International Journal of Research in Orthopaedics

Understanding the clinical and functional outcome of flexor hallucis longus tendon transfer and V-Y plasty for chronic Achilles tendon rupture: a case series

Vicky Kumar, Ravinder Kumar, Devarsh Goyal, R. P. Assat — Tue, 24 Feb 2026 00:00:00 +0530

Chronic Achilles tendon rupture secondary to insertional Achilles tendinopathy leads to significant functional disability, and its optimal surgical management remains a topic of discussion. This prospective case series evaluated the clinical and functional outcomes of flexor hallucis longus (FHL) tendon transfer with V-Y plasty in nine patients treated between January and December 2023. Following a standardised postoperative rehabilitation protocol, functional assessment was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and ankle range of motion (ROM) at three and six months postoperatively. The mean age of patients was 49.4±7.86 years, and most were male. AOFAS scores improved significantly from 72±2.5 at three months to 92±2.3 at six months (p=0.001), and significant gains in dorsiflexion and plantarflexion were observed over the same period (p<0.001). At six months, ankle ROM of the operated limb was comparable to the contralateral side, and no clinically relevant weakness of great toe flexion was noted. These findings suggest that FHL tendon transfer combined with V-Y plasty is an effective and reliable technique for managing chronic Achilles tendon rupture due to insertional Achilles tendinopathy, resulting in meaningful restoration of function and range of motion. Further larger-scale comparative studies are warranted to confirm these results.

En bloc resection of proximal fibular giant cell tumour in skeletally immature patients with common peroneal nerve neuropraxia: a retrospective case series of 20 patients with one-year follow-up

Mrinmoy Das, Mukesh Dhakar, R. P. Meena, Satish Kumawat — Tue, 24 Feb 2026 00:00:00 +0530

Giant cell tumour (GCT) of bone is rare in skeletally immature patients, and its occurrence in the proximal fibula presents unique challenges due to the risk of common peroneal nerve (CPN) injury and knee instability. This retrospective case series included 20 skeletally immature patients (≤18 years; mean age 16.35 years) with histologically confirmed proximal fibula GCT and preoperative CPN neuropraxia treated between September 2023 and August 2024 using en bloc (Malawer type I) resection with reattachment of the lateral collateral ligament (LCL) and biceps femoris. At a minimum 12-month follow-up, outcomes assessed included CPN recovery, recurrence, knee stability, MSTS score, complications, and return to school/sports. There were eight males and twelve females (right: left=9:11); 16 (80%) had Campanacci grade II and 4 (20%) grade III lesions, with a median symptom duration of seven months. All underwent resection with negative margins, and the mean operative time was 72 minutes. At 12 months, 17 patients (85%) achieved complete CPN recovery (mean 9 months), and 3 (15%) had partial recovery, with no persistent palsy or recurrence. The mean MSTS score was 28.6±1.87, and 17 knees (85%) were stable while 3 (15%) showed grade I varus laxity. Median return to school and sports were 28 and 32 weeks, respectively. Complications included two superficial infections and one wound debridement, with no permanent deficits. These findings indicate that en bloc resection with nerve preservation and lateral stabiliser reattachment provides excellent oncological control and functional outcomes in skeletally immature patients with proximal fibula GCT and preoperative CPN neuropraxia.

Iatrogenic distal femur fractures after long proximal femur nailing: a three-case series with prevention and management strategies

Tue, 24 Feb 2026 00:00:00 +0530

Proximal femur nails (PFNs) are widely regarded as the gold standard for unstable intertrochanteric fractures due to their biomechanical strength and minimally invasive nature; however, complications such as iatrogenic distal femur fractures and anterior cortical perforation remain important concerns. This case series describes three such complications: a 56-year-old female who developed a postoperative distal femur fracture after long PFN fixation, managed with ORIF using a distal femur plate with distal locking screws, proximal unicortical screws, and cerclage augmentation; an 82-year-old female with a similar fracture pattern managed with distal femur plating and cerclage wire; and a 58-year-old male who sustained anterior cortical perforation of the nail and was treated conservatively with non-weight-bearing due to medical unfitness for revision surgery. These complications typically arise from femoral bow mismatch, nail design limitations, surgical technique factors, and patient-specific anatomy. Management options include distal femur plating with or without cerclage augmentation or conservative treatment in selected patients, while prevention hinges on careful preoperative planning, appropriate implant selection, and meticulous technique. Although uncommon, distal femur complications after long PFN require early identification and individualized management to prevent progression and ensure favorable outcomes.

