectively.</p> <p><strong>Conclusions: </strong>There is significant serial improvement in the side-to-side difference of anterior tibial translation in the 6 months of post operative period following ACL reconstruction using hamstring tendon autograft. The improved IKDC score from preoperative to postoperative level is also indicating a positive functional outcome.</p> Vishnu K. D. Samson Samuel E. P. S. John Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 588 593 10.18203/issn.2455-4510.IntJResOrthop20241109 Study of degenerative (non-lytic) spondylolisthesis grade 1 and 2 in axial MRI images <p><strong>Background:</strong> The traditional imaging assessment of lumbar spondylolisthesis is in sagittal images noting movement of upper body over the lower body. It omits change at the facet.</p> <p><strong>Methods:</strong> The present observational, study included 35 patients with degenerative lumbar spondylolisthesis(non-lytic). Radiological analysis of all MRI images was done by 4 independent spinal surgeons and 2 radiologists. The study focused on the axial MRI images and changed relation between the superior articular process and inferior articular process and relation between inferior articular process and canal with thecal sac (traversing root).</p> <p><strong>Results:</strong> Majority of DS had sagittal oriented facets (71.43%). In 7 cases at the L3/4 and in 19 cases at L4/5 level both facet joints had sagittal orientation with forward (ventral) movement of IAP. The IAP was found to be encroaching or in close proximity of traversing root. In 1 patient at L3/4 and 6 patients at L4/5 joint was sagittal unilaterally, may be causing compression of the neural elements unilaterally, while on coronal side the IAP and SAP had a normal alignment and not causing neural encroachment</p> <p><strong>Conclusions:</strong> We need to concentrate on relation of IAP vs SAP at facet as seen in axial images of facet.</p> Amit Surana Alok Gadkari Satishchandra Gore Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 594 598 10.18203/issn.2455-4510.IntJResOrthop20241110 Comparison of effectiveness of intraoperative subperiosteal versus periarticular analgesic cocktail injection for post operative analgesia in patients undergoing total knee arthroplasty <p><strong>Background:</strong> Early postoperative pain management is pivotal in patients undergoing Total knee arthroplasty. The advantage of Local infiltration analgesia is its ability to provide control of pain without interfering with motor strength of the lower extremity, thereby allowing early mobilization of patients. This study compares the effectiveness of local analgesic cocktail injection given through subperiosteal vs. periarticular routes.</p> <p><strong>Methods:</strong> The study included 30 patients admitted for primary total knee arthroplasty. They were grouped into two groups based on different injection sites. Group A included patients who received subperiosteal injection and Group B included patients who received periarticular injection, under spinal anaesthesia. The difference in pain among the two groups, using VAS at 12, 24, 48, and 72 hrs postoperatively, postoperative range of movements, and Functional outcome using IKDC score at the end of 6 months were assessed and compared between the two groups.</p> <p><strong>Results:</strong> The mean VAS scores at 12, 24, 48, and 72 hrs were 0.87±0.35, 1.47±0.52, 1.80±0.41, 1.07±0.46 in subperiosteal group and 2.00±0.53, 2.47±0.52, 2.80±0.56, 1.93±0.59 in periarticular group. The 6 months postoperative IKDC scores were 51.34±0.41 and 51.04±0.61 respectively.</p> <p><strong>Conclusions: </strong>Subperiosteal cocktail injection can significantly reduce the postoperative pain and result in early recovery of range of movements, compared with periarticular cocktail injection in patients undergoing Total knee arthroplasty. But the long-term functional outcomes were comparable among both the groups.</p> Dijo P. Joy Samson Samuel E. P. S. John Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 599 605 10.18203/issn.2455-4510.IntJResOrthop20241111 Comparison of surgical times of various total knee replacement techniques and assessment of learning curve of robotic total knee replacement: a retrospective study <p><strong>Background: </strong>This study aims to compare the operating times of manual, computer-assisted and robotic- assisted TKA and to calculate the learning curve for image-less robotic-assisted TKA (RATKA).</p> <p><strong>Methods: </strong>This retrospective observational study, conducted at the Centre of Excellence, Bone, Joint and Spine, Meitra Hospital, Kozhikode, Kerala, India, focused on patients aged 60 and above undergoing total knee replacement for stage 4 osteoarthritis. The study included 75 consecutive cases of manual, computer- assisted, and robotic-assisted unilateral total knee arthroplasties performed between May 2021 and September 2022 (18 months). Data was collected from the hospital records.