International Journal of Research in Orthopaedics

Outcome of dynamization in delayed union of femoral shaft fracture

M. Humayun Kabir — 2025-10-27

Background: Delayed union in femoral shaft fractures presents a significant clinical challenge despite the widespread success of intramedullary nailing (IMN). Nail dynamization is a minimally invasive and cost-effective intervention that promotes healing by increasing interfragmentary motion. This study evaluates the clinical and radiological outcomes of nail dynamization in delayed union cases and identifies key prognostic factors influencing healing.

Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh, between March 2019 and March 2024. Twenty-four patients with delayed union of femoral shaft fractures, initially treated with static interlocking IMN, underwent dynamization. Radiological and functional outcomes were assessed, and statistical analyses were performed to identify predictors of union.

Results: The mean time from nailing to dynamization was 21.1±2.6 weeks, with a mean union time of 21.4±1.4 weeks. 79.17% of patients achieved union, while 20.83% progressed to nonunion. Earlier dynamization correlated significantly with higher union rates (p=0.01). Smoking was a major risk factor for nonunion (p=0.047), with 93.33% of nonunion cases occurring in smokers. FHI was a strong predictor of union (p=0.002), with higher FHI values associated with successful healing. Functional outcomes were excellent in 62.50% of patients, and 66.67% reported no pain at the final follow-up.

Conclusion: Nail dynamization is a clinically effective and low-cost intervention for delayed union of femoral shaft fractures. Timely dynamization and higher FHI values significantly predict successful healing, while smoking negatively impacts outcomes. These findings highlight the need for early intervention and patient-specific treatment strategies to optimize fracture healing.

Surgical outcome of brachial plexus surgery: our experience

Asif Ahmed Kabir — 2025-10-27

Background: Brachial plexus injuries (BPIs) result in significant functional impairments, especially in developing countries like Bangladesh, where road traffic accidents are common. Advances in microsurgical techniques, such as nerve transfers and grafting, have improved outcomes. This study aims to evaluate the surgical outcomes of BPIs and contribute to optimizing treatment strategies for better recovery and functional restoration in patients with these complex injuries. To evaluate surgical outcomes, assess functional recovery and compare various surgical techniques for BPI management.

Methods: This prospective observational study, conducted from May 2013 to March 2025, included 95 patients with post-traumatic BPIs from four major hospitals. Surgical interventions, including nerve transfers and grafting, were performed based on injury type. Preoperative and postoperative data were collected, including motor function assessment and patient rehabilitation outcomes, with follow-up at regular intervals for recovery monitoring.

Results: The study included 95 patients with brachial plexus injuries, predominantly in the 18–30 age group (63.16%) and male (63.16%). The most common injury type was upper brachial plexus (42.1%), followed by global injuries (21.1%). Nerve transfers, especially Oberlin II, were the most performed surgery (31.6%). Postoperatively, 42.1% achieved good motor recovery (Grade 4), while 26.3% had excellent recovery (Grade 5). The follow-up ranged from 0–25+ months.

Conclusions: Microsurgical techniques have improved brachial plexus injury management, but full upper limb function recovery remains suboptimal, especially in global injuries.

Result of management of closed distal radial fracture by Ayjaz Azim foundation mini external fixator

Shawon Dutta — 2025-10-27

Background: Distal radius fractures are one of the most common orthopedic conditions and intra-articular types (AO/ASIF type C) are difficult to treat. While various treatment options exist, external fixation remains valuable, particularly in the developing world. The present study evaluated the efficacy of the Ayjaz Azim foundation (AAF) mini external fixator for the treatment of closed, complete articular distal radius fractures.

Methods: This study evaluated outcomes in 32 patients with closed intra-articular distal radial fractures by purposive sampling. Patients between 18 and 60 years, within two weeks of injury, received standardized surgery. Structured questionnaires were used to collect data, and outcomes at 12 weeks after surgery were assessed using Sarmiento's radiological criteria and the Green and O'Brien functional scoring system. Statistical analysis was performed with SPSS v26, and significance was at p<0.05.

Results: The study population (41.63±12.39 years) had a predominance of males (78.1%), and the most common injury mechanism was motor vehicle accidents (68.75%). Surgery was performed in 90.6% of patients within 24 hours of trauma. Radiologically, 62.5% had excellent results, 31.3% good, and 6.3% fair. The mean loss of volar tilt was 5.03°±3.84°, radial shortening 2.47 mm±2.27 mm, and radial inclination 4.03°±3.27°. Functionally, 62.5% had excellent results, 21.9% good, 12.5% fair, and 3.1% poor. Pin tract infection occurred in 16% of the cases and post-removal stiffness in 62.5% of patients. Radiological and functional results had a good correlation (r=0.876, p<0.001).

Conclusions: AAF mini external fixator is a useful tool for the treatment of AO/ASIF type C distal radius fractures, with 94% patients showing satisfactory results. The technique is reliable for anatomical reconstruction and functional rehabilitation with acceptable complication rates and is a well-suited treatment method worthy of consideration, particularly in regions with limited resources.

The impact of putting a surgical drain in total knee arthroplasty on the postoperative hemoglobin level

Ziyad AlShaqsi — 2025-10-27

Background: The use of suction drains following total knee arthroplasty (TKA) remains controversial, with conflicting evidence regarding their impact on postoperative blood loss and hemoglobin levels.¹ To evaluate the impact of closed negative suction drainage on postoperative hemoglobin levels following primary unilateral total knee arthroplasty.

Methods: A retrospective cohort study was conducted involving 102 patients who underwent primary unilateral TKA. Patients were divided into two equal groups: 51 with closed suction drainage and 51 without drainage. Hemoglobin levels were measured preoperatively and 24 hours postoperatively. Statistical analysis was performed using SPSS with appropriate tests for continuous and categorical variables.

Results: No significant difference was observed in the hemoglobin drop between the drain group (1.1±0.6 g/dl) and the no-drain group (1.3±0.8 g/dl) (p=0.142). Both groups showed comparable preoperative hemoglobin levels and postoperative outcomes.

Conclusions: Closed negative suction drainage does not significantly impact postoperative hemoglobin levels within the first 24 hours following total knee arthroplasty, suggesting that routine drain use may not be essential for blood conservation in this patient population.

Evaluation of surgical treatment of recent diaphyseal fractures of the humerus in adults based on 42 cases

Mohamed Hachim — 2025-10-27

Background: Humeral shaft fractures (HDF) in adults account for 2% of all fractures. Surgical treatment can be either closed or open.

Methods: This was a retrospective, descriptive and evaluative study conducted from January 2020 to December 31, 2023, at Centre Hospitalier National Matlaboul Fawzaini de TOUBA (CHNMFT) on 42 cases. The exclusion criteria were all patients under 15 years of age receiving orthopaedic treatment.

Results: The average age of our patients was 40 years, with a male predominance. The most common circumstances were road traffic accidents (32 cases). According to the AO classification, type A fractures were the majority (32 cases). According to the surgical technique, pinning was the most common (22 cases). No complications were noted and all our patient’s achieved union within 12 to 24 weeks. At a mean follow-up of 13.5 months, according to the modified Stewart and Hundley classification, 61% of our patients were classified as Good versus 32% as Very Good.

Conclusions: FDHs in adults are very common. The radial nerve remains the dread of every surgeon and surgical treatment yields the best results.

Radiological and functional assessment of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach: a hospital-based observational study

Manash Chandra Sarker — 2025-10-27

Background: Tibial shaft fractures are among the most frequently encountered long bone injuries. Due to limited soft tissue coverage and subcutaneous location, the tibia is prone to complications such as non-union, infection and malalignment. The suprapatellar approach for intramedullary nailing has recently gained favour for its potential benefits over the traditional infrapatellar method, reducing anterior knee pain and facilitating easier intraoperative imaging. The aim of this study was to assess the radiological and functional outcome of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach.

Methods: This prospective observational study was conducted in the Department of Orthopaedics, National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh, from March 2022 to March 2023. Total 33 patients with closed tibial shaft fractures were included in the study.

Results: The study included 33 patients (mean age 38.3±11.6 years), predominantly male (69.7%). Right-sided fractures were more common (60.6%). Most injuries (81.8%) were due to motor vehicle accidents. AO type 42A fractures were most frequent (54.5%). Anterior knee pain was minimal, with a mean VAS of 0.5. Radiological union occurred in 90.9% within 21 weeks (mean 17.9±3.5). Complications were rare (12.1%). Most patients achieved a ROM of 130–139°, with fair to good functional outcomes in over 90% of cases.

Conclusions: Suprapatellar nailing offers a reliable and minimally painful solution for managing closed tibial shaft fractures with favourable radiological and functional outcomes.