Comparative analysis of total hip arthroplasty versus hemiarthroplasty for femoral neck fractures: a systematic review

Neel Sharma, Pranav Rathi, Mukesh Devpura, Sandeep Deshpande — Tue, 24 Feb 2026 00:00:00 +0530

Displaced femoral neck fractures (FNFs) are among the most common and debilitating injuries in elderly. The optimal surgical management-total hip arthroplasty (THA) or hemiarthroplasty (HA), remains a subject of debate. This study aimed to compare clinical outcomes reported in literature of patients with a femoral neck fracture treated with either hemiarthroplasty or total hip arthroplasty (THA).This review incorporates findings from landmark randomized controlled trials (RCTs), meta-analyses, and major guidelines, including NICE (2023), Falotico et al (2025) , the HEALTH trial (2019) , Ekhtiari et al (2020), Tang et al (2020) , Lewis et al (2019) , and large registry analyses Edelstein et al 2023 which included population based retrospective studies of elderly >65 years of age with neck of femur fracture. Across over 60,000 patients, mortality rates were similar between THA and HA. THA demonstrated modest improvements in medium-term function and quality of life, particularly in cognitively intact, independent patients. However, THA carried a higher dislocation risk and required longer operative time and greater blood loss. Revision and reoperation rates were comparable. Cost-effectiveness analyses favoured THA in healthy, active individuals but not in frail or dependent patients. Our study concludes that THA offers small functional advantages but with higher dislocation risk. Procedure choice should be individualized based on patient health, functional status, and life expectancy. HA remains appropriate for frail or low-demand patients.

Cosmetic satisfaction in operative versus non-operative treatment of clavicle fractures: a meta-analysis

Bawan Hama, Prathik Shiruru, Arjun Naik, Manjunath Koti — Tue, 24 Feb 2026 00:00:00 +0530

Midshaft clavicle fractures are increasingly treated operatively. Functional and union outcomes have been extensively studied, but patient satisfaction with cosmetic appearance is less frequently analysed. A systematic review of PubMed-indexed comparative studies of operative versus non-operative management of displaced midshaft clavicle fractures was performed, with specific focus on patient-reported cosmetic outcomes. Randomised or comparative cohort studies in adults were eligible. The primary endpoint was satisfaction with shoulder appearance. Where dichotomous data were available, risk ratios (RR) with 95% confidence intervals (CI) were calculated. Where cosmetic data were incomplete, results were synthesised narratively. Four adult studies (three randomised trials and one prospective cohort; 409 fractures in total) reported cosmetic outcome data. Only the multicentre root canal therapy (RCT) from the Canadian Orthopaedic Trauma Society (COTS) provided extractable binary data for global cosmetic satisfaction. At one year, 84% (52/62) of patients treated with plate fixation were satisfied with appearance compared with 53% (26/49) in the non-operative group (RR 1.58, 95% CI 1.19-2.10), indicating a 58% relative increase in cosmetic satisfaction with surgery. The RCTs by Robinson et al and Smekal et al both reported significantly higher cosmetic satisfaction in surgically treated patients. The cohort series by Jubel et al described excellent contour restoration and high cosmetic satisfaction after intramedullary fixation. Within the data limitations, operative fixation of displaced midshaft clavicle fractures in adults is associated with higher cosmetic satisfaction than non-operative treatment. Surgery markedly reduces dissatisfaction from bony deformity at the expense of a surgical scar and occasional hardware prominence.

