International Journal of Research in Orthopaedics

Radiographic evidence of medial longitudinal arch restoration following naviculocuneiform arthrodesis in progressive collapsing foot deformity: a retrospective case series

Galindo D. — 2025-12-26

The objective of this study was to demonstrate the corrective effect of naviculocuneiform (NC) arthrodesis on the medial longitudinal arch in collapsing foot deformity (CFD) and to establish radiographic criteria for its indication as a stand-alone or complementary surgical procedure. NC arthrodesis was performed in 17 patients diagnosed with CFD, with clinical and radiological follow-up conducted to evaluate correction of the medial longitudinal arch. Postoperative angular measurements were obtained at five weeks under weight-bearing conditions after removal of the short-leg cast. Statistically significant radiographic improvements (p<0.05) were observed in all parameters except for the calcaneal pitch angle (p>0.05). The mean preoperative Meary angle was 11.8°, with an average reduction of 10°, resulting in a postoperative mean of 1.9° (p<0.05). The preoperative talocalcaneal angle in the Saltzman view averaged 6.02° compared to 2.7° postoperatively (p<0.05). The talo–scaphoid coverage angle decreased from a mean of 34.5° preoperatively to 22.9° postoperatively (p<0.05), while the talo–scaphoid incongruence angle improved from 39.3° to 24.2° (p<0.05). Although the calcaneal pitch angle improved slightly (19.1° to 21.0°), the change was not statistically significant (p>0.05). NC arthrodesis proved to be an effective technique for correcting collapsing foot deformity, achieving significant restoration of medial arch alignment and stability with consistent improvements in key radiographic parameters.

Functional outcome of TENS nailing for paediatric long bone fractures

Amal Prabhakaran Sujaya — 2025-12-26

Musculoskeletal trauma constitutes a major portion of paediatric injuries. Titanium elastic nailing system (TENS) has emerged as a minimally invasive and effective method for internal fixation of long bone fractures in children.This study evaluates the functional outcome of TENS nailing in paediatric long bone fractures and compares the results with established literature. A prospective study of 20 children (aged 2–12 years) with diaphyseal fractures of femur, tibia, humerus, and forearm bones treated with TENS was conducted at ASRAM Medical College, Eluru, during 2023–2024. Patients were followed up clinically and radiologically at 1, 3, and 6 months postoperatively. Implant removal was planned at one year. The study included 14 males and 6 females. The most common cause of injury was accidental fall (65%), followed by road traffic accidents (25%). Excellent results were seen in 90% of cases and satisfactory in 10% of cases. The average hospital stay was 10 days, average blood loss was 45 ml, and the mean time to union was 4 months. Complications included knee stiffness (5%) and superficial infection (10%), which resolved with physiotherapy and antibiotics, respectively.

From fracture to function: surgical management of trifocal femur fractures: a case series

Kirubakaran Pattabiraman — 2025-12-26

Trifocal femur fractures, characterized by fractures occurring at three distinct levels of the femur, are exceptionally rare injuries that usually result from high-energy trauma. Their management is challenging due to limited published evidence, complex fracture patterns, and the technical difficulty of achieving stable fixation across multiple segments. We present a case series of four patients with ipsilateral multilevel femur fractures, including trifocal injury patterns. Case 1 sustained a subtrochanteric fracture associated with a segmental shaft fracture; case 2 had an intertrochanteric fracture with a segmental shaft fracture; case 3 presented with intertrochanteric, shaft, and distal intra-articular femur fractures; and case 4 sustained fractures of the femoral neck, shaft, and distal femur. All patients underwent surgical management using individualized fixation strategies, including long proximal femoral nailing, cancellous screw fixation, bone grafting, and distal femoral plating as required. Radiological union was achieved in all fracture components except for incomplete union of the distal femur in one patient at two-year follow-up. Functional outcomes were satisfactory in all patients, with restoration of limb alignment, implant stability, and ambulatory function. Early recognition, meticulous preoperative planning, and stable fixation using appropriate load-sharing constructs are essential for achieving favorable outcomes in these complex injuries.

Retrospective study on pre- and postoperative morphine equivalents demand in patients who underwent rotator cuff repair surgery

Vadim S. Dolgov — 2025-12-26

Background: Aim was to evaluate pre- and postoperative morphine milligram equivalent (MME) demands in patients undergoing rotator cuff repair (RCR), and identify demographic or clinical factors associated with postoperative opioid use.

Methods: A retrospective case series of 35 patients was conducted who underwent RCR between 2023 and 2024 at two orthopedic centers. Demographic data, preoperative pain scores, and opioid use (MME) were extracted. Postoperative opioid consumption was assessed at 90 days. Paired comparisons, subgroup analyses (sex, age group, smoking status), and linear regression were performed to evaluate predictors of postoperative opioid use.

Results: Postoperative opioid use at 90 days was significantly lower compared with preoperative levels (mean paired difference-18.3 MME, t=-2.82, p=0.0106, Hedges’ g=-0.62). No significant differences in 90-day MME were observed by sex (p=0.951), age group (p=0.271), or smoking status. Preoperative pain severity was not predictive of postoperative opioid use (slope=1.86 MME/point, p=0.411, R²=0.034).

Conclusions: Patients undergoing RCR demonstrated a significant reduction in opioid use at 90 days postoperatively, with no major demographic or clinical predictors of postoperative demand. These findings suggest that current prescribing practices may exceed actual consumption and highlight the importance of tailoring opioid prescriptions and integrating multimodal analgesia to reduce unnecessary exposure while maintaining adequate pain control.

Shark bite bone resection in treatment of surface sarcomas

Mahmoud M. Kamaleldin — 2025-12-04

Background: Surface bone sarcomas including parosteal sarcoma as the most common type are considered well differentiated sarcomas with rare intramedullary involvement. They are characterized by low incidence of local recurrence and distant metastasis. As they involve a portion of cortical bone, hemi-cortical resection (shark bite resection) seems to be an appealing option with low morbidity and better function. We aim to evaluate oncological outcome and functional results for a cohort of patients with surfaces sarcomas treated by shark bite resection.

Methods: A prospective study of 25 patients presented with surface malignant bone sarcomas between 2016 and 2022 in our institution. We performed hemicortical resection and biological reconstruction. Follow up period was 2-8 years. Functional outcome was assessed using MSTS scoring system.

Results: The mean MSTS at the end of follow up was 29 (range 27-30). Mean resected bone surface was 9 cm (range 7-14). Mean time for bone union was 8 months (range 6-15 months).

Conclusion: Shark bite resection is a valuable option for treatment of low-grade surface sarcomas. It provides better outcome, native joint preservation and low complication rate.

Comparison of outcomes in open-door laminoplasty versus laminectomy and instrumented fusion in patients with ossification of the posterior longitudinal ligament involving multiple levels

M. Anowarul Islam — 2025-12-26

Background: This study aims to determine, in cases of multi-level ossification of the posterior longitudinal ligament (OPLL), expansive open-door laminoplasty (LP) is a better option than laminectomy and instrumented fusion (LMF).

Methods: A total of 44 cases were included and divided into group LP (n=22) and group LMF (n=22). Patients, who underwent surgical treatment for continuous and mixed type multi-level OPLL between January 2010- December 2021 were retrospectively reviewed. The cervical lordosis was evaluated by C2-7 Cobb angle and cervical sagittal balance by C2-C7 sagittal vertical axis (SVA). Range of motion (ROM), Japanese Orthopedic Association (JOA), visual analog scale (VAS) and neck disability index (NDI) were used to assess clinical outcomes.

Results: The LP group had significantly lower blood loss (280±50 ml vs. 450±70 ml) and shorter operative time (120±15 min vs. 160±20 min) compared to LMF. LP preserved cervical lordosis (4±1.5° vs. 7±2°, p=0.001) and ROM (8±2° vs. 14±3°, p=0.003) more effectively. NDI improvement was greater in the LP group (27±5 vs. 20±6, p=0.021). OPLL progression was higher in LP (1.2±0.3 mm vs. 0.5±0.2 mm, p=0.017). LP was associated with higher postoperative kyphosis (32% vs. 14%, p=0.038) and kyphotic change rate (28% vs. 10%, p=0.029), but lower incidence of axial pain (14% vs. 27%, p=0.043).

Conclusions: Compared with the LMF, the LP is recommended for cases with OPLL and straight cervical lordosis ensuring comparable neurological recovery, improved neck ROM, less axial pain and better neck function improvement. The stabilization obtained by adding instrumented fusion could suppress progression of OPLL thickness.

Comparative analysis of landmark-guided intra-articular knee injections in outpatient clinics versus ultrasound-guided injections: a quality improvement study

Sangeetha Baskar — 2025-12-26

Background: Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and reduced mobility. Intra-articular steroid injections are a key management option when oral analgesics fail to improve symptoms and surgery is not imminent. These injections can be performed using ultrasound guidance or anatomical landmark techniques (“blind”) depending on clinician expertise and hospital setting. However, referring patients for ultrasound (US) -guided procedures may increase waiting times and costs imposing a significant burden on hospital resources.

Methods: A closed-loop audit at a London district general hospital evaluated the clinical and economic impact of US-guided versus landmark-guided intra-articular knee injections for osteoarthritis in an outpatient orthopaedic setting. The first (retrospective) cycle covered January–December 2023, and the second (prospective) cycle May–December 2024. Data from electronic health records, Picture Archiving and Communication Systems (PACS), and National Health Service (NHS) cost databases were analysed for waiting times (weeks) and procedural costs (£).