Prediction of hamstring tendon autograft dimensions for anterior cruciate ligament reconstruction in the Bangladeshi population

Raju Prasad Dey — 2025-10-27

Background: This study aimed to evaluate the predictive value of age, sex, height, weight, and body mass index (BMI) for estimating the length of semitendinosus and gracilis tendons, as well as the total graft diameter, in patients undergoing anterior cruciate ligament (ACL) reconstruction.

Methods: A study was conducted involving 58 patients undergoing ACL reconstruction using hamstring tendon autografts. Preoperative data were collected and intraoperative measurements of semitendinosus, gracilis tendon lengths, and total graft diameter were recorded.

Results: For semitendinosus, longer tendons were associated with greater height (B=89.77, p=0.020) and BMI (B=2.452, p=0.044), while higher weight showed a negative effect (B=-0.841, p=0.047). Males had significantly longer semitendinosus tendons than females (B=1.796, p=0.028). Similar trends were observed for gracilis tendon length, where height (B=113.77, p=0.005), BMI (B=3.245, p=0.012), and sex (B=1.747, p=0.040) were positive predictors, and weight showed a negative association (B=-1.132, p=0.011). Age was not a significant predictor for either tendon length (p>0.5). Regarding total graft diameter, only sex emerged as a significant factor (B=0.295, p=0.049), with male patients having thicker grafts, while age, height, weight, and BMI had no significant effect (p>0.05).

Conclusions: Height and BMI are reliable positive predictors of hamstring tendon length, while weight shows a negative association. Male sex is consistently associated with longer and thicker tendons. Age does not significantly influence graft dimensions.

Outcome of treatment of unstable intertrochanteric fractures using proximal femoral nail augmented with trochanteric stabilization plate

K. Nafiz Rahman — 2025-10-27

Background: Unstable intertrochanteric fractures remain a major challenge in the elderly population, often associated with high morbidity and complications. Proximal femoral nail (PFN) fixation provides stable internal fixation, while the addition of a trochanteric stabilization plate (TSP) is expected to enhance lateral wall support, reducing implant failure and improving outcomes.

Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka and a private clinic, from July 2024 to March 2025. Thirty patients with unstable intertrochanteric fractures underwent fixation with PFN augmented by TSP. Demographic data, operative details, perioperative complications, radiological outcomes and functional results were recorded. Patients were followed up for six months and functional outcomes were assessed using the Harris hip score (HHS).

Results: The mean age was 60.3±11.5 years, with males comprising 60% of patients. AO/OTA type 31-A2 fractures were the most common (63.3%). Mean operative time was 78±12 minutes, with minimal intraoperative complications. Radiological union occurred at a mean of 15.8±2.4 weeks. Implant-related complications were infrequent, with cut-out and back-out noted in 3.3% each. Early complications included superficial surgical site infection (3.3%) and deep vein thrombosis/pulmonary embolism (3.3%). Functional outcomes improved steadily, with the mean HHS rising from 42.3±6.1 at discharge to 88.2±6.7 at 6 months, indicating satisfactory hip function recovery.

Conclusions: PFN augmented with TSP appears to be an effective fixation strategy for unstable intertrochanteric fractures, ensuring reliable fracture union, low complication rates and favorable functional outcomes.

A retrospective study on magnetic resonance imaging findings in knee injuries

E. Dosita — 2025-09-04

Background: Magnetic resonance imaging (MRI) is a noninvasive and accurate tool for diagnosing internal knee injuries after trauma. It reliably detects anterior cruciate ligament (ACL) tears, meniscal injuries, collateral ligament damage, and bone contusions, which often coexist in traumatic knee injury. This study aimed to evaluate the prevalence and types of MRI-detected knee injuries and their associations with patient age and gender.

Methods: This retrospective observational study included 132 patients who underwent knee MRI following trauma at a radiology department. Patients of all ages and genders were included unless their MRIs showed only degenerative changes or incomplete data. MRI reports were reviewed for ligamentous injuries [ACL, posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL)], meniscal tears, and bone contusions. Data on age and gender were recorded and analysed.

Results: Among 132 patients, 70.45% were male and 29.55% were female, with the largest age groups being 21-30 years (30.3%) and 41-50 years (31.82%). ACL injuries were present in 78.78% of cases, meniscus injuries in 61.36%, PCL injuries in 39.39%, bone contusions in 14.39%, MCL injuries in 8.33%, and LCL injuries in 3.78%. Complete ACL tears accounted for 41.35% of all ACL injury cases. Significant associations were found between age and ACL injury (p=0.002), meniscus injury (p=0.001), bone contusion (p=0.046), and LCL injuries (p=0.044). No significant differences were observed between gender for any injury type.

Conclusions: Our study highlights MRI's effectiveness in detecting and classifying traumatic knee injuries. ACL tears, often accompanied by meniscal and PCL injuries, were the most common. Injury patterns varied with age but not gender, emphasising MRI’s role in early diagnosis and age-specific management.

Functional outcomes of anterior cruciate ligament reconstruction with peroneus longus autograft: a cohort study

Karthik Velayudham — 2025-09-09

Background: Injuries to the anterior cruciate ligament (ACL) are a frequent cause of functional limitation in active individuals. Reconstruction using autografts is the standard surgical approach. While hamstring and bone-patellar tendon-bone (BPTB) grafts are commonly used, each is associated with donor-site morbidity. The peroneus longus tendon (PLT) has emerged as a viable option with biomechanical properties comparable to the native ACL and fewer donor-site complications. Objectives were to assess the functional outcomes of ACL reconstruction with PLT autograft, focusing on knee stability, ankle function, and donor-site morbidity.

Methods: A prospective cohort of 35 patients underwent arthroscopic ACL reconstruction with PLT autograft between July 2019 and August 2021. Functional outcomes were evaluated preoperatively and at 3, 6, and 9 months using international knee documentation committee (IKDC) score, Lysholm score, foot and ankle disability index (FADI), and American orthopaedic foot and ankle society (AOFAS) score. Data were analyzed with Wilcoxon signed-rank test (p<0.05).

Results: Mean IKDC scores rose from 65.8 preoperatively to 92.6 at 9 months (p<0.001). FADI scores showed minimal change, from 99.3 preoperatively to 97.6 at 9 months, with no significant ankle morbidity. The average AOFAS score was 98.4 at 9 months. Ninety-six percent of patients expressed satisfaction with their results, with no neurovascular complications noted.

Conclusions: ACL reconstruction using PLT autograft provides excellent short-term outcomes with minimal donor-site morbidity, supporting its role as a safe and effective alternative to conventional grafts.

Functional and radiological outcomes of posterior column tibial plateau fractures treated with column-specific fixation: a prospective study

Puneeth — 2025-10-08

Background: Posterior column tibial plateau fractures are complex intra-articular injuries. This study aims to evaluate the functional and radiological outcomes of such fractures managed through column-specific open reduction and internal fixation based on CT classification.

Methods: A prospective interventional study on 30 patients with posterior column tibial plateau fractures treated surgically between 2020 and 2022 at Deen Dayal Upadhyay Hospital, New Delhi. Fractures were classified based on CT imaging and approaches selected according to column involvement. Functional and radiological outcomes assessed at 6 months using Rasmussen’s grading systems. Data were analyzed using SPSS v21, with significance set at p<0.05.

Results: Mean age of patients was 40.3±8.94 years, with a male predominance (86.67%). RTA accounted for 90% of injuries. Most common fracture pattern was PM/AM (33.33%), and the posteromedial approach was used in 60% of cases. The mean time to radiological union was 17.13±1.22 weeks. Functional outcomes were excellent in 33.33%, good in 60%, and fair in 6.67% of patients. Radiological outcomes showed excellent results in articular depression (63.33%), condylar widening (80%), and angulation (76.67%). A significant correlation was found between radiological and functional outcomes (p=0.030), but not between fracture classification and outcome (p=0.426). Minimal complications (4 superficial and 1 case of deep infection).

Conclusion: CT-based classification and column-specific fixation of posterior tibial plateau fractures provides favorable functional and radiological outcomes with minimal complications. Accurate reduction and stable fixation tailored to fracture morphology are key to optimal recovery.

Clinical and functional outcomes of proximal femoral nailing in proximal femur fractures: a prospective study of 100 cases

Sahil R. Dhingani — 2025-10-09

Background: Intertrochanteric fractures are common in elderly osteoporotic patients and carry high morbidity and mortality if not treated adequately. Proximal femoral nailing (PFN) has been developed to overcome limitations of extramedullary fixation devices. Objectives were to evaluate functional and radiological outcomes of PFN in proximal femur fractures.

Methods: A prospective study of 100 patients with intertrochanteric femur fractures was conducted between March 2022 and July 2024. Patients were treated with PFN and followed up for 6-18 months. Functional outcome was assessed using the Harris hip score (HHS).