Comparison of postoperative outcomes between open surgical release and ultrasound guided percutaneous release of trigger finger: a systematic review and meta-analysis

Tue, 24 Feb 2026 00:00:00 +0530

Trigger finger is a hand condition that can be treated surgically through an open procedure or ultrasound (US)-guided percutaneous release. While similar techniques differ in invasiveness, recovery time, and complication rates, our research aims to compare the clinical outcomes of both techniques, focusing on pain relief, functional recovery, and patient satisfaction. A literature search was conducted in PubMed and the Cochrane Library. Six reviewers screened titles and abstracts, resolving conflicts with a seventh, and assessed full texts for eligibility. Included studies involved adult patients treated surgically for trigger finger with reported postoperative outcomes. Data was extracted using a standardised sheet capturing study details, demographics, management approaches, outcomes, and statistical methods. Eleven studies comparing open and US-guided release were included. Pooled analysis of six studies showed no significant difference in postoperative pain visual analogue scale (VAS) score [MD: 0.04 (-0.27, 0.34), p=0.80], with substantial heterogeneity (I²=74%). Q-DASH analysis from three studies also showed no significant difference in functional outcomes [MD:-0.06 (-2.24, 2.13), p=0.96], with heterogeneity (I²=79%) resolved through sensitivity analysis. Patient satisfaction was initially similar between groups, but after removing one study, open surgery showed significantly lower odds of satisfaction compared to US-guided release [OR: 0.23 (0.08, 0.64), p=0.005]. Our meta-analysis suggests that US-guided trigger finger release appears to provide similar pain relief and functional recovery as open surgery, with greater patient satisfaction. However, study heterogeneity calls for more high-quality research to confirm these findings.

Comparing infection rates between hollow and solid intramedullary nails in long bone fracture fixations: a formal systematic review and meta-analysis (2000-2024)

Olusegun S. Oyagbesan, Esan Oluwadare, Afeniforo Bode — Tue, 24 Feb 2026 00:00:00 +0530

Whether solid intramedullary nails reduce postoperative infection risk compared with hollow (cannulated) designs in long bone fracture fixation remains controversial. A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines, with Pubmed, Embase, central, and Google Scholar searched from January 2000 to May 2024 for comparative studies reporting infection outcomes after solid versus hollow intramedullary nailing of femoral or tibial shaft fractures. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using fixed- and random-effects models, and heterogeneity and sensitivity analyses were performed. Four studies, including one randomized controlled trial, two retrospective cohort studies, and one quasi-experimental study, involving 288 patients were included. Infection rates ranged from 0% to 56% across studies. The fixed-effect model suggested lower infection risk with solid nails (RR=0.62; 95% CI 0.42-0.92), whereas the random-effects model showed no significant difference (RR=0.71; 95% CI 0.32-1.56), with moderate heterogeneity (I²=45%). Sensitivity analyses demonstrated that pooled estimates were highly dependent on a single observational study with unusually high infection rates and short follow-up. Current evidence does not demonstrate a consistent reduction in infection risk with solid compared to hollow intramedullary nails, and overall certainty of evidence is very low, indicating that implant choice should prioritize technical considerations and established infection prevention strategies rather than unproven differences in nail design.

Is motion the best medicine? Rethinking knee osteoarthritis through gait analysis

Aavrati Rastogi, Roop B. Kalia, Pradeep K. Meena — Tue, 24 Feb 2026 00:00:00 +0530

A gradual degenerative joint disease, knee osteoarthritis (OA), places an enormous strain on healthcare systems around the world, especially in older people and those with metabolic and biomechanical risk factors. Knee OA causes crippling pain, stiffness, and functional incapacity.It is characterized by the slow deterioration of articular cartilage, subchondral bone sclerosis, osteophyte formation, and persistent synovial inflammation. Because of its intricate pathophysiology and the interaction between systemic inflammation and biomechanical stressors, the disease continues to pose a significant challenge, even with the availability of pharmacologic medicines, intra-articular therapy, and surgical procedures.

Novel femoral head allograft reconstruction technique of giant cell tumor of the bone in the mid-foot: a case report

Tue, 24 Feb 2026 00:00:00 +0530

An 83-year-old female presented with seven months of right medial foot swelling. Imaging revealed a lesion of the medial and middle cuneiforms with extension into the 1^st and 2^nd metatarsals. Biopsy suggested giant cell tumor of bone. She underwent wide excision, argon beam adjuvant, and reconstruction with a custom-molded femoral head allograft and midfoot arthrodesis. At one-year follow-up, she was pain-free, weight-bearing, and demonstrated fusion without recurrence. This case highlights a novel cement-mold technique to optimize graft fit, introducing a reconstructive strategy that maintains midfoot function despite extensive resection.