Results: In 2023, 391 US-guided injections had an average waiting time of 16.2 weeks and cost ~£700 each, while 182 landmark-guided clinic injections averaged 15 weeks and cost ~£600. In 2024, 346 US-guided and 234 landmark-guided injections were performed, reducing US waiting times to nine weeks. A revised costing model achieved annual savings of ~£96,000. Increased clinic-based procedures reduced US demand, with no reported adverse events.

Conclusion: Clinic-based, landmark-guided knee injections provide a safe, cost-effective and efficient alternative to US-guided procedures, significantly reducing waiting times, and preserving radiology resources while improving care delivery without compromising patient outcomes.

Comparison of clinical and radiological outcomes between TLIF and PLIF in degenerative lumbar spondylolisthesis

Rasel Morshed — 2025-12-26

Background: Degenerative spondylolisthesis, often causing leg pain or radiculopathy, involves the forward displacement of a vertebra over the one below. Therefore, this study aims to compare clinical and radiological outcomes between transforaminal and posterior lumbar interbody fusion techniques in degenerative lumbar spondylolisthesis. The aim of the study was to compare clinical and radiological outcomes between transforaminal and posterior lumbar interbody fusion techniques in degenerative lumbar spondylolisthesis.

Methods: This prospective comparative study at the Department of Orthopaedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) and Bangladesh Spine and Orthopaedic Hospital (BSOH), Dhaka, Bangladesh (January 2022–December 2023) included 35 patients with degenerative lumbar spondylolisthesis. Preoperative evaluation included demographics, BMI, VAS, ODI and radiological assessment. TLIF and PLIF were performed under general anesthesia, with operative parameters, complications and postoperative outcomes recorded. Data were analyzed using SPSS v26.0; p<0.05 was considered significant.

Results: Baseline characteristics were similar between TLIF (n=18) and PLIF (n=17) (all p>0.05). Operative time and hospital stay were comparable, while blood loss was lower in TLIF (320±85 vs. 410±95 ml, p=0.01). Postoperative VAS, ODI and fusion rates were similar. Total complications were lower in TLIF (11.1% vs. 47.1%, p=0.03), mainly due to dural tears (0% vs. 29.4%, p=0.04).

Conclusion: TLIF and PLIF provide comparable clinical and radiological outcomes in degenerative lumbar spondylolisthesis, with TLIF showing a safer perioperative profile.

Two-week post-operative dressing: balancing cost and surgical site infection risk in orthopaedic procedures

Musa Muhammad — 2025-12-26

Background: The study was conducted to determine the safety of having first post-op wound inspection in two weeks following orthopaedic procedures.

Methods: It was a retrospective study involving 277 procedures. It involved clean procedures and selected clean contaminated and contaminated procedures. Patients’ records were used to determine the time of first post operative wound inspection. External fixations, sickle cell anemic and diabetic patients were excluded. Wound inspection was categorized before 2 weeks (early) and at or after 2 weeks post-op (delayed). Using southampton wound classification patients were followed for one year to see if there was surgical site infection (SSI).

Results: At two weeks, 84.9% patients had normal wound healing and 7.1% had evidence of SSI. 79.73% (n=59) of patients with early wound inspection had normal wound healing while 20.27% (n=15) had evidence of SSI. 97.1% (n=167) of patients with delayed wound inspection had normal wound healing and 2.9% (n=5) had surgical site infection. P value<0.01. At one year, (p value=0.162), 44.44% (n=123) had normal wound healing, 1.08% (n=3) had SSI, 27.80% (n=77) were lost to follow up, 24.19% (n=67) had no available records of their wound conditions, From the 123 with normal wound healing 21.95% (n=27) had early wound inspection, 73.17% (n=90) had delayed inspection.

Conclusions: Delayed wound inspection is safe and cost-effective and has less SSI compared to wounds opened early.

A prospective study on functional and radiological outcome of PHILOS plating for the management of proximal humerus fracture

M. Moniruzzaman — 2025-12-26

Background: Proximal humerus fracture is a common injury near the shoulder joint that poses a significant challenge in management due to its rising incidence and impact on functional recovery. Therefore, the purpose of this study was to evaluate the functional and radiological outcomes of PHILOS plating in the surgical management of proximal humerus fractures.

Methods: This prospective observational study at the Department of Orthopaedic Surgery, BMU, Shahbag, Dhaka and New Life Hospital Limited, Green Road, Dhaka (March 2021–September 2023) included 30 patients with proximal humerus fractures who underwent PHILOS plating. Functional (VAS, Constant Murley Score) and radiological outcomes were assessed at 1, 3, 6 and 12 months. Data were analyzed using SPSS v26 (p<0.05).

Results: In 30 patients treated with PHILOS plating, mean age was 49.1±9.7 years, 53.3% were male and 56.7% had 3-part fractures. Mean union time was 9.57±1.89 weeks. At 6 months, mean flexion was 152.1°±16.7, abduction 156.2°±18.8, internal rotation 67.1°±7.7 and external rotation 73.3°±7.8. VAS improved from 8.33±0.80 to 1.10±0.63 (p<0.001). Mean Constant Murley Score was 84.8±7.0 (excellent 43.3%, good 53.3%, moderate 3.3%). Complications occurred in 13.3% and 86.7% reported satisfactory outcomes.

Conclusions: PHILOS plating provides effective functional recovery, satisfactory pain relief and low complication rates in the management of proximal humerus fractures.

Patient satisfaction after total knee arthroplasty with and without open lateral release in Jordan: a retrospective analysis

Zainab Hammad — 2025-12-26

Background: Total knee arthroplasty (TKA) is an effective treatment for advanced knee osteoarthritis, providing substantial pain relief and functional improvement. Patellar maltracking remains a frequent postoperative challenge, and open lateral release (OLR) is often employed to correct abnormal patellar tilt intraoperatively. However, evidence on the impact of OLR on patient satisfaction is limited, particularly in Middle Eastern populations.

Methods: We conducted a retrospective analysis of patients who underwent primary TKA with or without OLR at a tertiary hospital in Jordan between 2016 and 2023. Eligible patients had at least six months of postoperative follow-up and were contacted by telephone to complete the Goodman satisfaction scale, which assessed pain relief, function, overall satisfaction, and quality of life (QoL). Mean satisfaction and QoL scores were compared between groups using independent t-tests.

Results: A total of 156 patients were included (77 TKA alone; 79 TKA+OLR), with a mean age of 67.7±8.6 years; 80.8% were female. More than 80% of patients in both groups reported being fully or somewhat satisfied with their surgery. Patients undergoing TKA+OLR demonstrated a significantly higher mean satisfaction score compared with TKA alone (85.1 vs. 78.2; p=0.049; 95% CI, 0.04-13.93). Differences in QoL improvement between the groups were not statistically significant (5.09 vs. 4.82; p=0.16).

Conclusions: TKA combined with OLR was associated with higher patient satisfaction compared with TKA alone, although QoL improvement was similar between groups. These findings suggest that adjunctive OLR may provide additional benefit in patient-perceived outcomes without compromising overall QoL. Further prospective studies with larger cohorts are warranted to validate these results.

Functional outcomes of proximal femoral locking plate versus proximal femoral nail in subtrochanteric femur fractures

M. Mostafizur Rahman — 2025-12-26

Background: Subtrochanteric femur fractures are difficult to manage because of strong deforming muscular forces and high rates of implant failure. Although several fixation devices are available, the optimal choice remains debated. This study compared the functional outcomes of proximal femoral locking plate (PFLP) and proximal femoral nail (PFN) in subtrochanteric femur fractures.

Methods: A prospective observational study was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, from September 2019 to March 2022. Forty-four patients were included, where 22 treated using PFLP and 22 with PFN. Demographic and clinical data were recorded. Outcomes were assessed by radiological union, limb length discrepancy (LLD), hip pain, range of motion (ROM), Harris hip score (HHS), and complication rates.

Results: Union occurred significantly earlier with PFN (13.5±3.2 weeks) than with PFLP (15.6±3.1 weeks; p=0.007). Mean LLD was lower in PFN (0.2±0.33 cm) than in PFLP (0.43±0.47 cm; p=0.0003). Pain-free status was more common in PFN patients (63.6%) compared with PFLP (31.8%). Hip ROM was similar in both groups. However, mean HHS was significantly higher in PFN at final follow-up (89.2±10.1 versus 83.6±12.9; p=0.04). Excellent outcomes were more frequent with PFN (51.9%) than with PFLP (36.4%). Complications were fewer in the PFN group.

Conclusion: PFN offers superior functional outcomes and fewer complications compared with PFLP, supporting PFN as the preferred implant for subtrochanteric femur fractures.

Impact of the COVID-19 pandemic on prior authorization delays for lumbar surgery: a retrospective cohort study

Harneet S. Sangha — 2025-12-26

Background: The objective of this study was to evaluate the impact of the COVID-19 pandemic on prior authorization (PA) delays for lumbar surgery and to assess whether these changes varied by insurance type and patient demographics.