Results: The mean patient age was 648. years (28-95 years). Left-sided fractures (57%) were more common than right (43%). 68% fractures were unstable (Evan’s classification). Average interval from injury to surgery was 42 days, mean operative time 85 minutes. At one-year follow-up, 66% had excellent, 19% good, 10% fair, and 5% poor outcomes (mean HHS: 8882.). Complications occurred in 15% cases. No non-union was observed.

Conclusions: PFN is a reliable fixation method for intertrochanteric fractures, offering stable fixation, early mobilization, and favorable functional outcomes with minimal complications.

Comparative analysis of the functional outcome of absorbable and non-absorbable suture material used in management of acute Achilles tendon rupture

Manoj Kumar — 2025-10-13

Background: Achilles tendon rupture is one of the most common tendon injuries in the adult population. The injury commonly occurs in middle-aged adults. Patients with acute rupture often present with sudden onset of pain at the site of injury and experience difficulty with ankle plantar flexion compared to the normal side. In most cases, patients report a sensation similar to being kicked in the lower leg. Achilles tendon rupture causes significant pain and disability. This study assessed the comparative analysis and functional outcomes of acute Achilles tendon rupture managed by polydioxanone (PDS) (absorbable) suture and polyester (non-absorbable) suture. We prospectively studied acute Achilles tendon rupture in patients over a 1 and ½ year period and reviewed functional outcomes and complications.

Methods: Forty-nine patients with acute Achilles tendon rupture were included, with a minimum follow-up period of six months. We used the Boyden score to assess outcomes and complications between the two groups repaired by and polyester (Ethibond), respectively.

Results: In our study, all 26 patients (100%) in the PDS (absorbable) group had good or excellent results based on the Boyden clinical assessment, whereas only 13 patients in the polyester repair group had good or excellent results.

Conclusions: Patients treated with the non-absorbable polyester (Ethibond) suture material for repair had a higher incidence of infection and foreign body granulomas. Surgical repair with the absorbable suture PDS is superior to polyester, as it results in significantly lower postoperative wound complications and higher patient Boyden scores. However, studies with larger sample sizes are recommended.

Clinical profile and surgical outcomes of displaced supracondylar humeral fractures in children

M. Arifur Rahman Talukdar — 2025-10-27

Background: Supracondylar humeral fractures are the most common elbow injuries in children, frequently resulting from low-energy trauma such as falls on an outstretched hand. Displaced fractures often require surgical intervention due to risks of neurovascular compromise and functional impairment. Understanding patient demographics, fracture types and treatment outcomes is essential for optimizing care. The aim of this study was to assess the clinical profile and surgical outcomes of displaced supracondylar humeral fractures in children.

Methods: This cross-sectional observational study was conducted at the Department of Orthopaedics, Shaheed Ziaur Rahman Medical College Hospital and Ibn Sina Diagnostic Centre, Bogura, Bangladesh from February 2025 to July 2025. Total 64 pediatric patients diagnosed with displaced supracondylar humeral fractures were enrolled in the study.

Results: In this study, mean (±SD) age was 9.2±3.5 years and majority patients (65.6%) were male. Most injuries were sustained from falls on an outstretched hand (84.4%) and 62.5% were classified as Gartland type III fractures. Closed reduction with percutaneous pinning (CRPP) was performed in 81.3% of cases, while 18.7% underwent open reduction. According to Flynn’s criteria, 59.4% achieved excellent outcomes, 28.1% good, 9.4% fair and 3.1% poor. Complications were minimal, with only 15.6% experiencing issues such as pin tract infections, nerve palsy or malunion.

Conclusions: Displaced supracondylar humeral fractures in children can be effectively managed with timely surgical intervention, particularly using CRPP. Most patients regain excellent to good elbow function, with a low rate of complications, reinforcing the safety and efficacy of current surgical protocols.

Association between haemoglobin A1C/albumin ratio and deep postoperative infection after total joint arthroplasty: a single centre study

Amit K. Srivastava — 2025-10-27

Background: Till the time in modern practice in a centre where total joint arthroplasty (TJA) including hip and knee mainly is being done in high volume (>100 TJA in a month), there are no guiding parameters to estimate the risk of developing periprosthetic infections in diabetes mellitus. This study aims to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus (DM) and to investigate the predictive significance of the HbA1c/albumin ratio, so that a guideline can be given to avoid such dreaded complication in diabetic patients.

Methods: Between January 2019 and January 2023, 490 patients who underwent total joint arthroplasty were analysed.187 diabetic patients were included in the study. 28 of them had periprosthetic infection. Six risk factors (Hba1c/albumin, age, BMI, ASA, length of hospital stay, and surgical duration) were analysed.

Results: The rate of HbA1c/albumin was 13.9 times higher than the patients with ≤2.35 cut off value. (Hba1c/albumin ratio (odds ratio (OR)=13.9, 95% CI: 3.18-67.1, p: 0.01). BMI (OR=1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR=0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR=1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR=0.503, 95% CI: 0.109-2.314, p: 0.378) was not found to be a significant risk factor for periprosthetic infection.

Conclusions: In view of our observation in present study we analysed that the HbA1c/albumin ratio has a reliable prognostic indicator than other risk factors in determining the chances of catching the risk of periprosthetic infection after TJA. HbA1c/albumin ratio is a cost effective and easily available parameter to many centres without posing much cost burden. Patients with an HbA1c/albumin cut-off ratio above 2.35 mg/dl in TJA better should avoided from surgery and should be followed more closely for the risk of periprosthetic infection after TJA.

Latitud total hip replacement system in younger and older patients: a comprehensive multi-center assessment of clinical and functional outcomes

Kunal Aneja — 2025-10-27

Background: Total hip arthroplasty (THA) is a standard treatment for end-stage hip disease. With rising demand across age groups, evaluating implant performance in younger and older patients is important. The Latitud total hip replacement system (HRS) is a novel implant,with no data on its safety and performance in younger patinets. Hence, We aimed to evaluate safety and functional outcomes of the Latitud HRS in younger (≤40 years) and older (>40 years) patients undergoing unilateral or bilateral THA.

Methods: This prospective multicenter study across 11 Indian centers enrolled 192 patients undergoing primary THA with the Latitud HRS, followed for 2 years. Primary outcomes were implant survivorship and revision rates; secondary outcomes were clinical improvement using Harris Hip Score (HHS), Oxford Hip Score (OHS), and adverse events.

Results: Of 192 patients, 67 were ≤40 years (55 unilateral, 12 bilateral) and 125 were >40 years (119 unilateral, 6 bilateral). Avascular necrosis predominated in younger patients, while osteoarthritis dominated older cases. At 2 years, OHS improved significantly in all groups: younger (unilateral 10.18±3.39 to 43.76±4.8; bilateral 8.75±2.83 to 43.08±4.01) and older (unilateral 8.06±4.67 to 43.69±4.68; bilateral 10.83±0.98 to 44.67±5.82). HHS also increased substantially: younger (unilateral 23.58±8.55 to 84.9±9.79; bilateral 19.71±10.93 to 89.4±5.07) and older (unilateral 18.16±12.13 to 86.38±7.89; bilateral 27.09±4.77 to 90). Implant survivorship was 100% in all except older unilateral (99.15%) due to one liner breakage.

Conclusion: The Latitud HRS demonstrated excellent survivorship and functional recovery across both age groups, supporting its safety and durability in Indian patients, including younger adults with high functional demands.

Clinical practice trends and therapeutic preferences in osteoarthritis management: a cross-sectional survey of orthopaedic surgeons in India

Manish Khanna — 2025-10-27

Background: Osteoarthritis (OA) is a leading cause of disability worldwide and presents a growing challenge, particularly in India’s aging population. Despite its burden, there is a limited data exist on how OA is managed in real-world clinical settings across India. This study assessed the prescribing patterns and therapeutic preferences of orthopaedic surgeons in India, focusing on pharmacological interventions, intra-articular therapies, and the utilization of adjunctive treatments such as collagen and nutritional supplements.

Methods: A total of 250 orthopaedic surgeons across India participated in this cross-sectional survey carried out by the Indian Orthopaedic Rheumatology Association (IORA). The 32-item questionnaire created by orthopaedic surgeons explored clinical observations, treatment preferences, comorbidity challenges, and attitudes toward nutraceutical use in OA management.

Results: Most clinicians reported a high OA burden in their practice, with symptom onset frequently observed as early as 30–45 years. Obesity and poor nutritional status were identified as common complicating factors. Lifestyle modification was the preferred initial approach, followed by acetaminophen as the first-line pharmacologic agent, especially in elderly patients or those with comorbidities. Topical NSAIDs were favoured for their efficacy and safety profile. A growing role for undenatured collagen type II (UC-II, Lonza) was evident, with 55.2% of respondents prescribing it routinely, particularly in mild-to-moderate OA. Over 75% supported its early initiation, and nearly half considered it for preventive use in high-risk individuals.