</p> <p><strong>Results</strong>: The surgeon transitioned from learning to proficiency phase of RATKA after 14 cases. In the robotic learning phase, the overall operative time was 113.14 minutes (±8.96), significantly longer than the robotic proficiency phase's average of 98.24 minutes (±2.98) and that of CATKA (99.57±10.700 minutes) and manual TKAs (97.01±7.17 minutes). No statistically significant difference was observed in the global operative time between the proficiency phase RATKAs and the CATKA and manual groups (p=0.139).</p> <p><strong>Conclusions: </strong>By optimizing techniques and modifying workflow, one can swiftly overcome the initial learning curve of RATKA and achieve operating times comparable to manual TKA. To enhance efficiency and productivity, the study proposes a revised workflow modifying various rate limiting surgical steps.</p> Sameer Ali Paravath Amarnath Anand Bhavan Prasad Nabeel Mohammed Therakka Parambil Basheer Abdul Gafoor Lulu Damsas Alwin Prince Swetha Punathil Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 606 612 10.18203/issn.2455-4510.IntJResOrthop20241112 Unstable trochanteric fractures treated with proximal femoral nail show functional outcomes independent of the fracture type <p><strong>Background: </strong>The proximal femoral nail has replaced the sliding hip screw devices and gamma nails as the implant of choice for unstable trochanteric fracture (AO 31A2-A3). In our study we aimed to find a correlation between fracture type, time taken for radiographic union and their functional outcome according to Harris Hip score at 6 months after PFN fixation of such fractures.</p> <p><strong>Methods: </strong>We assessed 38 patients sustaining unstable (AO 31A2-A3) trochanteric fractures. All the fractures were treated with short PFN. Functional outcome was assessed according to the HHS at sixth month follow-up.</p> <p><strong>Results: </strong>No statistically significant association was found between HHS with fracture type (p=0.184) and bone union time (p=0.587). The association between bone union time and fracture type was found to be statistically significant (p=0.007).</p> <p><strong>Conclusions: </strong>Functional outcome (HHS) does not depend upon the fracture type.</p> Sourav Bhattacharjee Ashir Abdul Rasheed Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 613 617 10.18203/issn.2455-4510.IntJResOrthop20241113 Functional outcome after arthroscopic mosaicplasty for localized osteochondral defects in the knee <p><strong>Background:</strong> Articular cartilage is complex tissue that is able to withstand tremendous amount of force over many cycle but does not have the ability to heal even after minor injury. Treatment recommendation for articular cartilage injury and arthritis includes non-operative and operative management. Mosaicplasty is a reconstructive osteochondral grafting procedure for the treatment of articular defects of the knee. Mosaicplasty entails transplantation of small cylindrical osteochondral grafts from the non-weight bearing area of the femoral condyles and transplanting them in a mosaic like fashion into a prepared defect site on the weight-bearing surfaces of the same knee.</p> <p><strong>Methods:</strong> The present study was carried out in 30 patients in our hospital prospectively to determine the functional outcome results after arthroscopic mosaicplasty for localized osteochondral defects in the knee. We conducted a prospective study on 30 patients of osteochondral defect of knee. Patients were presented with pain and recurrent swelling in the knee after sustaining twisting injury in the knee. Diagnostic arthroscopy was done and the osteochondral defects is localized and treated with mosaicplasty. The graft is harvested arthoscopically from the non-weight bearing part of the femoral condyles using a harvester. Follow up of these patients is done according to Tenger Lysholm knee scoring scale at 03 months, 06 months after surgery.</p> <p><strong>Results:</strong> In our study 93.33% patients showed good to excellent results and 7% patients had fair and poor results.</p> <p><strong>Conclusions: </strong> Advantage of arthroscopic mosaicplasty includes implantation of hyaline cartilage without the need for any suture or adhesive, need for smaller incision minimally invasive and very less complications. Associated injuries like ACL/PCL or meniscal tear can be addressed in the same procedure. To conclude arthroscopic mosaicplasty is excellent procedure to address the focal articular cartilage injuries of knee.</p> <p> </p> Pravendra Singh Jashandeep Singh Chahal Nipun Aggarwal Harsh Kumar Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 618 623 10.18203/issn.2455-4510.IntJResOrthop20241114 Functional outcome of mini external fixator in hand injuries: an observational study in a tertiary care hospital <p><strong>Background: </strong>Metacarpal and phalangeal fractures are one of the common fractures of the upper extremity that account for about 10% of total body fractures. The distal parts of the hand are the most common parts to be injured. Outcome is also influenced by other factors such as patient’s age, occupation, socio economic status, systemic illness, surgeon’s skill and the patient’s compliance.