Methods: A retrospective cohort study comparing lumbar surgery patients treated before the COVID-19 pandemic (2017-2018) and after the pandemic (2022–2023). We reviewed 400 patient charts from Alpine Ortho spine clinic database in Eastern Washington, of which 363 met inclusion criteria. Eligible patients had documentation of preoperative clinic visit, PA request, and lumbar surgery as defined by CPT codes. Demographics, comorbidities, payer type, and surgical details were extracted from electronic medical records. For Medicare patients, who do not require PA, the interval from preoperative clinic visit to surgery was used for consistency. The primary outcome was time from PA request to surgery. Statistical analysis was performed using two-way ANOVA with Tukey’s HSD for post-hoc comparisons.

Results: The mean PA interval increased from 38.7±14.2 days in 2017-2018 to 60.4±15.8 days in 2022-2023 (p< 0.001). Female patients in 2022-2023 experienced longer delays (62.0 ± 15.1 days) than males (58.5±16.3 days, p=0.03). Across payer types, Medicaid patients waited the longest. In 2022-2023, Medicaid patients waited 66.7±15.6 days, Private patients 53.9±14.9 days, and Medicare patients 61.5±15.2 days.

Conclusions: PA delays for lumbar surgery significantly worsened following COVID-19, with disproportionate impacts on Medicaid and Medicare patients.

Retrospective observational study of role of platelet rich plasma in osteoarthrosis of knee joint among Indian population

Alok Prusty — 2025-12-06

Background: Direct release of platelet-derived factors at the site of cartilage disease, especially knee osteoarthrosis (OA), may promote tissue repair by further mediating the anti-inflammatory response and stimulating the natural regeneration signalling cascade. The study's objective was to assess how well platelet rich plasma (PRP) injections worked to improve joint function and lessen pain in Indian patients with osteoarthrosis of the knee.

Methods: The study was a retrospective, observational. It was a multi-centric study. The retrieved study data covered one year. Data of 150 participants were retrieved for the study. The study comprised patients between the ages of 40 and 75 who had knee osteoarthrosis (Kellgren–Lawrence grade I–III) that was confirmed by radiography and clinical examination. Only individuals who had received intra-articular PRP injections with at least six months of follow-up data, experienced chronic knee pain that lasted longer than three months, and were not responding to conservative treatment were eligible.

Results: The mean WOMAC score for patients with grade I–II OA (n=93) increased by 49.3%, from 66.1±7.3 at baseline to 33.5±5.4 after six months. On the other hand, the WOMAC score increased by 31.8% in grade III OA patients (n=57), from 72.1±6.8 to 49.1±5.7. In terms of pain and function, 65 patients (43.3%) reported good improvement and 58 patients (38.7%) reported outstanding improvement.

Conclusion: In patients with knee osteoarthrosis, especially in the early and intermediate phases of the condition, PRP therapy greatly reduced discomfort and improved functional outcomes.

A study of the functional assessment of the outcomes of proximal humerus fractures treated with the proximal humerus internal locking system

Vijay Yadav — 2025-12-15

Background: Proximal humerus fractures are common in adults, particularly in elderly individuals with osteoporosis. Modern fixation systems such as the PHILOS (Proximal Humerus Internal Locking System) plate aim to improve stability, reduce complications and facilitate early mobilisation. To assess the functional outcomes of displaced proximal humerus fractures managed with PHILOS plating in a tertiary care hospital.

Methods: This prospective observational study included skeletally mature adults (>18 years) with displaced proximal humerus fractures who underwent open reduction and internal fixation using PHILOS plating between July 2020 and July 2021. Exclusion criteria included open fractures, undisplaced fractures, fracture–dislocations limited to tuberosity, neurovascular injury and medical unfitness. Follow-up at 2, 6, 8 and 12 weeks assessed radiological union and functional recovery using the Constant–Murley Score. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0.

Results: Fifty–three patients were included with a mean age of 50 years and a male–to–female ratio of 4:1. Road traffic accidents accounted for 58.5% of injuries. Radiological union was confirmed in 96% by 12 weeks. Functional outcomes were good in 13 patients, moderate in 35 and poor in 5. Superficial wound infection occurred in 3 patients and implant failure in 1.

Conclusions: PHILOS plating provides stable fixation with predominantly moderate to good short-term functional outcomes and low complication rates in displaced proximal humerus fractures.

A prospective comparative study of functional outcome following platelet-rich plasma versus Triamcinolone injection for treatment of early primary osteoarthritis knee

Nirav Trivedi — 2025-11-11

Background: Osteoarthritis in knee joints is very common in developing countries in middle aged and elderly populations. Triamcinolone and platelet rich plasma (PRP) injections can increase the functional outcome and delayed need for surgical intervention in early primary osteoarthritis. This study is aimed to evaluate the functional outcome and the total time effect of the injection in the patients.

Methods: This is a prospective comparative study which included 100 patients out of which 50 were given triamcinolone injection and 50 were given PRP injection. Patients were selected as per grade 1 and grade 2 according to Kellgren Lawrence grade.

Results: Among 100 patients 71 were male and 29 were female with most common age group being 51 to 60 years followed by 41 to 50 years. Out of 100 patients grade 1 consisted of 69 patients and grade 2 consisted of 31 patients. The triamcinolone group had immediate better functional outcome for an average of 3-6 months whereas PRP injections had better outcome for an average of 6-12 months.

Conclusions: Patients injected with triamcinolone had an immediate better functional outcome for an average of 3-6 months whereas PRP injections had a delayed betterment of functional outcome which lasted for an average of 6-12 months.

Effectiveness of percutaneous autologous bone marrow injection in delayed and non-union of long bones after definitive fixation

Kumar Shreyaskar — 2025-11-17

Background: Delayed and non-union of long bones remain challenging complications despite stable fixation. Percutaneous autologous bone marrow injection (PABMI) provides osteogenic stimulation without the morbidity of open grafting.

Methods: This prospective observational study included 32 patients with delayed or non-union following internal fixation. Forty to sixty milliliters of autologous bone marrow aspirate was collected from the anterior iliac crest and injected percutaneously around the non-union site under fluoroscopic guidance. Patients were followed clinically and radiologically at 4, 8, 16, and 24 weeks.

Results: Radiological union improved progressively, from 3.1% at 4 weeks to 87.5% at 24 weeks (p=0.02). Patients operated within 1 week of injury and those presenting within 12 months of fixation had significantly higher union rates (p=0.021 and p=0.0038). No major complications were observed apart from transient donor-site pain.

Conclusion: PABMI is a safe, simple, and effective biological method for achieving union in delayed and non-union of long bones, with earlier intervention significantly improving outcomes.

From fracture to function: a Baird and Jackson score-based evaluation of bimalleolar ankle injuries

Saurabh Yadav — 2025-12-26

Background: Bimalleolar ankle fractures are common injuries that significantly impact mobility and quality of life. Open Reduction and Internal Fixation (ORIF) remains the standard for displaced fractures, though limited evidence exists regarding outcomes of combined fibular plating with screw or tension band fixation for the medial malleolus in Indian populations.

Methods: This prospective observational study was conducted at a secondary care teaching hospital in India. Thirty patients aged 18–65 years with displaced closed bimalleolar fractures underwent ORIF. The lateral malleolus was fixed with a one-third semi tubular or anatomical plate, while the medial malleolus was fixed with either cannulated cancellous (CC) screws (n=18) or tension band wiring (TBW) (n=12). Patients were followed up for three months and functional outcomes were assessed using the Baird and Jackson scoring system.

Results: The mean age was 37.9 years; males comprised 63.3% of cases. Road traffic accidents were the predominant cause (60%), with Supination-External Rotation being the most frequent injury mechanism. Weber type B fractures were most common (53.3%). At three months, functional outcomes were excellent in 43.3%, good in 36.7%, fair in 16.7% and poor in 3.3% of patients. The mean Baird and Jackson score was 93.4±4.57. Postoperative complications occurred in 26.7% (stiffness in 4, superficial infection in 4), all managed conservatively.

Conclusions: ORIF with fibular plating and medial malleolus fixation using CC screws or TBW provides favourable short-term functional outcomes and minimal complications. Larger studies with longer follow-up are needed to further validate these findings.

Condylar blade plate in subtrochanteric femur fractures: a robust implant forgotten way too early

Subodh Solanke — 2025-12-26

Background: Subtrochanteric femur fractures comprise 10-34% of hip fractures. While cephalomedullary (CM) nails have largely replaced fixed-angle devices like the condylar blade plate (CBP), CBP's superior angular and rotational stability warrant reassessment. This study evaluated functional and radiological outcomes of subtrochanteric fractures treated with CBP.

Methods: This prospective observational study at MIOT International Hospitals, Chennai, included 36 patients (31 males, 5 females; mean age 51.47 years) treated with CBP fixation from June 2015 to December 2016. Patients with acute unilateral subtrochanteric fractures aged >17 years were followed for two years or until union. Outcomes were assessed using the Lower Extremity Functional Scale (LEFS), clinical examination (range of motion, pain, deformity), and radiographic monitoring. Statistical analysis employed Chi-square and ANOVA tests (p<0.05).

Results: Mean radiographic union occurred at 15.61 weeks. Functional outcomes were excellent in 36.1% (n=13), very good in 13.9% (n=5), good in 27.8% (n=10), moderate in 16.7% (n=6), and poor in 5.6% (n=2). No patients exhibited varus malalignment or implant failure. The reoperation rate was 5.55%. CBP demonstrated effective anatomical reduction, strong stability, limb length restoration, and bone stock preservation.