Proximal fibula resection with tibial stabilization: a surgical challenge of proximal fibular tumors

Tue, 24 Feb 2026 00:00:00 +0530

Primary fibular bone tumors are rare, representing 2.5–4% of all. Most occur in the proximal third and are benign, however their proximity to neurovascular and ligament structures may cause morbidity period. Surgical management is challenging, requiring careful dissection and reconstruction to preserve knee stability and function. Three proximal fibular tumors were resected en bloc with neurovascular preservation. The lateral collateral ligament and biceps femoris tendon were reattached to the proximal tibia using anchors. Minimum follow-up was 12 months. Functional outcomes were assessed with the musculoskeletal tumor society score (MSTS) score. All patients underwent successful resection with preservation of common peroneal nerve and key stabilizing structures. Anchor-based reconstruction provided good knee stability. No recurrence occurred. Transient peroneal nerve (CPE) deficits occurred in two patients, with full recovery. MSTS scores ranged from 83.3% to 93.3%. Proximal fibular resections are technically challenging due to anatomical complexity and close relationship with CPE. Larger resections increase the risk of CPE palsy, highlighting the need for meticulous planning and careful nerve handling. Although the need of lateral collateral ligament reconstruction is debated, reattachment using tibial anchors provided stable knees and good function in all cases. With proper technique, both oncological control and excellent functional outcomes are achievable.

Segmental bone defect of the femur: a clinical case of reconstruction with an osteoseptocutaneous fibular free flap with allograft

Tue, 24 Feb 2026 00:00:00 +0530

Segmental bone defects (SBD) of the distal femur present complex challenges in orthopedic surgery with various reconstruction methods available, such as fibular flaps. We present a case of a SBD of the distal femur reconstructed with an osteoseptocutaneous fibular free flap with allograft, as described by Capanna. A 25-year-old man suffered a Gustillo-Anderson-IIIA supraintercondylar fracture AO/OTA C2.3 with an SBD of the distal femur from a motorcycle accident. Initial treatment included closed reduction, internal fixation with percutaneous screws and osteotaxis. Subsequently, he underwent minimally invasive osteosynthesis. Reconstruction at 17 days post-injury involved a contralateral vascularized osteoseptocutaneous fibular free flap with allograft using the Capanna technique. The patient was allowed free range of motion, achieving 95º by 6 weeks postoperatively, and 120º by 7 months. Partial weight-bearing was allowed at 3 months postoperatively, progressing to full weight-bearing at 5 months. Radiographic graft integration was found at the 18 month re-evaluation. At 4 years the graft is integrated, and no complications were reported. SBDs of the femur pose a challenging entity. Among the various described reconstruction techniques, notable ones include arthroplasties, induced membrane technique (Masquelet), bone transport, allografts/autografts, and flaps. The use of the described technique increases integration rates despite donor site morbidity. Early percutaneous reduction and fixation of the distal femur articular component reduced the complexity of the subsequent procedure. The technique described by Capanna allows for reconstruction with structural support, possibly reducing the risk of non-union and fracture, and represents a valid alternative in SBDs >6 cm.

Trabecular metal augmentation for idiopathic avascular necrosis of the patella following non-resurfaced total knee arthroplasty

Tue, 24 Feb 2026 00:00:00 +0530

Avascular necrosis (AVN) of the patella is an uncommon complication following non-resurfaced total knee arthroplasty (TKA) and is typically attributed to compromised blood supply during surgery. We presented a case of idiopathic patellar AVN in a 71-year-old male one year after TKA with a non-resurfaced patella. Radiographs at that time revealed patellar erosion, prompting patelloplasty with a Zimmer NexGen Trabecular Metal Augmentation Patella (Zimmer Biomet, Warsaw, Indiana). Two weeks post-operatively, the patient resumed activities of daily living with minimal pain. At nine months, radiographs showed further patellar resorption and fragmentation, though the implant remained well-aligned. The patient exhibited no extensor lag but did present with mild weakness compared to the contralateral side. This case highlights trabecular metal patellar augmentation as a viable surgical option for managing symptomatic idiopathic patellar avascular necrosis following non-resurfaced total knee arthroplasty. The procedure preserved extensor mechanism function and provided meaningful clinical improvement, underscoring its potential role in select patients with limited patellar bone stock.