</p> <p><strong>Methods: </strong>We are doing an observational study with 40 patients included according to the inclusion and exclusion criteria for a period of six months with age group between 20 and 60 years. We use mini external fixators with JESS clamps, 1.8 mm threaded pins and k wires. Patients were followed up periodically with required radiograph for the union of the fracture.</p> <p><strong>Results: </strong>Out 40 patients, most of the patients were between the age of 21 to 40 years with male preponderance, open fractures were more when compared with closed fractures. Functional outcome was excellent and good on the higher side which was analysed with Strickland score. Radiological union were also in greater side with 17.5% of them with delayed union.</p> <p><strong>Conclusions: </strong>Simple surgical technique will minimize complications and an aggressive rehabilitation will ensure best result. In general, mini external fixator is a good treatment for management of fractures with best functional outcome. </p> Saravanakumar P. Arun Kumar B. Kanchan N. Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 624 628 10.18203/issn.2455-4510.IntJResOrthop20241115 Evaluation of safety, clinical outcomes, and patient-reported outcomes after meniscus repair using surestitch all inside meniscal repair implant: a retrospective and observational study <p><strong>Background: </strong>Anterior cruciate ligament (ACL) injuries and meniscus injuries frequently co-occur, underscoring the interconnected nature of knee joint structures. Meniscus injuries, often caused by sports trauma or degenerative changes, necessitate careful management to preserve joint function and prevent complications like osteoarthritis. This retrospective observational study evaluates the safety, clinical outcomes, and patient-reported outcomes of meniscus repair using Surestitch all inside meniscal repair implant, a contemporary solution designed to optimize meniscal repair.</p> <p><strong>Methods: </strong>The study, approved by the institutional ethics committee, included patients aged 18-80 years who underwent meniscus repair with Surestitch between October 2020 and July 2022. Data on demographics, surgical details, and outcomes were collected from medical records and telephonic follow-ups.</p> <p><strong>Results: </strong>Among 36 subjects, the mean age was 36.89 years. The mean (SD) duration of follow-up was 364 days (127). There was no meniscus repair failure noted in any of the patients. Functional patient-reported outcomes assessed using international knee documentation committee (IKDC) with a score of (60.15±12.40), and Lysholm scores (77.03±14.45) demonstrated favorable results. The knee injury and osteoarthritis outcome score (KOOS) of (54.63) further indicated positive knee health across domains. There were no adverse events or reoperations.</p> <p><strong>Conclusions: </strong>The study demonstrated favorable safety, clinical outcomes, and patient-reported outcomes, yielding satisfactory results, and consequently establishing the safety and effectiveness of the Surestitch All inside meniscal repair implant in meniscus repair.</p> Mukesh Garg Ashish Tomar Ashok Kumar Moharana Sachin Angrish Deepak T. S. Cismitha Sharol Pinto Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-03-05 2024-03-05 10 3 629 633 10.18203/issn.2455-4510.IntJResOrthop20240659 Comparison of Singh’s index in view of osteoporosis in patient with in tertrochanteric fracture and intracapsular fracture <p><strong>Background:</strong> Osteoporosis is a progressive, systemic, skeletal disease with low bone mass. Diagnosing osteoporosis in practice is a major challenge, where resources are limited and costly. Measurement of osteoporosis through Singh’s index in proximal femur fracture patients is consistent with Bone Mineral Density estimation like DEXA scan. Singh’s index is a reliable, reproducible and easily available investigation for osteoporosis. The aim of this study is to evaluate the Singh’s index of the patients with inter-trochanteric and intra-capsular fracture.</p> <p><strong>Methods:</strong> A retrospective observational study of 20 IT and IC fracture each. Singh’s index evaluated from the X-rays at time of fracture presentation. Other required information collected at presentation.</p> <p><strong>Results:</strong> Out of 40 Patients, 6 had Singh's Index Grade 1 (15%), 11 had Grade 2 (27.5%), 10 had Grade 3 (25%), 7 had Grade 4 (17.5%), 6 had Grade 5 (15%), 0 Patients had Singh’s index Grade 6. There was no noticeable significant variation in relation of gender with the type of fracture. Patients with higher age tend to have a lower grade of Singh’s index.</p> <p><strong>Conclusions:</strong> Singh’s Index indeed represents bone quality and a fall in the grades predisposes to fractures. Inter trochanteric fractures are common in the older age group with poor Singh’s index (&lt;3) compared to the relatively younger age group with Singh’s index around 3. Gender, exercise, history of hypertension and diabetes, sunlight exposure, etc. has no significant impact on Singh's Index. Age is deciding factor for Singh’s Index.</p> Mohammed Jaan Basha Hunaina Mansufa Mohammed Jalal Mohiuddin Sajid Salman C. Shamsunder Copyright (c) 2024 International Journal of Research in Orthopaedics 2024-04-29 2024-04-29 10 3 634 638 10.18203/issn.2455-4510.IntJResOrthop20241116