Conclusions: CBP remains a viable fixation method for subtrochanteric fractures, offering outcomes comparable to CM nails with minimal complications. Its advantages in anatomical reduction, rotational stability, and bone preservation suggest CBP is underutilized in current practice and deserves reconsideration as a valuable treatment option.

A study to compare the functional outcome of anterior cruciate ligament reconstruction using autologous tendon graft with or without platelet rich plasma augmentation

Vikas Sharma — 2025-12-26

Background: Reconstructing the anterior cruciate ligament (ACL) poses significant challenges, particularly in achieving secure attachment between the tendon and bone. Bone integration within the bone tunnel determines the outcome, influenced by graft type and fixation method. Platelet rich plasma (PRP) may enhance the ligamentization process of the graft, facilitating improved incorporation within bone tunnels. This synergistic approach could mitigate tunnel enlargement and graft failure over time.

Methods: A prospective comparative study (August 2023-June 2024) involved 80 patients (18-45 years) with acute complete ACL tears. Patients were divided into two groups: Group A (n=40) received 6 ml PRP injection during arthroscopic ACL reconstruction, while Group B (n=40) underwent surgery without PRP. Follow-ups occurred at 6 weeks, 3 months, and 6 months

Results: At 6 months, PRP group's SNQ values indicated improved tendon-bone healing. Lysholm scores showed significant improvements at 3 (14.49%) and 6 months (10.67%) (p<0.05). IKDC scores demonstrated similar trends, with significant differences at 3 (12.67%) and 6 months (7.08%) (p<0.05).

Conclusions: The use of PRP improved Lysholm score, IKDC score and SNQ value to certain extent but we did not find any statistically significant benefit in the PRP group.

A comparison of intramedullary nailing versus plating in AO type 15.2B and 15.2C clavicle fractures: a prospective study

Nikhil Jain — 2025-12-26

Background: Midshaft clavicle fractures, particularly AO types 15B and 15C, are common orthopedic injuries. Surgical management is preferred in displaced fractures due to complications associated with conservative treatment. This study compares intramedullary fixation using titanium elastic nailing system (TENS) with conventional plating.

Methods: A prospective cohort study was conducted on 80 patients aged 15-70 years with AO 15B and 15C clavicle fractures. Patients were randomized into two groups: one treated with TENS and the other with plating. Surgical, radiological, and functional outcomes were evaluated at 1, 3, and 6 months postoperatively using Constant-Murley and DASH scores, union time, and complications.

Results: TENS group had significantly shorter union time (7.4 weeks vs. 8.9 weeks, p=10.024), smaller incision size, and shorter hospital stay. Functional scores were superior in the TENS group. TENS group had significantly shorter union time (p=0.024), smaller incision size, and shorter hospital stay. Implant prominence was more common with TENS, but plating had higher rates of infection, non-union, and implant failure.

Conclusions: TENS provides superior functional recovery, better cosmetic results, and fewer complications in AO 15B and 15C clavicle fractures. It is a cost-effective and efficient alternative to plating, especially in resource-limited settings. However, plating may offer more stable fixation in complex fracture patterns.

Correlation of neck-shaft angle with functional recovery following internal fixation of intertrochanteric femur fractures: a prospective observational study

Siddanagouda B. Biradar — 2025-12-26

Background: Intertrochanteric femur fractures are a common orthopaedic injury among the elderly. The postoperative neck-shaft angle (neck-shaft angle (NSA)) is a critical biomechanical parameter that may influence functional outcomes following internal fixation. This study aimed to assess the correlation between NSA and functional recovery in patients treated with proximal femoral nail (proximal femoral nail (PFN)) or proximal femoral nail (PFN)A2.

Methods: This prospective observational study included 80 patients aged >45 years with intertrochanteric femur fractures treated using PFN or proximal femoral nail anti-rotation 2 (PFNA2). NSA, femoral neck shortening and Harris Hip Score (Harris Hip Score (HHS)) were evaluated at immediate postoperative, 3 months and 6 months intervals. Statistical analysis included Pearson correlation, multivariate regression and ANOVA.

Results: At 6 months, NSA positively correlated with HHS (r=0.296, p=0.0077). Patients with NSA between 125°-135° showed statistically significantly better outcomes (63% excellent/good), while those with varus alignment (<125°) had poor outcomes in 83% of cases. Age negatively correlated with recovery (r=-0.452, p<0.0001). Closed reduction and PFNA2 implants were associated with more favourable results.

Conclusions: Restoration of NSA within the physiological range (125°-135°) is significantly associated with improved functional outcomes following intertrochanteric fracture fixation. Accurate anatomical alignment should be a surgical priority, particularly in elderly patients.

Functional and radiological outcome of patella resurfacing vs non-resurfacing in total knee replacement

Deepak D. Chitragar — 2025-12-26

Background: The knee joint is crucial for gait and mobility and osteoarthritis remains its most common debilitating condition. Total knee replacement (TKR) is the standard treatment, though controversy persists regarding patellar resurfacing. While anterior knee pain (AKP) is a leading source of dissatisfaction after TKR, resurfacing carries risks such as subluxation, fracture and loosening. The debate continues, particularly in populations with differing anatomy and lifestyle. To compare functional and radiological outcomes of TKR with versus without patellar resurfacing in a South Indian population.

Methods: This prospective comparative study was conducted at IORAS, Madurai, between August 2018 and July 2020. Out of 200 TKRs, 110 patients met inclusion criteria and were evenly divided into two groups: one underwent TKR with patellar resurfacing and the other without. All surgeries were performed by the same surgeon using the Posterior Stabilized Insall Burstein II knee system. Outcome measures included Knee Society Score (pain and function), Feller patellar score and radiographic patellar tilt, with follow-up at one year.

Results: At one year, no statistically significant differences were observed between resurfacing and non-resurfacing groups across pain, function, patellar scores or patellar tilt angles (p>0.05).

Conclusions: Patellar resurfacing offered no short-term advantage over non-resurfacing in terms of functional or radiological outcomes. Given the complexity of pain perception and lifestyle variability, further long-term studies are warranted. Each TKR case remains unique and modifying a single surgical variable is unlikely to change outcomes significantly.

Portal placement in elbow arthroscopy and risk of injury to major nerves and vessels: a cadaveric study

Mathew Joseph — 2025-12-26

Background: Elbow arthroscopy is one of the popularly used surgical procedures in treating various elbow pathologies. Cadaveric data on the safety of arthroscopic portals and data on outcome following an arthroscopic procedure of elbow is lacking. This study aimed to measure the distance of 5 arthroscopic portals from 7 selected neurovascular structures in cadaveric elbow in 3 different elbow positions.

Methods: Observational study was conducted at the All India Institute of Medical Science (AIIMS) Rishikesh, Uttarakhand India. A total 20 soft embalmed cadaveric elbow were dissected following placement of arthroscopic portals at different elbow positions. Data were compared and analysed using SPSS software with ANOVA test.

Results: Medial cutaneous nerve of forearm (MCNF) was injured (5/1020) which is <0.5% when using superomedial (SM) and anteromedial (AM) portals. Statistically significant change was found while considering Lateral cutaneous nerve of forearm (LCNF) from anterolateral (AL) portal at various angles of the elbow and brachial artery (BA) from AM portal. Rest of all structures did not show any statistical significance on changing angles of elbow flexion.

Conclusions: Minor nerves are at risk in certain portals. Position of AL portal is safer when compared to AM portal. With proper surgical guidelines, elbow arthroscopy is safe and much useful procedure which help the operating surgeon to choose the appropriate portal and also may aid in minimizing trauma to underlying structures during intervention.

Functional outcomes of distal radial fractures by 5 pin technique

Abdulla Harafan — 2025-12-26

Background: Distal radius fractures (DRF) are among the most common orthopaedic injuries. This study assesses the efficacy of a percutaneous five-pin fixation method for DRF, a procedure chosen for its minimal invasiveness and mechanical stability which promotes early postoperative wrist movement. We report on the clinical and functional results achieved with this technique in our patient cohort.

Methods: We prospectively followed 35 patients. At the 6-month postoperative mark, wrist function was quantified using the QuickDASH questionnaire, while radiographic alignment was assessed based on the criteria defined by Sarmiento's modification of Lindstrom.

Results: The mean age of patients was 45.2 years (range: 23-70 years), with a male predominance (71.4%). Road traffic accidents were the most common mode of injury (57.1%). The mean QuickDASH score at 6 months was 11.4, with 74.3% of patients achieving an excellent or good outcome. Radiological assessment showed excellent or good results in 80% of patients based on Sarmiento's criteria.

Conclusions: For displaced DRF with minimal fragmentation, the five-pin method offers a valuable treatment strategy that is not only successful but also economical and tissue-sparing. It provides stable fixation, enables early mobilization, and results in functional outcomes comparable to more invasive procedures like volar plating.

The functional outcome of hemiarthroplasty with cemented modular bipolar prosthesis in comminuted fracture intertrochanteric femur in elderly population

Mrinmoy Das — 2025-12-26

Background: There are several surgical treatment options available for comminuted intertrochanteric fractures but still, many controversies persist, as the postoperative complications increase with increased age. So, it is necessary to evaluate the role of hemiarthroplasty with cemented modular bipolar prosthesis in treating comminuted intertrochanteric fractures in elderly patients. The study aimed to analyse the functional outcomes of hemiarthroplasty with cemented modular bipolar prosthesis in comminuted fracture intertrochanteric femur in 42 elderly patients.