Iatrogenic chronic osteomyelitis of the clavicle: a rare case presentation

Rajat Gupta, Lokesh Pratap Singh — Tue, 24 Feb 2026 00:00:00 +0530

Chronic osteomyelitis of the clavicle is a rare clinical entity, as it is an uncommon infection at uncommon location. This is a case report of a young male with chronic osteomyelitis of the clavicle following surgical intervention after a traumatic fracture of left clavicle, highlighting diagnostic challenges, radiological features, surgical management, and favorable outcomes. A 24-year-old Indian male farmer presented with a 4-month history of a discharging sinus over the midshaft of the left clavicle. He had sustained a clavicular fracture five months earlier, managed elsewhere with K-wire fixation, followed by implant removal after one month. Subsequently, he developed a persistent discharging sinus without systemic symptoms. Clinical examination revealed local tenderness, induration, and purulent discharge. Laboratory investigations showed elevated ESR (65 mm/hr) and CRP (42 mg/l). Culture from the sinus discharge yielded methicillin-sensitive Staphylococcus aureus (MSSA). Radiographs demonstrated sclerotic changes with patchy rarefaction suggestive of chronic osteomyelitis. The patient underwent surgical debridement and sequestrectomy. Intraoperatively, necrotic bone and sinus tracts were excised completely. Postoperatively, he received culture-sensitive antibiotics for six weeks. The wound healed primarily, inflammatory markers normalized, and shoulder function recovered fully without recurrence. This case underscores the importance of considering osteomyelitis as a differential diagnosis in patients presenting with chronic sinus formation after clavicular surgery. Prompt surgical management combined with targeted antibiotic therapy ensures optimal recovery and prevents recurrence. As iatrogenic chronic clavicular osteomyelitis is rarely reported, this case enhances clinical awareness among orthopaedic surgeons and broadens current understanding of post-operative bone infections in uncommon anatomical sites. It highlights that timely diagnosis and radical debridement can yield excellent functional and infection control outcomes.

Isolated Tillaux fracture in an adult: a rare case and review of management

Tue, 24 Feb 2026 00:00:00 +0530

Isolated Tillaux fractures of the ankle joint are predominantly seen in adolescents due to the presence of open epiphyses, which makes the region more susceptible to injuries. In adults, this fracture is rare because the anterior inferior tibiofibular ligament (AITFL) typically ruptures before bone avulsion occurs. These injuries can be easily missed or misdiagnosed. Recognizing such injuries is critical to prevent long-term complications, including joint instability and post-traumatic arthritis. We report a rare case of an isolated Tillaux fracture in a 35-year-old male following a road traffic accident. This report outlines our diagnostic approach, management strategy, and postoperative outcome.

Recurrent diffuse pigmented villonodular synovitis of the knee with posterior extension: clinical outcomes following arthroscopic synovectomy with radiosynoviorthesis and platelet rich plasma- a case report

Tue, 24 Feb 2026 00:00:00 +0530

Pigmented villonodular synovitis (PVNS) is a rare, benign, and locally aggressive synovial disorder that most commonly affects the knee. The diffuse form carries a high recurrence risk and is challenging to treat, particularly when the posterior compartments are involved. A 29-year-old man presented with recurrent right knee stiffness and swelling without pain, five years after his second arthroscopic synovectomy for diffuse PVNS. MRI revealed extensive synovial proliferation involving the suprapatellar pouch and posterior knee compartment along the posterior cruciate ligament (PCL). He underwent arthroscopic synovectomy using a posterior trans-septal portal for complete posterior access, followed by radiosynoviorthesis with phosphorus-32, structured physiotherapy and adjuvant platelet-rich plasma (PRP) injection. At five-year follow-up, MRI showed moderate residual synovial thickening; however, the clinical outcomes improved markedly. The IKDC score increased from 41.4% to 83.9% and the Tegner-Lysholm score increased from 44% to 94%. The patient regained pain-free ambulation and knee motion from 0° to 120°, with no recurrent swelling. Recurrent diffuse PVNS with posterior compartment involvement benefits from a multimodal approach that integrates advanced arthroscopic techniques and adjuvant therapies. Significant functional recovery is achievable despite residual radiologic changes, highlighting the value of comprehensive management and long-term follow-up.