Conclusions: Indian orthopaedic surgeons are increasingly adopting a holistic, multimodal approach for osteoarthritis management, balancing early intervention with safety. The growing use of UC-II and nutritional supplements highlights a preventive shift in clinical practice.

Cross-sectional descriptive study of characteristics of infants with congenital talipes equino varus requiring and not requiring tendo-Achilles tenotomy post Ponseti casting

Sharvari P. Varute — 2025-10-27

Background: Congenital talipes equinovarus (CTEV) is a common musculoskeletal anomaly with prevalence ranging from 0.4-7.0 per 1000 live births. The Ponseti method has revolutionized CTEV management, though percutaneous Achilles tenotomy requirements vary across populations. Objective was to evaluate characteristics of infants with CTEV requiring and not requiring tendoachilles tenotomy following Ponseti casting at an Indian tertiary care center.

Methods: A prospective and retrospective cross-sectional study was conducted over 24 months (January 2022-December 2024) involving 44 children with idiopathic CTEV aged <12 months. All patients were treated using standardized Ponseti method with serial casting. Pirani scoring system assessed deformity severity. Statistical analysis compared patients requiring versus not requiring tenotomy using appropriate tests.

Results: The study included 35 males (79.55%) and 9 females (20.45%) with mean age 2.70±2.47 months. Bilateral involvement occurred in 50% of cases. Mean Pirani score improved significantly from 5.55±0.70 to 0.28±0.61 (p<0.001). Ten children (22.73%) required percutaneous Achilles tenotomy while 34 (77.27%) achieved correction through casting alone. Patients requiring tenotomy had significantly higher mean age at presentation (3.5±3.27 vs 2.47±2.19 months, p=0.001), higher initial Pirani scores (5.80±0.63 vs 5.47±0.71, p<0.001), and required more casts (4.5±1.65 vs 3.85±1.33, p<0.001).

Conclusions: The Ponseti method achieved 100% initial correction with relatively low tenotomy requirements (22.73%). Older age at presentation, higher initial Pirani scores, and increased casting requirements significantly predict tenotomy need. Early treatment initiation optimizes outcomes in CTEV management.

A study on factors affecting the functional outcome in patients with soft tissue sarcoma: experience from a tertiary care centre

Suresh Kumar D. — 2025-10-27

Background: Soft tissue sarcoma (STS) patients undergoing surgery may experience reduced functional outcome compared to the general population. The aim of this study is to evaluate the functional outcome and to determine important predictive factors that affect the post-operative functional outcomes in patients who had undergone surgery for STS.

Methods: Authors retrospectively analysed patients who had undergone surgery between January 2016 to November 2023, in our institution and assessed for post-operative functional outcomes, at the end of 6 months and one year. To evaluate the functional outcomes, Musculoskeletal Tumor Society Score (MSTS) was used. Established predictive factors like age, size of the tumor and time since surgery were analysed with Multivariate regression analysis.

Results: In the study, a total of 51 patients were assessed with median age of 50 yrs. Age (MSTS score–80 versus 74, p=0.01), size of the tumor (MSTS score–79 versus 74, p=0.03). Time since surgery (significant linear association between functional scores at the end of 6 months and one year, p value=0.0004) were identified as significant predictive factors. Patients who are younger than 40 years, tumor less than 10 cm have better functional outcomes.

Conclusion: Functional outcomes in patients who underwent surgery for STS, improve with time. Patients can be reassured that final functional outcome will be better than early post-operative outcome. Age of the patient, size of the tumor and time since surgery were the most consistent and significant determinants of functional outcome.

Correlation between clinical, MRI and arthroscopic findings in various shoulder joint disorders

Ayush Gupta — 2025-10-27

Background: Shoulder joint is the most freely moveable, but a relatively unstable joint in the body. The most commonly used currently prevalent diagnostic tools for shoulder joint disorders are clinical examination, Magnetic Resonant Imaging (MRI) and the gold standard arthroscopy. All have their inherent advantages and disadvantages and none is an all-inclusive tool. Furthermore, the current literature lacks studies comparing all the three diagnostic tools together or has just included one or two of the wide array of shoulder joint disorders. Therefore, this study was undertaken to identify correlation between all three diagnostic methods in arriving at a diagnosis in various shoulder disorders taking arthroscopy as a gold standard.

Methods: The study was a prospective descriptive study carried out at a tertiary care hospital over period of 2 years. 33 symptomatic shoulder patients underwent standardized history, physical examination and MRI prior to diagnostic/therapeutic arthroscopy procedure. Shoulder arthroscopy considered as the gold standard, was used as a benchmark for comparing and confirming the results of clinical and radiological findings using the standard statistical data analysis.

Results: Amongst clinical and radiological (MRI) findings; clinical examination was found to be superior to MRI in diagnosing adhesive capsulitis and bicipital tendinitis; MRI was found to be superior to clinical examination for diagnosing rotator cuff tears and Gleno-Humeral (GH) arthritis; both were equivocal in diagnosing Sub-Acromial Impingement Syndrome (SAIS), GH instability and Superior Labrum Anterior Posterior (SLAP) lesions.

Conclusions: No modality in isolation is accurate and a combination of various available diagnostic tools gives the best precision in diagnosing shoulder joint disorders.

Evaluation of the result of open reduction and internal fixation of transverse fracture of acetabulum by reconstruction plate and screws through Kocher-Langenbeck approach

S. K. Abdul Hakim — 2025-10-27

Background: Acetabular fracture occurs from high-velocity injury and affects young, economically productive populations. Previously, treatment was inadequate, leaving patients with incapacitating pain and limited movement. Proper management in our setup is needed to save lives and minimize long-term complications. This study evaluated the outcome of open reduction and internal fixation of transverse acetabular fractures.

Methods: This prospective observational study was conducted at Dhaka Medical College Hospital from July 2017 to June 2019. A total of fifty patients with transverse fracture of acetabulum within 3 weeks of incidence were enrolled in this study. Radiological and functional outcomes were evaluated six months post-surgery using Matta's radiographic criteria and Merle d'Aubigne and Postel criteria. Effects of age, gender, hip dislocation, fracture displacement, reduction quality and trauma on surgery time were evaluated.

Results: Mean age was 36.2±14.12 years. Male and female ratio was 48:2. Mean follow-up 8.5±1.7 months, range 6-12 months. According to Matta's criteria, 24 patients had excellent, 8 good and 18 fair radiological outcomes. Per Merle d'Aubigne and Postel criteria, 20 patients had excellent, 10 good, 2 fair and 18 poor functional outcomes. Overall, 38 patients (76%) showed satisfactory and 12 patients (24%) unsatisfactory outcomes. Heterotrophic ossification occurred in 1(4.0%) patient. 20 patients achieved anatomic (0, 1 mm) reduction, 3 achieved imperfect (2,3 mm) reduction and 2 achieved poor (>3 mm) reduction.

Conclusions: Open reduction and internal fixation of transverse acetabular fracture is a satisfactory treatment method.

Modern prescribing practices and perspectives among Indian Orthopaedicians on Denosumab in osteoporosis: a cross-sectional survey

S. K. Mahendra — 2025-10-27

Background: Denosumab reduces vertebral, hip and nonvertebral fracture risk by improving bone mineral density (BMD) in Osteoporosis. This survey aimed to understand the prescribing patterns and perspectives of Denosumab Indian Orthopaedic practice.

Methods: This cross-sectional survey was conducted among Indian Orthopaedicians for insights on Denosumab prescription patterns, patient profile, treatment duration, adherence, safety and efficacy. Data were analysed descriptively by cross-tabulation.

Results: Among 91 Orthopaedicians prescribing Denosumab for Osteoporosis (T-score<-2.5), 63.74% prescribed for fragility fractures, 60.44% to prevent recurrent fractures and 57.14% in patients without fragility fractures. Denosumab was preferred considering better patient compliance (56.04%), safety (54.95%), efficacy (51.65%) and dosing frequency (49.45%). Patient adherence for up to three years was reported by 79.13%. Teriparatide was the most common drug prescribed in combination (55%) or sequential manner (60% pre and 30.43% post-denosumab). Calcium and Vitamin D were supplemented by 94.51% of doctors. Denosumab drug holiday was not recommended by 62.64%. Approximately 52.7% and 66.7% of doctors reported 10% and 20% BMD increases after 12 and 12-24 months of therapy, respectively. Highest improvements were reported in the lumbar spine and hip. Myalgia (60.44%) and musculoskeletal pain (26.37%) were the most common side effects. Among all, 82.4% prescribed Denosumab in elderly osteoporotic patients with co-morbidities like diabetes (85.33%), cardiovascular disorders (62.67%), renal (54.67%) and hepatic impairment (21.33%).

Conclusions: Our findings underscore the significance of Denosumab in Osteoporosis with insights into the prescribing patterns of Indian Orthopaedicians. It highlights the need for strategies to improve patient adherence for optimizing therapeutic outcomes.