Methods: In this observational prospective study, all patients were taken up for surgery within seven days of their injury. Assessment was done by the modified Harris Hip Score (HHS) during discharge and follow-up visits and results are analysed by paired t test.

Results: There were 26 male and 16 female patients and a 50-50 % side distribution, with mean blood loss of 363.63 ml. Pre-injury ambulation, hypertension distribution analysis, diabetes distribution, hospital stay distribution analysis was done. Complications included superficial infection (14.29%), re-surgery (9.52%), limb length discrepancy seen in none of 76.19%, with a mean duration of surgery 95.86 minutes.

The primary focus was the functional recovery as measured by the HHS. The average HHS improved progressively from 58.24 at discharge to 85.9 at 6 months, reflecting sustained recovery across all follow-up intervals.

Conclusions: Cemented modular bipolar hemiarthroplasty is a highly effective treatment modality for elderly patients with unstable intertrochanteric fractures facilitating excellent functional recovery and minimizes complication rates.

Clinical evaluation of core decompression with bone marrow aspirate concentrate in early-stage avascular necrosis of the hip: a prospective observational study

G. V. S. Rawi Babu — 2025-12-26

Background: To evaluate the efficacy of core decompression (CD) combined with bone marrow aspirate concentrate (BMAC) in early-stage avascular necrosis (AVN) of the hip by assessing pain, stiffness, functional impairment and quality of life (QOL).

Methods: This prospective observational study was conducted at Gemcare Kamineni Hospital, Kurnool, on 46 patients with early-stage AVN (ARCO I–III). Patients underwent CD with BMAC. Outcomes were assessed pre- and post-operatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. Data were analyzed using paired t-test.

Results: Mean pain severity score decreased from 4.18±0.90 pre-operatively to 2.50±0.86 post-operatively (p<0.05). Joint stiffness improved from 3.31±0.76 to 2.15±0.76 (p<0.05). Physical functioning score improved from 3.68±0.86 to 2.38±0.78 (p<0.05). Total WOMAC score reduced significantly from 3.75±0.90 to 2.38±0.80 (p<0.05).

Conclusions: Core decompression combined with BMAC provides significant pain relief, improves hip function and enhances quality of life in early-stage AVN, delaying disease progression and the need for total hip arthroplasty.

Endoscopic lumbar decompression: a single-centre 40-case retrospective series

Dev R. Agarwal — 2025-12-26

Background: Endoscopic lumbar decompression is a minimally invasive technique with advantages of reduced blood loss, shorter hospital stays and early mobilisation compared to conventional open procedures. This study reports outcomes of 40 patients who underwent lumbar endoscopic decompression at a single tertiary care center.

Methods: Retrospective review of 40 consecutive patients with lumbar disc herniation or spinal stenosis who underwent endoscopic decompression. Clinical outcomes were measured using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pre-operatively and at final follow-up. Operative time, blood loss, hospital stay and complications were recorded.

Results: The mean age was 52 years (range 30–72), with 24 males and 16 females. The most common level was L4–L5 (60%). Mean VAS for leg pain improved from 8.1 to 2.1 (p<0.001) and ODI improved from 62% to 18% (p<0.001). Complications included 2 dural tears and 1 superficial wound infection. No revision surgeries were required. Mean hospital stay was 1.8 days.

Conclusions: Endoscopic lumbar decompression is a safe and effective technique for carefully selected patients, providing excellent pain relief, functional recovery and reduced morbidity.

Journey of a standalone paediatric orthopedic day-care surgical center catering wide variety of cases judiciously: a review of 300 surgeries

Soumya Paik — 2025-12-26

Background: In spite of known advantages of day care surgery (DCS) in children, multiple ambulatory surgical centres (ASCs) in different subspecialities of orthopedics, enhanced recovery after surgery (ERAS) protocol and advancement of paediatric anesthesia with guidelines, we see limited popularity of standalone day care paediatric orthopaedic facilities. We also do not have definite paediatric orthopaedic case guidelines for day care surgery unlike pediatric anesthesia and paediatric surgery. Purpose of this study to determine the possibility of various types of child orthopaedic surgery in a standalone day care set up in a safe, comfortable environment with cost minimisation.

Methods: A retrospective review of cases in a standalone private paediatric orthopaedic day care centre involving its first 300 surgeries over a span of two years. Wide variety of paediatric orthopaedic surgeries were performed in spite of having a long exclusion criteria list. Adverse reaction, cost minimisation and comfortable nature of this pathway were assessed.

Results: A total of 300 day-care surgeries between 17th August 2023 and 4th July 2025 in our centre. We broadly divided our surgeries into 12 categories like trauma, infection, benign tumour, osteotomy, cerebral palsy, removal of Implant, clubfoot etc. We selected our surgeries after 22 long exclusion criteria. We segregated our surgeries depending on duration of surgery, mode of anaesthesia, bodyweight of patient, age of patients. We had overall 8 adverse events, for an overall 2.6%. Our average surgical cost was USD $564 per surgery. No child suffered psychological disturbances requiring medical intervention.

Conclusions: DCS in paediatric orthopaedics in a standalone setup can be performed if we choose our patients judicially and follow appropriate pathways.

Evaluation of the results of intramedullary nailing of subtrochanteric femur fractures using either open or closed technique: a prospective study

Abhishek — 2025-12-26

Background: Subtrochanteric femur fractures constitute a difficult subset of proximal femoral injuries owing to the complex biomechanical stresses acting across the region. Although intramedullary nailing is the preferred fixation method, there remains controversy regarding whether open or closed reduction provides better clinical outcomes.

Methods: A prospective cohort study was conducted at Dr. RPGMC Tanda from 2022–2024 including 40 patients with subtrochanteric femur fractures. Patients were divided into two groups: open reduction internal fixation (ORIF) with intramedullary nail (n=18) and closed reduction internal fixation (CRIF) with intramedullary nail (n=22). Demographic, perioperative, and outcome parameters were analyzed. Functional outcome was assessed using the Merle d’Aubigné hip score. Statistical analysis was performed using SPSS v25.0; p<0.05 was considered significant.

Results: Mean age was 53.2±20.8 years. The mean operative time was significantly higher in the open group (124.2±24.9 min) than the closed group (94.6±9.8 min, p<0.001). Blood loss was greater in the open group (274.4±88.5 ml vs. 103.9±44.7 ml, p<0.001). Mean union time was 17.7±4.6 weeks in open versus 19.6±5.0 weeks in closed group (p=0.29). The open group demonstrated significantly higher Merle d’Aubigné scores at 18–42 weeks (p<0.05). Complication rates were similar between groups, with superficial infection noted in two open cases.

Conclusion: Both open and closed techniques of intramedullary nailing are effective for subtrochanteric fractures. Although open reduction entails longer surgery and higher blood loss, it allows better anatomical reduction and improved mid-term functional outcomes without increasing major complications.

Comparative study with 2 years follow up on the functional outcome of subvastus versus medial parapatellar approach in total knee arthroplasty in a tertiary care center in South India

Ashish Jacob Mathew — 2025-12-26

Background: There are many approaches while performing a total knee arthroplasty, with the medial parapatellar and the subvastus approaches being the more common among surgeons. While there are many studies comparing both the approaches, there is a lacuna regarding their long term functional outcome in the Indian population. The study aimed to evaluate the functional outcome of TKA through subvastus approach and medial parapatellar approach by using the knee society score, at postoperative day 5, 2 weeks, 6 weeks, 3 months, 6 months, 12 months and 24 months postoperatively.

Methods: This randomized controlled prospective study included patients with advanced knee osteoarthritis who underwent elective primary TKA either through the subvastus or medial parapatellar approaches at a tertiary care center in South India from January 2021 to December 2024 .Knee Society Scores were compared in the two groups of patients on postoperative day 5, 2 weeks, 6 weeks, 3 months, 6 months, 12 months and 24 months postoperatively.

Results: 300 people were included in the study of which, of which 150 of them underwent a TKA via a medial parapatellar approach and the rest via the subvastus approach. There was an overall significant change over time in KSS scores but the results were comparable between the two groups. The subvastus group showed significantly quicker return of quadriceps function and shorter hospital stays. The medial parapatellar group has the shorter surgical time.

Conclusions: Both approaches are comparable in terms of functional outcome, with the subvastus approach showing a longer surgical duration but a quicker return of quadriceps function and shorter hospital stay.

Retrospective analysis of prevalence of discoid lateral meniscus in medial compartmental osteoarthritis knee lead to total knee arthroplasty: an observational study

Sreejith Thundathil — 2025-12-26

Background: In Asia, the occurrence of the discoid lateral meniscus in the knee ranges from 9.1% to 10.5%. Nawata et al, found that among individuals with a discoid lateral meniscus, subchondral bone sclerosis was more frequently observed in the medial compartment and there was a higher prevalence of varus inclination. Our hypothesis was that individuals with a discoid lateral meniscus faced a significantly higher incidence of osteoarthritis and deformities. In our study, we assessed the prevalence of discoid lateral meniscus in individuals who underwent total knee arthroplasty for osteoarthritis knee.