Primary calcaneal aneurysmal bone cyst in a 5-year-old treated with serial polidocanol sclerotherapy: a case report

Soumya Paik, Tathagata Bose, Sourav Bhomwik — Tue, 24 Feb 2026 00:00:00 +0530

Aneurysmal bone cyst (ABC) is rarely seen in the calcaneus of young children. To our knowledge, till date very less number of calcaneal ABC have been reported in the literature. A 5-year-old female child suffered chronic heel pain for last 2 months and was presented with x-ray showing a solitary and expansile osteolytic lesion within the calcaneus. Detailed clinico-radiological and histopathological examination suggested the lesion as ABC. The volume of the lesion was 11.9 cm3 as measured in the MRI. Curettage was not opted as wall of entire calcaneus was very thin and lesion was big compared to the age of child. Treatment was done with 4 sequential sclerosant polidocanol injection therapy over 9months, with minimum of 6 weeks interval in each injection. Dosage of the sclerosant therapy was calculated by weight of the patient (2-4 mg/kg) instead of volume of the cyst. No recurrence was observed over next 1 year by sequential X-rays. Age of the patient, anatomical location and severity in our case makes it unique. ABC can also be found in unusual locations like calcaneus even at 5 years age and can be managed by standard polidocanol protocol. In very young children with thin-walled, calcaneal ABCs, serial sclerosant injection may avoid morbid curettage/grafting.

Elastofibroma: a rare entity

Lokesh P. Singh, Sanchit Jain, Anupam Mural, Sumeet Kumar — Tue, 24 Feb 2026 00:00:00 +0530

Elastofibroma dorsi is a rare, benign soft-tissue pseudotumor that typically arises in the infrascapular region of elderly individuals. Due to its deep location and firm consistency, it may clinically and radiologically mimic malignant soft-tissue tumors, leading to diagnostic uncertainty. We report the case of a 57-year-old male who presented with a gradually enlarging, painful swelling in the right infrascapular region, associated with mechanical discomfort during shoulder movements. Clinical examination revealed a poorly defined, non-tender mass beneath the inferior border of the scapula. Imaging studies demonstrated characteristic findings, including a heterogeneous soft-tissue lesion with interspersed fatty streaks on computed tomography and a typical “striated” appearance on magnetic resonance imaging, with bilateral involvement. As the patient was symptomatic on the right side, surgical excision was performed. Histopathological examination confirmed the diagnosis of elastofibroma, showing fibrocollagenous tissue with abnormal elastic fibers and interspersed adipose tissue. The postoperative course was uneventful, with complete symptom resolution and no recurrence at six-month follow-up. Elastofibroma dorsi should be considered in the differential diagnosis of chronic infrascapular swellings, particularly in older patients with mechanical shoulder symptoms. Recognition of characteristic imaging features allows for accurate diagnosis and appropriate management. Surgical excision provides excellent symptomatic relief in selected cases.

Right congenital pseudoarthrosis of clavicle managed with plate fixation alone

Tue, 24 Feb 2026 00:00:00 +0530

Congenital pseudoarthrosis of the clavicle is a rare developmental anomaly caused by failure of fusion between the medial and lateral ossification centers of the clavicle. Although often asymptomatic, surgical intervention may be indicated for cosmetic deformity, pain, or functional impairment. We report a case of a 12-year-old male with right-sided congenital pseudoarthrosis of the clavicle treated surgically by excision of the pseudoarthrosis and rigid plate fixation without bone grafting. Histopathological analysis confirmed fibrocartilaginous tissue consistent with pseudoarthrosis. At one-year follow-up, the patient was asymptomatic with full, pain-free shoulder range of motion and radiographic evidence of complete union without implant-related complications. This case demonstrates that stable internal fixation alone may be sufficient to achieve union in selected cases of congenital pseudoarthrosis of the clavicle, potentially avoiding donor-site morbidity associated with bone grafting.