Functional outcome of intramedullary screw fixation of fifth metatarsal Jones fracture

Kundan Kushwah — 2025-10-27

Background: Management of fractures of the base of 5th metatarsal has long been a topic of debate, particularly regarding the effectiveness of operative and non-operative treatment approaches. This study aimed to evaluate the outcomes of internal fixation using an intramedullary screw in management of Jones fracture.

Methods: Twenty-one patients diagnosed with Jones fracture were surgically fixed with intramedullary screw and were evaluated on the basis of union time and the American Orthopaedic Foot and Ankle Society score at 6 weeks and 12 weeks.

Results: Overall union time of the study patients was 6.76 weeks (SD=0.768). There was a non-significant relationship between age and union time (r=0.146, p=0.528) in the patients. The overall mean AOFAS score at 6 weeks increased from 87.43±5.005 to overall mean score 94.09±2.364 at 12 weeks after treatment. There was a significant negative correlation between age and AOFAS at 6-weeks (r=-0.673, p<0.001) and at 12-weeks (r=-0.542, p=0.011) post treatment.

Conclusions: The treatment with surgical screw fixation is safe and effective method for treatment of acute Jones fracture and can be strongly recommended in those who want to return to normal activity earlier.

Outcome of femoral shaft fracture in paediatric age group with titanium elastic nail

Dinesh Kumar Bairwa — 2025-10-27

Background: Femoral shaft fractures are among the most serious and disruptive injuries in children, not only physically but also emotionally—for both the child and their family. Traditionally, such fractures were treated with conservative methods like traction and casting. However, with evolving medical practices and increasing emphasis on early mobility, surgical options like titanium elastic nailing system (TENS) have become more popular, especially in older children.

Methods: This prospective study was conducted at Government Medical College, Kota, between December 2022 and November 2023, involving 30 children aged 4 to 14 years with femoral shaft fractures treated using TENS. We evaluated healing time, complication rates, functional outcomes, and overall effectiveness of this technique.

Results: Most fractures (96%) were managed successfully with closed reduction. The average time to fracture union was 8 weeks, and most children could bear full weight by that time. By 12 weeks, nearly 90% regained full range of knee movement. Minor complications like skin irritation and superficial infection occurred in a few cases but were easily managed. Importantly, no child developed severe complications such as delayed union, non-union, or avascular necrosis.

Conclusions: Using Flynn's criteria, 87% of children had excellent outcomes, while the rest had satisfactory results. No poor outcomes were observed. Our findings suggest that TENS is a safe, minimally invasive, and highly effective method for treating femoral shaft fractures in children, allowing quicker recovery, early mobility, and a return to normal life with minimal complications.

Precision vs. tradition: evaluating alignment accuracy and functional outcomes in robotic vs. conventional total knee arthroplasty

Ravikumar Mukartihal — 2025-10-27

Background: Total knee arthroplasty (TKA) is the treatment of choice in severe osteoarthritis (OA) knee. Robot-assisted TKA (RA-TKA) promises superior precision and personalized bone resection and alignment, whereas conventional TKA (C-TKA) relies on manual alignment techniques. This randomized controlled trial compares alignment accuracy and short-term functional outcomes between the two modalities.

Methods: 100 patients with bilateral knee OA were randomized to RA-TKA (n=50) or C-TKA (n=50). Postoperative mechanical alignment (hip-knee-ankle (HKA) angle) and functional outcomes (new knee society score (NKSS) and forgotten joint score (FJS)) were assessed at 6 months.

Results: RA-TKA achieved significantly better alignment, with 82% of patients within±3° of the target HKA angle compared to 64% in C-TKA (p<0.01). However, functional outcomes were comparable: KSS (RA-TKA: 205.42±6.52 vs. C-TKA: 205.4±7.94, p=0.989) and FJS (RA-TKA: 88.6±4.07 vs. C-TKA: 88.92±4.16, p=0.662).

Conclusions: RA-TKA offers improved alignment accuracy over C-TKA but does not confer superior short-term functional outcomes. Despite achieving more precise mechanical alignment, no significant differences in key functional scores are observed within six months postoperatively. The potential long-term benefits of this improved alignment, such as increased implant longevity or reduced wear, remain unconfirmed and warrant further investigation in studies with extended follow-up.

Functional outcomes after titanium elastic nailing of mid-shaft clavicle fractures in a rural tribal cohort of Western Maharashtra

Farhan Umatiya — 2025-10-27

Background: Mid-shaft clavicle fractures are common injuries, often affecting young active individuals. Although plating has traditionally been used for displaced fractures, Titanium Elastic Nailing (TENS) offers a minimally invasive alternative with potential advantages of faster recovery, cosmesis, and ease of implant removal. Limited evidence exists on outcomes in rural tribal populations, where occupational demands and access to rehabilitation may differ from urban cohorts.

Methods: This prospective observational study was conducted at a tertiary care teaching hospital in Western Maharashtra from January 2023 to June 2024. Thirty adult patients (mean age 34 years; 76.6% male) with displaced mid-shaft clavicle fractures underwent intramedullary fixation with TENS. Patients with open, medial, or lateral third fractures were excluded. Functional outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analogue Scale (VAS) for pain at baseline and scheduled follow-ups. Radiological union and complications were recorded.

Results: Ninety percent of patients achieved radiological union by one month, increasing to 96.7% by three months. The mean union time was 12.2 weeks. At final follow-up, the mean CMS was 96.2, mean DASH score was 2.3, and mean VAS score improved from 7.1 preoperatively to 1.2. Complications were minor, including superficial infection (n=2), nail migration (n=2), skin irritation (n=3), and hypertrophic scarring (n=1). No nonunion, implant failure, or deep infection occurred.

Conclusions: TENS is an effective and safe option for displaced mid-shaft clavicle fractures in rural tribal patients, providing excellent functional outcomes, reliable union, and minimal complications. Its minimally invasive nature makes it particularly suitable for resource-limited settings.

Intra-articular migration of the tibial bone plug during anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: a case series

Woon-Hwa Jung — 2025-10-27

Bone-patellar tendon-bone (BPTB) autografts are a preferred choice for anterior cruciate ligament (ACL) reconstruction due to their potential for reliable bone-to-bone healing. However, technical errors can lead to significant complications. This report presents a series of three cases where the tibial bone plug of a BPTB autograft migrated into the intra-articular space. Postoperative analysis identified that proximal displacement of femoral bone plug, divergence of the interference screw during femoral screw fixation was the primary cause. This led to proximal migration of the graft, increase of tension, and subsequent displacement of the tibial bone plug. These cases underscore the critical importance of meticulous surgical technique, particularly in ensuring accurate screw placement to prevent graft migration.

Chronic tendo-Achilles ruptures treated by suture anchor repair and augmentation with flexor hallucis longus tendon transfer, fixed with ACL screw

B. Ramesh — 2025-10-27

Different surgical procedures have been used for treatment of chronic ruptures of the Achilles tendon with varying results. This study assesses the functional outcomes and complications of chronic insertional tears of Achilles tendon. 10 patients with chronic ruptures of the Achilles tendon were followed for a mean period of 10.3 months. Only ruptures at or near (within 1 cm) insertion were included. They were treated by direct repair of tendon to calcaneum by suture anchor. Flexor hallucis longus (FHL) tendon transfer fixed to calcaneal tunnel with an interference screw was used to augment the repair. Outcome was assessed by AOFAS Ankle-Hindfoot (AHS) score. The mean preoperative score of 41.2 improved to 85.4 at final follow-up out of a total 100 points. We achieved excellent results in 80% and good outcome in 20% cases. No re-ruptures were noted. In insertional chronic ruptures of Achilles tendon, FHL transfer to calcaneum with interference screw fixation and repair of Achilles tendon with suture anchor is a reliable technique with good outcome and is recommended.

Morphometric analysis of scaphoid: influence of screw design and surgical approach in scaphoid fracture fixation: a study in Indian population

Saurabh Yadav — 2025-10-27

Scaphoid fractures are among the most frequent carpal bone injuries, and screw fixation has become the treatment of choice. The stability of fixation is maximized when the screw is centrally placed and of maximum possible length. In this case series, we examined scaphoid morphometry in the Indian population and assessed the influence of sex, surgical approach, and screw design on achievable screw length. The study was performed on ten computed tomography (CT) scans of normal wrists, including five men and five women. Three-dimensional reconstructions were created, and the central longitudinal axis of the scaphoid was defined. Virtual headless compression screws from five commercially available designs were positioned along this axis. The scaphoid length measured along its central axis was greater in men (mean 27.52 mm, standard error of the mean 0.70 mm) than in women (mean 23.32 mm, standard error of the mean 0.61 mm). Longer screws could be inserted through a volar approach (male mean 25.28 mm, standard error of the mean 0.84 mm; female mean 20.92 mm, standard error of the mean 0.91 mm) compared with a dorsal approach (male mean 24.84 mm, standard error of the mean 0.94 mm; female mean 20.48 mm, standard error of the mean 1.00 mm), irrespective of screw design. This case series highlights sex-related differences in scaphoid size and suggests that the volar approach permits the placement of longer screws. Screw design continues to play a crucial role in determining fixation options.