Methods: In our study, we retrospectively reviewed 324 patients (364 knees) fulfilling the criteria who underwent Total knee replacement. We analyzed the prevalence of discoid lateral meniscus in osteoarthritis knee in our study.

Results: In our study involving 324 patients (364 knees) with Osteoarthritis knee, varus deformity was observed in 298 patients (312 knees). Among these 324 patients, 64 patients (72 knees) had discoid lateral meniscus. Our findings show that individuals with a discoid meniscus are likely to develop osteoarthritis approximately 5 years earlier than those with a normal meniscus. Furthermore, in our study, the prevalence of discoid lateral meniscus among individuals with osteoarthritis of the knee was found to be around 20 percent (19.75%).

Conclusions: A discoid lateral meniscus can lead to osteoarthritis in the knee with varus malalignment much earlier than people with a normal semilunar meniscus.

Functional outcomes of anatomical anterior cruciate ligament reconstruction using single-bundle quadruple hamstring graft: a prospective study using the Lysholm score and single hop test

Shanshah Sheikh — 2025-12-26

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related knee injuries. Anatomical reconstruction techniques have evolved to restore native knee kinematics. This study aimed to evaluate the functional outcomes of anatomical ACL reconstruction using a single-bundle quadruple hamstring tendon graft.

Methods: A prospective study was conducted involving 30 patients with isolated ACL tears confirmed clinically and radiologically. All patients underwent anatomical single-bundle ACL reconstruction using a quadruple hamstring graft with femoral fixation via an Endobutton and tibial fixation with an interference screw. Functional outcomes were assessed using Lysholm Knee Scoring Scale and the Single Hop Test preoperatively and at 6 months postoperatively.

Results: The mean preoperative Lysholm score improved from 54.46 to 91.06 at 6 months, indicating statistically significant improvement (p<0.001). The Single Hop Test showed a marked increase in limb symmetry index from a preoperative mean of 44.35% to 83.50% postoperatively, reflecting substantial functional recovery. No major postoperative complications were reported.

Conclusions: Anatomical ACL reconstruction using a single-bundle quadruple hamstring graft provides excellent short-term functional outcomes with minimal morbidity. This technique offers reliable restoration of knee function and stability, with promising results in active patients.

Prospective study to evaluate the functional and radiological outcome of intra-articular fractures of distal end humerus fixed with dual plating

Yogesh Kumar Shahu — 2025-12-26

Background: Distal humerus fractures, however rare in adults, pose significant surgical problems due to their intricate anatomy and articular involvement. For functional motion, AO type C intra-articular fractures need stable fixation. Despite scant Indian evidence, dual-plate osteosynthesis is commonly used.

Methods: A prospective observational study at Tata Main Hospital, Jamshedpur, patients with AO type C distal humerus fractures. Each was open reduced and internally fixed with dual plating (orthogonal or parallel). Radiological combination was described by joining three cortices and functional outcomes were measured by the Mayo Elbow Performance Score (MEPS). After the Shapiro–Wilk test showed that the data were normal, statistical analysis was done.

Results: Mean age: 49.5±12.5 years and 51.6% of them were women. Falls were the main cause of most AO type C2 fractures (51.6%). MEPS was much higher in people younger than 60 than in people older than 60 (p=0.016). Mean MEPS was highest for C1 fractures and lowest for C3 fractures (p=0.068), but there was no link between the two that was significant. As many as 80.6% of the results were good or excellent.

Conclusions: Dual-plate fixation effectively reduces AO type C distal humerus fractures, enabling early mobilization and improved function. Younger age improves prognosis, but fracture complexity does not. Prospective design and standardized evaluation are study strengths, but small sample size and restricted follow-up are weaknesses. Multicentric trials should be larger.

Comparison of functional outcomes of modular bipolar hemiarthroplasty done in direct lateral versus posterior approaches

Navneeth Sushama Bhaskaran — 2025-12-26

Background: Fracture neck of femur (FNF) is a common osteoporotic injury in the elderly, contributing significantly to morbidity and mortality. Hemiarthroplasty is widely accepted for displaced FNF; however, the optimal surgical approach remains debated. This study compared the functional and radiological outcomes of cemented modular bipolar hemiarthroplasty performed via direct lateral versus posterior approaches.

Methods: A retrospective cohort study was conducted at Kovai Medical Centre and Hospital, Coimbatore, including 100 patients (aged 51–90 years) who underwent cemented modular bipolar hemiarthroplasty for FNF between June 2018 and June 2019, with one-year follow-up. Patients were grouped based on surgical approach: direct lateral (Group L, n=50) and posterior (Group P, n=50). Intraoperative and postoperative parameters, including operative time, blood loss, hospital stay and complications, were recorded. Functional outcome was assessed using the Harris Hip Score (HHS) and radiological assessment included stem alignment, loosening, acetabular erosion and heterotopic ossification. Statistical analysis was performed using Chi-square and t-tests, with p<0.05 considered significant.

Results: Baseline demographics and injury characteristics were comparable between groups. Group L had slightly higher mean operative time and blood loss, while hospital stay and time to weight bearing were similar. Functional outcomes favored Group L, with a higher mean HHS (84.04 vs. 80.06) and greater proportion of excellent/good results (90% vs. 68%). Radiological complications were infrequent and comparable across groups.

Conclusions: Cemented modular bipolar hemiarthroplasty is effective in managing FNF in the elderly. The direct lateral approach offers superior functional outcomes, whereas the posterior approach provides shorter operative time but higher dislocation risk. Surgical approach should be individualized.

Arthroscopic anterior cruciate ligament reconstruction with meniscal repair: single-sitting versus multiple-staged-functional outcome analysis

Praveen T. Kunapareddy — 2025-12-26

Background: Anterior cruciate ligament (ACL) injuries are frequently associated with meniscal tears. Management can be performed either as a single sitting procedure (ACL reconstruction with concomitant meniscal repair) or in staged operations. The optimal strategy regarding functional recovery remains debated. The purpose of this study was to compare functional outcomes of single sitting versus multiple sitting arthroscopic ACL reconstruction with meniscal repair using peroneus longus tendon (PLT) autograft.

Methods: A prospective comparative study was conducted on 30 patients aged 18–50 years with ACL rupture and repairable meniscal tears, treated between November 2023 and November 2025. Patients were divided into two groups: group A (n=15) underwent single sitting ACL reconstruction with meniscal repair, and group B (n=15) underwent staged procedures. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Lysholm score at baseline and at 12 months.

Results: All patients completed a minimum follow-up of 12 months. Both groups showed significant improvement from baseline. IKDC: 84.8±6.4 (group A) versus 82.1±6.8 (group B), p=0.21. Lysholm: 89.4±5.2 (group A) versus 86.7±5.6 (group B), p=0.19. Median time to return to sport was 7 months in group A and 9 months in group B. No graft re-ruptures were reported. Meniscal healing failure occurred in 1 patient (6.7%) in group A and 2 patients (13.3%) in group B.

Conclusion: Single sitting arthroscopic ACL reconstruction with meniscal repair using peroneus longus tendon autograft provides functional outcomes comparable to multiple sitting procedures, with the added advantage of earlier return to sport. It is a safe and effective option in appropriately selected patients.

Comparative outcomes of open and arthroscopic approaches for recurrent anterior shoulder instability

Buddharaju Suraj Verma — 2025-12-26

Background: A prominent orthopedic ailment that severely impairs function and lowers quality of life in young, energetic people is recurrent anterior shoulder instability. Surgical intervention is often required to restore stability and prevent repeated dislocations. Open Latarjet and arthroscopic Bankart repair are the two widely employed techniques, but comparative outcomes remain debated. Aim was to evaluate the clinical and functional results of open surgery against arthroscopic surgery in the past for patients with recurrent anterior shoulder instability.

Methods: A retrospective study was conducted at the Department of Orthopaedics, NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam, from May 2023 to April 2025. A total of 30 patients with recurrent anterior shoulder instability were included, with 15 undergoing open surgical repair and 15 receiving arthroscopic repair. Data on demographics, clinical presentation, surgical procedure, functional outcomes (Rowe and Constant-Murley scores), recurrence, and complications were collected from hospital records. SPSS version 23.0 was used for the statistical analysis, and a p-value of less than 0.05 was deemed significant.

Results: Both open and arthroscopic groups demonstrated significant postoperative improvement in functional scores. The mean Rowe score was 85.4±6.8 in the open group and 88.1±5.9 in the arthroscopic group (p=0.28), while the Constant-Murley score was 82.6±7.2 and 85.3±6.7, respectively (p=0.31). Recurrent instability occurred in 20% of the open group and 13.3% of the arthroscopic group (p=0.63). Complications such as stiffness and superficial infection were slightly higher in the open group, However, there were no statistically significant variations.

Conclusions: Recurrent anterior shoulder instability can be effectively managed with both open and arthroscopic surgical procedures providing excellent functional recovery and low recurrence rates. Arthroscopic repair demonstrated marginally better functional outcomes and fewer complications, but differences were not statistically significant. The choice of surgical technique should be individualized based on patient characteristics, extent of glenoid bone loss, activity level, and surgeon expertise. Both procedures remain reliable options for restoring shoulder stability.