Multiple glomus tumors in left hand digits: a case report with literature review

Tue, 24 Feb 2026 00:00:00 +0530

Glomus tumors are rare, benign vascular neoplasms that arise from the neuromyoarterial glomus body, most commonly occurring in the subungual region of the fingers. Despite their small size, which causes disproportionate symptoms characterized by severe localized pain, pinpoint tenderness, and cold sensitivity, they often lead to delayed or missed diagnosis. This case report is of a 48-year-old male with a 20-year history of localized pain in the left index, ring, and small fingers. He had visited multiple healthcare centers and received various treatments, but not relief. On detailed history and physical examination, with visual analogue scale (VAS) 9/10 findings were suggestive of a glomus tumor. Magnetic resonance imaging (MRI) confirmed the diagnosis and precisely localized the lesion. The patient underwent complete surgical excision, and histopathological examination of the specimen confirmed a glomus tumor. Postoperatively, the patient experienced immediate symptomatic relief, with a VAS 1/10. with no recurrence observed during nine months of follow-up. This case highlights the presence of a multiple-digit-long-standing glomus tumor in the left hand that remained undiagnosed and undertreated for a long time, the presence of multiple glomus tumors in the same hand digits is rarely reported in the literature.

Refracture of a malunited clavicle: angular deformity as an under-recognized biomechanical risk factor

Lalit Panchal, Sagar Bagwe, Bhushan Rathod, Akash Ambhore — Tue, 24 Feb 2026 00:00:00 +0530

Angular deformity in clavicle fractures is often considered acceptable in adults when displacement and significant shortening are absent. However, altered biomechanics resulting from angular malunion may predispose to refracture. We report a 40-year-old male with a previously malunited clavicle fracture treated non-operatively who sustained a refracture following minor trauma. After failure of conservative management, open reduction and internal fixation with a clavicular reconstruction plate was performed. This case highlights angular malunion as an under-recognized biomechanical risk factor for clavicle refracture in adults and suggests that angular deformity should be considered during initial fracture assessment.

Short-term clinical and functional outcomes of all-inside anterior cruciate ligament reconstruction surgery

Tue, 24 Feb 2026 00:00:00 +0530

Background: The clinical efficacy and safety of all-inside anterior cruciate ligament (ACL) reconstruction remain subjects of ongoing discussion. This study aimed to evaluate the outcomes and complications associated with this technique in patients undergoing primary ACL reconstruction.

Methods: This prospective cohort study included fifty patients presenting with a first-time traumatic ACL tear who underwent all-inside ACL reconstruction. In all cases, a Semitendinosus autograft harvested from the ipsilateral limb was prepared and used for reconstruction. Patients were followed for one year after surgery. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, the Lysholm knee score, and instrumented laxity testing with KT-1000, along with clinical evaluation of the pivot-shift and Lachman tests.

Results: There was a significant improvement in Lachman and pivot-shift test scores post-operatively (p<0.001). The IKDC score after surgery was 96.1±7.1 (range 70-100), respectively. Based on Lysholm scoring, there were excellent knee function in 88%, 6% good and 6% fair knees. The mean side-to-side difference in tibial translation was 1.1±1 mm. Physiotherapy sessions revealed a direct positive correlation with IKDC scores (r= 0.504, p<0.001). In none of the cases was graft failure seen. 2 patients had final follow-up grade I or more tibial-creaking at the pivot.

Conclusions: The inlay allograft ACL reconstruction provides excellent clinical and objective stabilization results and low complications with good subjective scores.

A retrospective cohort study: risk factors for hip abductor disruption in patients undergoing total hip arthroplasty and hemiarthroplasty

Tue, 24 Feb 2026 00:00:00 +0530

Background: Hip abductor pathology is increasingly recognized as a contributor to impaired mobility and suboptimal outcomes following total hip arthroplasty (THA) and hemiarthroplasty. However, the prevalence and clinical significance of abductor disruption across fracture-related and elective indications remain unknown.