Cervical trauma imaging reinvented: the expanding role of ultrasound

Vinícius R. G. Moreira — 2025-08-30

Cervical spine trauma represents a critical emergency requiring prompt and accurate imaging to guide management and prevent irreversible neurological damage. While computed tomography (CT) is considered the diagnostic gold standard, ultrasonography (US) has emerged as a viable alternative or adjunct, particularly in environments where CT is unavailable or in populations vulnerable to ionizing radiation, such as children. This systematic review aimed to evaluate the diagnostic accuracy, clinical utility, and limitations of ultrasound in the acute assessment of cervical spine injuries. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science through July 2025. Studies were selected based on pre-defined inclusion criteria, focusing on original clinical investigations reporting the use of ultrasound in acute cervical trauma. Data were extracted regarding sample size, US modality, diagnostic metrics (sensitivity, specificity, predictive values), and clinical outcomes. Quality assessment was conducted using the QUADAS-2 tool. A total of 30 studies were included. Results demonstrated that point-of-care ultrasound (POCUS) offers high specificity (up to 98%) and moderate sensitivity in identifying cervical fractures and spinal misalignment. Color Doppler imaging proved effective in detecting vascular injuries such as vertebral artery dissection or thrombosis. Intraoperative ultrasound enhanced surgical precision, and pediatric applications showed promise for minimizing radiation exposure. However, limitations included operator dependence, reduced visualization of deep or posterior structures, and variability in training protocols. In conclusion, ultrasound is a promising, rapid, and radiation-free modality for selected cases of cervical spine trauma, particularly in pediatric or resource-limited settings, though it should complement rather than replace advanced imaging.

Comparative utility of dual spectral computed tomography and functional magnetic resonance imaging in the preoperative evaluation of unstable fractures of the craniocervical complex: a systematic review of diagnostic accuracy and neurosurgical outcomes

Jesús Jiménez-Sánchez — 2025-09-04

This systematic review critically appraises the sensitivity and clinical applicability of dual-energy computed tomography (DECT) compared with functional magnetic resonance imaging (fMRI) in evaluating unstable fractures involving the craniocervical complex and vertebral muscles. Nine studies were included, comprising retrospective cohorts, prospective diagnostic trials, and meta-analyses, with sample sizes ranging from 8 to 515 patients and heterogeneous fracture types. DECT demonstrated strong diagnostic performance in several contexts. For bone marrow edema (BME), DECT achieved 89% sensitivity, 98% specificity, and an AUC of 0.96 (p<0.001). In intervertebral disc injuries, sensitivity and specificity were 0.85 and 0.75, with significant attenuation differences (p<0.001). For pelvic fractures, DECT reached 89.5% sensitivity and 84.6% specificity, with moderate inter-rater reliability (kappa=0.516). Optimization with electron density imaging improved hematoma detection, raising sensitivity and specificity above 80% (kappa=0.82; p=0.04). Meta-analytic results confirmed overall sensitivity, specificity, and accuracy of 86.2%, 91.2%, and 89.3%, respectively. Nonetheless, MRI clearly outperformed CT in detecting ligamentous injuries and occult trauma, with a negative predictive value of 100% for cervical instability. Limitations of the current evidence include small samples, retrospective designs, interobserver variability, and incomplete subgroup analyses. Despite these, DECT remains a promising adjunct or alternative when MRI access is limited, particularly for BME and fracture line imaging. Future multicenter studies are needed to standardize protocols and strengthen generalizability.

Medial patellofemoral ligament reconstruction after patellar instability: a systematic review of when and for whom to operate

Íris de B. V. Teixeira — 2025-08-30

Recurrent patellar dislocation is a common condition in adolescents and young adults, often associated with significant functional limitations. The medial patellofemoral ligament is the primary passive stabilizer against lateral patellar displacement, and its insufficiency plays a central role in instability. While surgical reconstruction has become the mainstay treatment for recurrent cases, the optimal indications and patient selection remain subjects of ongoing debate. This systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Databases were searched for studies evaluating medial patellofemoral ligament reconstruction, with inclusion criteria focused on surgical indications, patient characteristics, clinical outcomes, and postoperative complications. Data on redislocation rates, functional scores, surgical techniques, and return-to-sport outcomes were extracted and qualitatively synthesized. Across the included studies, medial patellofemoral ligament reconstruction demonstrated consistent success in reducing redislocation rates to below 5% in appropriately selected patients. Mean postoperative Kujala scores ranged from 85 to 92, with similar improvements in Lysholm and Tegner scales. Isolated reconstruction was preferred in patients with mild anatomical abnormalities, while combined procedures (such as tibial tubercle osteotomy or trochleoplasty) were indicated in cases with elevated tibial tubercle–trochlear groove distance or high-grade trochlear dysplasia. Pediatric populations benefited from physeal-sparing techniques. Reported complication rates ranged from 2% to 7%. This review confirms the effectiveness of medial patellofemoral ligament reconstruction in managing recurrent patellar instability. Patient selection based on anatomical parameters and surgical precision are critical to successful outcomes. The procedure yields high functional recovery and return-to-sport rates with a low incidence of complications.

Anterior cruciate ligament allografts and low-dose gamma irradiation: a systematic review

Arash Ghoroghi — 2025-09-12

Anterior cruciate ligament (ACL) rupture is a common injury requiring surgical reconstruction in active patients. Autografts are considered the gold standard due to superior early biomechanical performance, but allografts offer advantages such as reduced operative time and elimination of donor-site morbidity. Irradiation is the primary sterilisation method; however, high doses impair mechanical integrity. Low-dose irradiation has been proposed to preserve graft strength while ensuring sterility. A systematic review was performed using EMBASE, PubMed and Scopus, supplemented with backward snowballing. Cohort and randomised studies comparing low-dose irradiated allografts to autografts in vivo were included. Primary outcomes were graft failure/revision rates, knee laxity (KT-1000/2000, Lachman, pivot shift) and patient-reported measures (IKDC, Lysholm). Eight studies comprising over 10,000 patients were included. Autografts demonstrated lower graft failure rates in younger (<22 years) patients, with revision rates of 10.1% for allografts vs. 2.9% for autografts. In older cohorts, outcomes were largely equivalent. Arthrometric testing showed greater knee laxity with allografts, but this did not consistently translate into differences in patient-reported outcomes. Return-to-sport was faster with autografts, reflecting earlier graft incorporation, while long-term outcomes converged once allografts remodelled. Autografts remain the graft of choice for younger, high-demand patients due to superior early stability and lower revision rates. Low-dose irradiated allografts may represent a viable alternative in older or less active populations. High-quality, prospective studies with standardised protocols are required to clarify long-term efficacy and guide graft selection.

Rare mimicry of bone tumors: systematic review of xanthogranulomatous osteomyelitis and its therapeutic implications

Vinícius R. G. Moreira — 2025-10-16

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory lesion of bone that closely mimics malignant neoplasms. Its etiology and pathogenesis remain poorly defined, and only a small number of cases have been reported since the first description in 1984. The objective of this systematic review was to analyze all documented cases of XO to clarify clinical characteristics, diagnostic challenges, treatment strategies, and outcomes. A comprehensive search of PubMed, Scopus, and Embase, supplemented by reference screening, identified 26 well-documented cases. Data regarding demographics, anatomical distribution, clinical features, imaging findings, microbiology, pathology, treatment, and prognosis were extracted and synthesized. Patients ranged in age from 10 to 65 years, with a median of 32 years and a slight male predominance. The femur was the most frequently affected bone, followed by the tibia, ulna, humerus, pelvis, and spine. Pain and swelling were the predominant presenting features, while fever and systemic symptoms were less common but often led to misdiagnoses such as tuberculosis or malignancy. Imaging consistently suggested aggressive neoplasia, but histopathology confirmed the diagnosis in all cases, showing foamy histiocytes admixed with lymphocytes, plasma cells, and multinucleated giant cells. Microbiological cultures were positive in 35% of cases, most often Staphylococcus aureus, followed by Pseudomonas aeruginosa, Aspergillus spp., and Mycobacterium marinum. Treatment was primarily intralesional curettage with or without grafting, with wide resections performed only when malignancy could not be excluded preoperatively. Outcomes were uniformly favorable, with recurrence reported in only two cases after incomplete curettage. In conclusion, XO is a benign but deceptive entity that mandates biopsy for accurate diagnosis. Curettage with pathogen-specific antimicrobial therapy when indicated achieves excellent results, and multidisciplinary collaboration is essential to avoid unnecessary radical resections.