From oysters to orthopedics: Bone-02 as a novel injectable fixation material

Muhammad S. Aamir — 2025-12-26

Fractures remain a major global health burden, with 178 million new cases reported in 2019 and annual costs exceeding $100 billion worldwide. Conventional fixation methods, though effective, are limited by stress shielding, delayed remodeling, and the need for secondary hardware removal. Bio-inspired adhesives have long been sought as alternatives, and recent reports describe Bone-02, a novel oyster-inspired injectable adhesive developed at Wenzhou Medical University and Sir Run Run Shaw Hospital in Hangzhou. Bone-02 is designed to cure in wet physiological environments, achieve stable fixation within minutes, and biodegrade over approximately six months. Early clinical experience in more than 150 patients suggests rapid application, reduced operative time, and favorable recovery outcomes, with one case of wrist fracture reportedly managed in under three minutes and healing completed within six months. The material mimics oyster cement, combining organic and inorganic bone-derived components to provide mechanical strength, biodegradability, and safety, though mechanistic details and degradation by-products remain undisclosed. While these preliminary institutional reports are compelling, independent validation, peer-reviewed clinical data, and multicenter trials are lacking. Key questions regarding long-term safety, union rates, inflammatory response, and performance under load-bearing conditions must be resolved before global adoption. Bone-02 represents a promising advance in fracture fixation, with the potential to minimize invasiveness, eliminate hardware-related morbidity, and redefine fracture care worldwide. However, it should currently be regarded as an experimental innovation requiring rigorous scientific validation before routine clinical use.

A case report of Leri-Weill dyschondrosteosis with bilateral Madelung deformity managed by Vicker’s ligament release and dome osteotomy

Adarsh Rajan Sujatha — 2025-12-26

Leri-Weill dyschondrosteosis (LWD) is an uncommon skeletal dysplasia marked by mesomelic limb shortening and the typical wrist abnormality known as Madelung deformity. It results from reduced activity of the SHOX gene. We report a 9-year-old girl with a 4-year history of progressive, painless deformities affecting both forearms. Examination revealed short stature (116 cm), bilateral forearm shortening, dorsal prominence of the ulna, and restricted ulnar deviation and elbow extension. Genetic evaluation confirmed a pathogenic SHOX mutation. Surgical treatment with bilateral distal radius dome osteotomy combined with Vicker’s ligament release was performed. Postoperatively, the patient achieved good cosmetic correction and marked functional improvement. This case emphasizes the importance of evaluating SHOX-related disorders in children presenting with short stature and wrist deformity. Combined ligament release with corrective osteotomy offers both functional and cosmetic benefit in LWD patients.

Dual approach for internal fixation of a complex talar fracture in a 20-year-old male

Yogesh D. Narkhede — 2025-12-26

Talus bone plays a pivotal role in foot and ankle function. Due to its inherent blood supply, talar fracture poses high risk of AVN (avascular necrosis). The objective of this case report was to provide valuable insights into the surgical management of this unique talar fracture, shedding light on the efficacy of specific surgical techniques and the absence of avascular necrosis in the patient's 18-month postoperative follow-up. By detailing the distinct characteristics and management of this complex talar fracture, we hope to contribute to the existing body of knowledge on talus fractures and aid in the development of improved treatment approaches for similar cases. A 20-year-old male with a history of fall, presented to hospital after 1 day of fall with swelling, tenderness around foot and ankle, ecchymosis. the patient was evaluated in the form of imaging and blood work up and planned for surgery. open reduction and internal fixation were done with Herbert screws. talus was approached through anteromedial and anterolateral incisions without medial malleolus osteotomy. Identification of fracture patterns is crucial for management and outcome. Dual incision facilitates disimpaction, accessing talar dome area. At 18 months the outcome was satisfactory painless ROM, with no signs of AVN.

From collapse to consolidation: salvage of lateral plate failure in a medial-deficient distal femur fracture

Suyog Wagh — 2025-12-26

Distal femur fractures with medial metaphyseal deficiency pose significant biomechanical challenges, and lateral plating alone may be insufficient to resist varus forces. We reported the case of a 40-year-old male who sustained a distal femur extra-articular fracture with substantial medial cortical bone loss. Initial fixation with a lateral locking plate and cancellous graft failed due to early, unadvised weight bearing, resulting in varus collapse and plate deformation within one week. Revision surgery included removal of failed implants, debridement, and application of a longer lateral locking plate, combined with reconstruction of the medial column using an autologous fibular strut graft inserted intramedullary. A contoured medial plate was added to create a dual-plating construct. Postoperative rehabilitation followed a protected, staged weight-bearing protocol. Radiographs at 3 months demonstrated bridging callus, and by one year the patient achieved painless independent ambulation with maintained alignment and no implant-related complications. This case illustrates the mechanical vulnerability of lateral-only constructs in medial-deficient distal femur fractures and highlights the benefits of dual plating with structural grafting in both primary and salvage settings. Augmenting the medial column improves load sharing, reduces varus stress on the lateral plate, and enhances construct stability. Early recognition of at-risk patterns, appropriate implant selection, and cautious rehabilitation are critical to preventing fixation failure. Timely revision using dual plating and graft support can successfully salvage early collapse and restore function.

Single staged rotational osteotomy for congenital radioulnar synostosis: a case report

Sushant Nadkarni — 2025-12-26

Congenital radioulnar synostosis is a rare congenital anomaly characterized by a failure of segmentation between the proximal radius and ulna during embryonic development, leading to restricted forearm rotation. The condition is often bilateral and may be associated with syndromic disorders. Management varies depending on severity, ranging from observation and physiotherapy to surgical correction. A six-year-old boy presented with bilateral limitation of forearm rotation interfering with daily activities. The right forearm was fixed in 60° pronation and the left in 20° pronation. Radiographs confirmed osseous fusion between the proximal radius and ulna without radial head dislocation, consistent with Cleary and Omer type II congenital radioulnar synostosis. A single-stage rotational osteotomy of the radius and ulna was performed on the right side under general anesthesia. The osteotomies were created distal to the synostosis, and the forearm was rotated to achieve 20-30° of supination without internal fixation. The limb was immobilized in an above-elbow cast for five weeks. Postoperative recovery was uneventful, and at four months, the patient demonstrated union at the osteotomy sites with significant improvement in functional activities such as feeding and self-care. Surgical correction is indicated in cases with significant functional limitation. Performing the osteotomy distal to the synostosis reduces the risk of neurovascular injury. The single-stage rotational osteotomy provided satisfactory correction and improved forearm function without complications. This case highlights the effectiveness and safety of distal single-stage rotational osteotomy in managing congenital radioulnar synostosis in children.

Tuberculous tenosynovitis of wrist – a diagnostic uncertainty

Udayakumar D. — 2025-12-26

Among the rare manifestations of extrapulmonary TB, musculoskeletal involvement is uncommon but significant, with TB synovitis being a particularly rare form. TB synovitis typically affects the larger, weight-bearing joints such as the hip or knee, but the involvement of the wrist is exceedingly rare, and the reported incidence is around 5%. So, it may be easily mistaken for other inflammatory conditions like rheumatoid arthritis or septic arthritis. Here we report a rare case of a 50-year-old gentleman who presented with complaints of swelling over the right wrist for 3 months. Swelling was insidious in onset, progressive and associated with pain and restriction of movements. The patient had no history of trauma. On examination, there were 2 swellings of size 5×5 cm noted over dorsal aspect and 2×2 cm over volar aspect of wrist which was soft in consistency and fluctuation test was found to be positive. Radiological imaging showed erosion of all carpal bones and base of 2^nd, 3^rd, 4^th, 5^th metacarpals extending to radio-ulnar joint. MRI showed T1 hypointense, T2/STIR high signal density collection in subcutaneous plane. Patient underwent open tenosynovectomy and intraoperatively, cheesy caseous material was found. Samples were sent for analysis and showed granulomatous tenosynovitis on histopathological examination and M. tuberculi was detected on CBNAAT. This case is being reported for its rare, uncommon site and presentation. TB synovitis of wrist can be misdiagnosed as simple ganglion cyst, so we recommend CBNAAT analysis for all tenosynovitis cases. This case report highlights a rare instance of TB synovitis involving the wrist, focusing on its clinical presentation and diagnostic approach. It emphasizes the need for a high index of suspicion for tuberculosis in endemic regions or in patients with relevant risk factors, as early diagnosis and treatment are crucial to prevent irreversible joint damage and systemic complications.

Synovial haemangioma in posterior intercondylar region of knee: a case report

Vivek G. Shetty — 2025-12-26

We report the case of a young male with gradually worsening knee pain and terminal restriction of flexion which on magnetic resonance imaging (MRI) showed features suggesting a diagnosis of synovial haemangioma in the posterior intercondylar region. The mass was excised, and the histopathology confirmed the diagnosis post-operatively. After excision, the patient was pain free with full range of movements at 2-year follow-up.

Late presentation of distal biceps brachii tendon rupture in a collegiate cricket player treated with peroneus longus interposition graft augmented repair – a case report

Anand K. Somasundaram — 2025-12-26

The incidence of distal biceps brachii tendon rupture in athletes is a rare condition with an incidence of 1.2 – 2.55 cases per 100,000 patients per year. The injury mechanism often involves an eccentric load on a flexed, supinated elbow. Most commonly, these injuries occur in strength athletes and in those involved in contact sports such as American football and rugby. The additional risk factors include smoking, anabolic steroid use and obesity. Distal biceps brachii tendon rupture is a very rare injury in cricket players which has not been reported in the published literature. A delayed presentation of such an injury is even more rare and a challenge to the treating physician. A club-level cricket player in his late thirties presented 3 months after an injury to his left elbow while playing a match. His complaints were pain and inability to play the cricketing drive shots. On clinical examination he had good power of isolated elbow flexion with poor grades of power of supination of his forearm in a flexed elbow position. The distal biceps brachii tendon was not palpable in a hook test with mild swelling of his arm with a ‘popeye’ bulge on attempted elbow flexion. He was diagnosed to have a distal biceps brachii tendon rupture and was managed with surgical repair incorporating an autologous peroneus longus tendon as an interposition graft. At six months follow-up he was completely recovered and back to playing cricket. This case signifies the importance of diagnosing a rare cricketing injury. A detailed surgical plan which essentially involved confirming the site of rupture of the tendon, planning for an interpositional tendon augmentation in view of the retracted, immobile tendon ends and a tailored rehabilitation program was instrumental in yielding a successful outcome.

Anterior cruciate ligament and popliteus tendon injuries associated with a cyamella: a rare case report

Mounika N. S. Chodavarapu — 2025-12-26

The cyamella is a rare sesamoid bone in the popliteus muscle. This small ossicle may alter the biomechanics of the popliteus, potentially affecting knee function leading to instability. We report a 19-year-old male with a right knee injury from an auto rollover accident. Imaging revealed an anterior cruciate ligament (ACL) rupture, an intra-articular loose body, a cyamella, and a popliteal tendon avulsion. ACL reconstruction was performed, and the cyamella and loose body were excised. The tendon avulsion was repaired with a suture anchor. At one-year follow-up, the patient had full knee movement without instability. This case highlights a rare injury combination and excellent surgical outcomes when promptly identified and treated.

Repurposing the Suzuki frame: a novel approach for neglected proximal interphalangeal joint intra-articular fracture management

Sunil Patidar — 2025-12-26

Neglected intra-articular fractures of the proximal interphalangeal (PIP) joint pose significant challenges due to joint stiffness, malalignment, and compromised function. Traditional management often yields suboptimal outcomes, especially in delayed presentations. We report a novel application of the Suzuki frame-conventionally used for distal interphalangeal (DIP) joint injuries-in the treatment of a neglected PIP joint intra-articular fracture in a young male patient. The fracture was managed using a dynamic external fixator constructed with K-wires and rubber bands, allowing controlled distraction and early mobilization. A modified Suzuki frame was applied across the PIP joint, achieving stable fixation and facilitating gradual distraction. The construct enabled early range-of-motion exercises while maintaining reduction. Radiological and functional outcomes were assessed over a 12-week follow-up. The patient demonstrated excellent clinical recovery, with restoration of joint alignment, pain-free range of motion, and return to pre-injury activity levels. Radiographs confirmed satisfactory fracture healing and joint congruity. This case highlights the versatility of the Suzuki frame in managing complex PIP joint injuries, especially in neglected cases. The technique offers a minimally invasive, cost-effective, and function-preserving alternative that warrants further exploration in larger cohorts.

Primary bone lymphoma of the distal femur – a case report

Praloy Basu — 2025-12-26

Primary bone lymphoma (PBL) is a rare extranodal lymphoma that arises within skeletal structures, most often as diffuse large B-cell lymphoma (DLBCL). It typically presents with localized pain and swelling and requires a high index of suspicion for diagnosis. A 53-year-old man presented with pain and swelling over the distal femur. Imaging revealed a lytic-sclerotic lesion with cortical breach and soft-tissue extension. Biopsy confirmed large B-cell lymphoma, germinal center subtype. Staging workup showed no nodal or marrow involvement, consistent with Stage IE disease. The patient was treated with one cycle of CVP followed by six cycles of Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone (R-CHOP) and involved-field radiotherapy (40 Gy/20 fractions). Post-treatment positron emission tomography-computed tomography (PET-CT) showed complete metabolic response. Combined-modality treatment with R-CHOP chemoimmunotherapy and radiotherapy offers excellent outcomes in localized PBL. Early diagnosis, accurate staging, and multidisciplinary management are crucial for durable remission and optimal survival.

Surgical management of an isolated humeral trochlear fracture: a rare case report

Rijesh Pottangadi — 2025-12-26

Isolated fractures of the humeral trochlea (Laugier’s fracture) are extremely rare, with few cases documented in literature. We report the case of a 78-year-old man with diabetes, hypertension, and chronic kidney disease who sustained a displaced intra-articular trochlear fracture following a fall. Diagnosis was confirmed with CT after plain radiographs suggested a distal humeral fracture. Open reduction and internal fixation (ORIF) were performed using a Herbert screw through an anteromedial approach. The patient achieved good functional recovery with early mobilization. This case highlights the importance of CT in diagnosis, surgical planning, and the efficacy of headless screw fixation in restoring stability and function.

Effectiveness and safety of robotic-assisted total knee arthroplasty versus conventional manual technique: a systematic review focusing on clinical and functional outcomes

Alfredo Carlos Chávez — 2025-11-06

Robotic-assisted total knee arthroplasty (RA-TKA) improve surgical precision over conventional manual TKA (CM-TKA). This review discussed their clinical and functional outcomes and safety. A PRISMA-compliant systematic review of comparative studies from multiple databases up to October 2024. Data were pooled for key outcomes. RA-TKA significantly reduced mechanical alignment outliers (RR=0.33, 95% CI 0.19-0.59) and mean deviation from neutral axis (MD=-0.93°). Operative time was longer for RA-TKA (MD=+19.94 minutes). Analysis of patient-reported outcomes showed a statistically significant but clinically insignificant improvement in Knee Society Score (MD=+1.03 points). No significant differences were found in WOMAC, Oxford Knee Scores or overall complication and revision rates. However, RA-TKA was associated with a higher Forgotten Joint Score at 1, 2, and 5 years and improved early gait stability. Some cohorts reported shorter hospital stays and higher patient satisfaction (95.0% vs. 87.4%) with robotics. Registry data confirmed no reduction in early revision risk. RA-TKA provides superior alignment but no consistent functional superiority or safety advantage over CM-TKA.

Critical evaluation of the parameters used in randomized controlled trials of quadriceps tendon, bone-patellar tendon-bone, and hamstring tendon for anterior cruciate ligament reconstruction: a systematic review

Juan Ramón Jiménez-Castro — 2025-12-26

Anterior cruciate ligament (ACL) reconstruction using autologous quadriceps tendon (QT), bone-patellar tendón-bone (BPTB), and hamstring tendon (HT) grafts has been extensively investigated in randomized controlled trials (RCTs). However, few systematic reviews have analyzed how functional and stability outcomes are measured or the methodological consistency of the evaluation tools employed. Objectives were to systematically review RCTs comparing QT, BPTB, and HT grafts for ACL reconstruction, emphasizing the assessment methods, parameters used, and methodological limitations. Eleven RCTs were included. Functional scales (IKDC, Lysholm, Tegner, KOOS), stability tests (Lachman, pivot-shift, KT-1000), pain and strength measurements, and follow-up duration were analyzed. Methodological consistency, completeness of outcome reporting, and comparability between studies were also assessed. Eleven RCTs comprising 692 patients were analyzed. Comparable clinical efficacy was observed among QT, BPTB, and HT grafts regarding joint stability and function. Nevertheless, significant heterogeneity existed in evaluation tools. Objective assessments such as quadriceps strength, KT-1000 anterior translation, and MRI follow-up were inconsistently reported. Most studies relied primarily on patient-reported outcome measures (PROMs) such as Tegner, Lysholm, and IKDC, without standardized timing or threshold values, limiting interstudy comparability. This review highlights substantial methodological variability in how clinical and functional outcomes are evaluated after ACL reconstruction. Beyond clinical equivalence among grafts, there is a pressing need to establish standardized, objective, and comprehensive assessment protocols to enhance the quality, reproducibility, and clinical relevance of future comparative trials.

Nutritional considerations for postoperative recovery in orthopaedic surgeries

Priyank Sahoo — 2025-12-26

India has witnessed a substantial increase in joint replacement surgeries over the past two decades. Despite surgical advances, suboptimal nutritional status remains a major determinant of poor postoperative outcomes, including delayed wound healing, muscle atrophy, and increased infection risk. Protein energy malnutrition (PEM) is a strong predictor of adverse outcomes and delayed wound healing. Supplementation with high quality protein, essential amino acids (EAAs), and β-hydroxy β-methylbutyrate (HMB) have demonstrated benefits in preserving muscle mass, promoting anabolic recovery and reducing postoperative complications. Emerging evidence suggests promising roles for collagen, hyaluronic acid, and plant-based nutraceuticals in orthopaedic recovery, though the extent of impact of these nutrients remain underexplored. Collagen peptides may enhance wound healing, connective tissue regeneration, and mitigate the relapse of osteoarthritis (OA). Hyaluronic acid, with its immunomodulatory and regenerative functions, shows potential in post-surgical tissue repair and symptom relief. Furthermore, plant-derived bioactives such as curcumin, Boswellia serrata, and palmitoylethanolamide (PEA) demonstrate anti-inflammatory and analgesic effects, offering alternatives to conventional NSAIDs with fewer adverse effects. This review evaluates the current evidence supporting perioperative nutritional strategies to enhance recovery following orthopaedic surgeries.