Proximal femoral nail versus dynamic hip screw in treatment of intertrochanteric fractures: a systematic review

Dhruvin Patel — 2025-09-30

Intertrochanteric femoral fractures are common in the elderly and typically require internal fixation. This systematic review compared the clinical and radiological outcomes of the proximal femoral nail (PFN) and the dynamic hip screw (DHS) by analyzing 25 studies published between 2000 and 2024 across PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Key parameters included operative time, intraoperative blood loss, complication and reoperation rates, union time, and functional outcomes measured by the Harris hip score (HHS). Pooled evidence showed that PFN offers significant advantages in unstable fractures (AO/OTA 31-A2 and A3), demonstrating shorter operative time, reduced blood loss, lower implant-failure and reoperation rates, faster radiological union, and higher HHS at 3- and 6-month follow-up compared with DHS. DHS produced comparable results in stable fracture patterns (AO/OTA 31-A1) but was associated with higher mechanical complications in complex cases. Although PFN requires greater technical expertise and carries a small risk of iatrogenic femoral shaft fracture, its intramedullary design provides biomechanical superiority that supports early mobilization and improved functional recovery, especially in elderly osteoporotic patients. Surgical decision-making should therefore consider fracture stability, patient comorbidities, and surgeon experience to optimize outcomes.

Management of a rare fifth metatarsal exostosis with pseudoarthrosis in a 29-year-old male

Jatin Banal — 2025-10-27

Exostoses of the fifth metatarsal are uncommon, and their association with pseudoarthrosis is exceptionally rare. Such lesions can lead to chronic pain and functional impairment, often delaying diagnosis. Authors report the case of a 29-year-old male with longstanding lateral foot pain unresponsive to conservative treatment. Radiographic evaluation revealed a fifth metatarsal exostosis with pseudoarthrosis. Surgical excision and debridement were performed, with preoperative evaluation and planning aided by 3D bone models to better define the lesion and optimize the approach. Postoperatively, the patient experienced significant improvement in pain and function, achieving full return to normal activities and work. This case highlights the need to consider unusual bony pathologies in patients with persistent lateral foot pain.

Acetabular fractures in the elderly population: internal fixation combined with acute total hip arthroplasty

Goncalo Modesto — 2025-10-27

The incidence of acetabular fractures in the elderly population is increasing, primarily due to pre-existing osteoporosis and low-energy trauma. Nevertheless, the optimal treatment algorithm remains a subject of debate. This case report details the treatment of a 77-year-old male patient with an acetabular fracture involving both columns and dome, treated with open reduction and internal fixation plus concomitant total hip arthroplasty.

A case of post-COVID Aspergillus fumigatus spondylodiscitis

Abdulla Harafan — 2025-10-27

Spondylodiscitis caused by Aspergillus fumigatus is rare, particularly in immunocompetent individuals. This case highlights a unique instance of post-COVID Aspergillus spondylodiscitis, emphasizing the potential role of COVID-19-related immune dysregulation in predisposing patients to opportunistic fungal infections. A 75-year-old man with a history of hypertension, hypothyroidism, and severe COVID-19 (requiring ICU admission and steroid therapy) presented with chronic low back pain and acute bilateral lower limb weakness. Imaging revealed L1-L2 disc space narrowing, vertebral destruction, and epidural compression. Histopathological and microbiological analyses confirmed Aspergillus fumigatus infection. The patient underwent surgical decompression, debridement, and posterior stabilization, followed by intravenous voriconazole therapy, resulting in significant clinical improvement. This case underscores the importance of considering fungal etiologies in spondylodiscitis, especially in post-COVID patients with persistent symptoms. A multidisciplinary approach involving radiological, microbiological, and histopathological evaluation is critical for timely diagnosis and management. Combined surgical and antifungal therapy yielded favorable outcomes, aligning with existing literature recommendations. Further research is needed to explore the link between COVID-19 and opportunistic fungal infections.

Incidental finding of an accessory pronator during anterior transposition of the ulnar nerve with anterior interosseous nerve supercharge transfer: a case report

Swagat Mahapatra — 2025-10-27

The anterior transposition of the ulnar nerve with anterior interosseous nerve (AIN) supercharge transfer is a well-established procedure for improving motor recovery in severe ulnar neuropathy. Anatomical variations in the forearm musculature, such as the presence of an accessory pronator muscle, can have surgical and clinical implications. A 54-year-old female with cubital tunnel syndrome presented with progressive ulnar nerve dysfunction, including intrinsic muscle weakness and sensory deficits. She underwent anterior transposition of the ulnar nerve with AIN supercharge transfer. During the procedure, an unexpected accessory pronator muscle was identified between the pronator quadratus (PQ) and flexor digitorum profundus (FDP). The AIN innervated the muscle and was carefully dissected to facilitate nerve transfer. Postoperatively, the patient demonstrated improved intrinsic muscle strength without complications. Accessory muscles in the forearm are rare but may contribute to nerve compression syndromes or impact surgical approaches. This case highlights the importance of recognizing such anatomical variations to optimize surgical technique and avoid iatrogenic injury. Awareness of accessory pronators is crucial in upper limb nerve surgeries to ensure successful nerve transfer and prevent intraoperative complications.

Surgical challenges in total hip replacement after failed proximal femoral osteosynthesis: two case reports

Vaibhav Kumar — 2025-10-27

Conversion total hip arthroplasty (THA) after failed proximal femoral osteosynthesis is a technically demanding procedure due to altered anatomy, poor bone quality, retained hardware and risks of intraoperative complications like stem perforation and periprosthetic fractures. A 60 years old hypertensive female presented with pain and limited mobility two years after undergoing proximal femoral nailing for an intertrochanteric fracture. Imaging revealed malunion and avascular necrosis (Ficat and Arlet Stage 4). She underwent hybrid THA, complicated by stem perforation. Revision THA with a long uncemented stem and trochanteric osteotomy was performed. Postoperatively, she developed wound gaping and sterile serous discharge, managed successfully with VAC therapy and debridement. A 44 years old male with prior bilateral subtrochanteric fracture fixation presented with left hip pain and avascular necrosis. Following implant removal, uncemented THA was done but complicated by stem perforation through a prior lag screw hole. Revision THA with corrected trajectory using the same stem was performed. Recovery was uneventful. THA following failed internal fixation carries higher risks than primary THA due to distorted anatomy and implant-related challenges. Intraoperative adaptability, use of long-stem prostheses and meticulous wound management were essential in both cases. Fluoroscopic guidance and preoperative planning helped manage complications effectively. Conversion THA after failed fixation presents significant technical challenges. However, with individualized surgical strategies and diligent perioperative care, satisfactory outcomes can be achieved.

Right recurrent patellar dislocation treated surgically via the Campbell method: an illustrative case report

Anmol Katkani — 2025-10-27

Recurrent patellar dislocation is a disabling condition, particularly prevalent among adolescents and young adults, often caused by anatomical abnormalities such as trochlear dysplasia or prior trauma. Surgical intervention, including the Campbell technique, is indicated when conservative management fails. A 24 years old male with recurrent right patellar dislocation and trochlear dysplasia (Dejour type B) underwent proximal realignment via the Campbell technique. The procedure involved creating a medial capsular flap, reinforcing it with Fiber wire sutures and repositioning it to stabilize the patella. Postoperative immobilization and rehabilitation were implemented. Surgical stabilization using the Campbell technique is a viable option for recurrent patellar dislocation, offering excellent functional outcomes in anatomically predisposed patients. Comprehensive evaluation and tailored surgical planning remain essential for optimal results.

A rare case of Monteggia fracture dislocation with distal radius epiphyseal injury in a 12-year-old male: case report and review of literature

Sachin Kumar — 2025-10-27

Monteggia fracture dislocation is a fracture of proximal ulna with dislocation of radial head. Its association with ipsilateral distal radius fracture is very rare and only ten cases have been reported in the English literature. Authors report a case of a 12 years old male, who sustained Monteggia fracture with ipsilateral distal radius epiphyseal injury following a fall while playing cricket. He was managed conservatively at a local centre elsewhere. As the fracture was found to be displaced, surgical fixation was done at our hospital. At 3 months follow up, the fracture was found to have united and the child had a good functional range of motion. Early diagnosis and one stage surgical management can lead to a satisfactory outcome even in these complex fracture dislocations.

Unusual combination of Bado type I Monteggia lesion and ipsilateral humerus lateral condyle fracture with intercondylar extension in an adult following high velocity trauma: a case report

Sachin Patel Lokesh — 2025-10-27

Monteggia fracture dislocation is a rare injury pattern which accounts for less than 2% of all forearm fractures (in both adults and children) and accounts for 0.7% of all elbow fractures and dislocations in adults. The present case involves a 22-year-old male with Bado type I Monteggia fracture dislocation with ipsilateral lateral condyle humerus fracture with intercondylar extension with no distal neurovascular deficits which is the first case to be reported in literature to the best of our knowledge. A successful outcome was achieved due to early diagnosis, anatomical reduction, stable internal fixation and early mobilization. This case report aims to highlight this rare presentation and in adding data to literature for describing this injury pattern in Bado type I equivalents. These injuries require a comprehensive clinical and radiological evaluation for diagnosis as well as management.

Case report of isolated lesser trochanter avulsion fracture

Anand Asok — 2025-10-27

An isolated lesser trochanter avulsion fracture is a rare injury. It is of two types, true fracture which occurs only in adults or as epiphyseal separation which are found in adolescent population. It is caused by a sudden forceful eccentric contraction of the iliopsoas in an attempt to accelerate or decelerate the body. In this case report, 15 year old male football player presented with acute onset of pain while playing football, associated with difficulty in walking. On X ray, it was lesser trochanter avulsion fracture which was fixed with cortical screw with washer+ fibre wire+5 mm suture anchor. the outcome was good. The patient reverted to his obvious activities with normal range of movement. The minimal invasive surgical management have better outcome with faster healing, early mobilization, good range of hip movement.

Pipkin fracture dislocation with ipsilateral lateral collateral ligament and medial collateral ligament avulsion injury-a rare case report

Sanjeev Jindal — 2025-10-27

Pipkin fractures are complex femoral head fractures typically associated with posterior hip dislocation. Concomitant injuries of the knee ligaments, especially involving both the medial collateral ligament (MCL) and lateral collateral ligament (LCL), are exceedingly rare. Early diagnosis and coordinated management are critical to preserving joint function and preventing long-term complications such as osteonecrosis or instability. We report an unusual case of a high-energy trauma resulting in a Pipkin type II fracture-dislocation with ipsilateral LCL and MCL avulsion injuries.

Anterior fibulocalcaneus muscle: a must-see when performing arthroscopic Brostrom

Emanuel Cortesão de Seiça — 2025-10-27

Accessory muscles of the ankle and hindfoot are rare anatomical variants that are typically asymptomatic but may become clinically significant following trauma or surgery. The anterior fibulocalcaneus muscle (AFCM) is a rare accessory muscle, with limited documentation in the literature and no previously reported symptomatic cases requiring surgical intervention. The authors present the case of a 32-year-old man with persistent lateral ankle pain and instability following high-energy trauma and surgical fixation of a medial malleolar fracture. Despite appropriate bone healing, the patient’s symptoms persisted until MRI identified an accessory muscle tendon consistent with the AFCM, originating from the distal fibula and inserting onto the anterolateral calcaneus. Its superficial trajectory over the anterior talofibular ligament (ATFL) risked intraoperative misidentification as part of the lateral ligament complex, potentially leading to inadvertent preservation or tensioning during repair. Surgical excision of the AFCM tendon, combined with lateral ligament repair, resulted in complete resolution of symptoms and full functional recovery. This case highlights the importance of considering accessory musculature that can mimic or obscure native ligaments and complicate surgical management of chronic post-traumatic ankle pain, and demonstrates that surgical excision can be effective when such variants are implicated.

Ipsilateral femoral shaft and medial Hoffa fracture in a 13-year-old male following road traffic accident

Pankaj Kumar — 2025-10-27

Hoffa fractures, particularly of the medial femoral condyle, are rare in pediatric populations. Their association with ipsilateral femoral shaft fractures is exceedingly uncommon. We present a case of a 13-year-old boy who sustained an ipsilateral femoral shaft fracture and medial Hoffa fracture following a high-energy road traffic accident (RTA). The shaft fracture was managed with closed reduction and titanium elastic nailing (TENs), and the medial Hoffa fracture was treated via open reduction and internal fixation with cannulated Herbert screws using a medial parapatellar approach. This report highlights the importance of high clinical suspicion and appropriate imaging to diagnose these rare injury patterns.

Current management approaches for anterior cruciate ligament tears in young athletes

Alenzi Faisal Mosleh G. — 2025-10-27

Anterior cruciate ligament (ACL) tears are among the most frequent serious knee injuries in young athletes and often lead to prolonged time away from sport and elevated risk of re‑injury. Purpose was to synthesize contemporary evidence (2015-2025) on diagnosis, operative and non‑operative management, rehabilitation, and return‑to‑sport (RTS) in adolescents and young adults with ACL tears. Narrative review informed by a structured search of PubMed/Medline and Google Scholar using MeSH terms ("anterior cruciate ligament/injuries", "anterior cruciate ligament/surgery", "athletes", "rehabilitation", "platelet-rich plasma", "anterolateral ligament"), limited to english language and human studies. Current guidelines recommend individualized treatment; when surgery is indicated, reconstruction is favored over primary repair due to lower revision risk. Graft choice should consider sport demands and age; evidence suggests slightly lower failure with bone-patellar tendon-bone (BTB) versus hamstrings in some cohorts, though patient‑reported outcomes are comparable. Adjunct procedures such as anterolateral augmentation (ALL/LET) may reduce graft failure and pivot shift in high‑risk patients. PRP shows mixed benefits, with possible modest improvements in early pain and stability but inconsistent long‑term effects. Criteria‑based rehabilitation with delayed RTS (≈9-12 months) and psychological readiness assessment lowers second‑injury risk. Management of ACL tears in young athletes should be individualized, balancing surgical technique, biologic adjuncts, and rigorous criteria‑based RTS testing that integrates strength, hop performance, movement quality, and psychological readiness.

Return to sport after lumbar spine surgery: a comprehensive review

Elena Albertazzi — 2025-10-27

Spinal pathologies are a significant challenge for athletes, often affecting performance and threatening career longevity. This review summarizes current evidence on return-to-sport (RTS) outcomes following lumbar spine surgeries, focusing on procedures such as microdiscectomy, spinal fusion and stabilization. Lumbar microdiscectomy demonstrates high RTS rates, with recovery averaging 5-6 months, while lumbar fusion poses greater challenges, particularly in high-impact sports, with recovery often exceeding 8-12 months. Pediatric and adolescent athletes show promising RTS outcomes, with up to 96% resuming pre-surgical performance within a year. Key factors influencing successful RTS include the type of surgery, sport-specific demands and adherence to structured rehabilitation protocols emphasizing trunk stabilization and core strength.

Bone health from infancy to adolescence: a narrative review of nutritional and lifestyle determinants

Khayati Moudgil — 2025-10-27

Lifelong bone health is largely determined by the foundation established during childhood and adolescence, when the skeleton undergoes rapid growth and mineralization. This paper explores the critical influence of early-life factors including nutrition, physical activity, hormonal balance and disease states on the development of peak bone mass, a key predictor of osteoporosis and fracture risk in later years. Emphasis is placed on the roles of calcium and vitamin D, the resurgence of nutritional rickets in both developing and developed regions and the decline in physical activity among youth worldwide. This narrative review integrates findings from global studies to highlight the importance of balanced diets, regular weight-bearing exercise and early screening in vulnerable populations. Ultimately, it underscores the need for a comprehensive public health strategy to promote optimal bone development from infancy through adolescence, ensuring skeletal resilience across the lifespan.

Radiation safety in orthopaedic surgery: educational guidelines for surgeons using X-rays and C-arm fluoroscopy

Kuru Parvir — 2025-09-22

Orthopaedic surgeries frequently rely on intraoperative imaging, particularly X-rays and C-arm fluoroscopy, to enhance procedural accuracy. However, these modalities expose surgeons and operating theatre personnel to ionizing radiation, leading to both immediate and long-term health risks. Despite the availability of protective measures and the ALARA (As low as reasonably achievable) principle, adherence to radiation safety in orthopaedics remains suboptimal. This review highlights radiation hazards in orthopaedic practice and presents practical, evidence-based strategies for minimizing occupational risk. A comprehensive literature review was performed, focusing on intraoperative radiation exposure in orthopaedics, its biological effects, and preventive measures. International radiological safety guidelines, surgical protocols, and recent orthopaedic studies were analyzed, with emphasis on practical recommendations for operative settings. Ionizing radiation can cause deterministic effects (cataracts, skin injury) and stochastic effects (malignancy, infertility, genetic mutation). Key strategies to reduce exposure include minimizing fluoroscopy time, increasing distance from the source, using shielding devices, adopting pulsed fluoroscopy, and optimizing C-arm positioning. Pregnant staff require additional precautions such as double dosimetry and modified work schedules. Despite the availability of personal protective equipment (PPE), lack of structured education and poor compliance remain major challenges. Radiation exposure during orthopaedic procedures is a preventable occupational hazard. Strict enforcement of safety protocols, adequate PPE, routine training, and institutional monitoring are essential to protect surgeons and operating teams.