Methods: We conducted a retrospective cohort study of 67 patients who underwent total hip arthroplasty, hemiarthroplasty, or hip abductor repair between 2017 and 2023, identified using CPT codes from the AthenaOne healthcare system and Alpine Ortho Spine Clinic database.

Results: Fracture patients were significantly older than elective total hip arthroplasty patients (76.8±8.2 versus 66.4±7.9 years, p<0.001) and demonstrated a higher proportion of Dorr type C femora (p=0.02). Both iliopsoas and quadriceps strength improved postoperatively across the cohort (iliopsoas: 2.7±0.9 to 3.4±0.8, p<0.01; quadriceps: 3.0±0.8 to 3.6±0.7, p<0.01). Elective patients showed greater strength gains than fracture patients (iliopsoas Δ0.9 versus Δ0.5, p=0.03; quadriceps Δ0.8 versus Δ0.4, p=0.04). Trendelenburg gait was more prevalent preoperatively in fracture patients (38% versus 19%, p=0.04) and remained higher at follow-up (24% versus 12%, p=0.05).

Conclusions: Pre-existing hip abductor disruption is common in both fracture and elective arthroplasty populations. These findings highlight the importance of recognizing abductor pathology as a modifiable factor influencing recovery and support the role of targeted perioperative management and rehabilitation strategies.

Needle gauge and patient pain in steroid injection of the knee: a prospective randomized controlled trial

Tue, 24 Feb 2026 00:00:00 +0530

Background: Intra-articular corticosteroid injection (IACI) is a common conservative treatment modality for knee osteoarthritis (OA) but can cause procedural discomfort. Needle gauge is a modifiable factor that may influence patient pain perception, though evidence remains limited. This study compared 18- versus 22-gauge needles in knee IACIs.

Methods: The authors performed a single-blinded, prospective, randomized controlled trial at a public teaching hospital (San Joaquin General Hospital, in French Camp, CA) from May 10, 2023 to October 16, 2024. Adults with primary knee OA indicated for corticosteroid injection were randomized to receive injection with either an 18-gauge or 22-gauge needle. All injections were performed via the superolateral approach using triamcinolone acetonide and lidocaine. Pain scores were measured using a visual analogue scale (VAS). Secondary outcomes included anticipated pain, nervousness, and satisfaction.

Results: Twenty-six patients were randomized (14 in the 18-gauge group, 12 in the 22-gauge group). Median injection pain was similar between groups (median 2.5 vs 2.5, p=0.71). Post-injection pain was lower in the 18-gauge group (median 1.5 vs 3.5, p=0.21), but not statistically significant. Pre-injection nervousness correlated with both injection pain (ρ=0.50, p=0.011) and post-injection pain (ρ=0.55, p=0.004).

Conclusions: Needle gauge did not significantly affect pain or satisfaction during knee IACIs. Psychosocial factors appear to play a greater role in pain perception than needle size.

Study of mortality rate following fixation of proximal femur fractures by gamma nail

Mohie Eldin Fadel, Awad E. Rafalla, Albraa Ahmed Abbadi, Ahmed Alaaeldin — Tue, 24 Feb 2026 00:00:00 +0530

Background: Proximal femur fractures, are prevalent in elderly individuals due to osteoporosis. These fractures are significant causes of morbidity and mortality worldwide. Surgical treatment typically involves fixation techniques like the gamma nail, a cephalomedullary implant designed to provide stable fixation with minimal soft-tissue trauma. However, despite these advancements, the mortality rates post-surgery remains high, with early mortality reaching 7-10% and one-year mortality between 20-30%. Identifying risk factors for mortality in patients undergoing gamma nail fixation is crucial to improve patient outcomes and guide surgical decision-making. The primary aim of the study was to evaluate the mortality rate following Gamma Nail fixation for proximal femur fractures in elderly patients at Elhadra University Hospital. The study sought to correlate various preoperative factors, including age, comorbidities, and mobility scores, with mortality outcomes to better predict patient prognosis.

Methods: This retrospective study included 220 patients aged 60 years or older who underwent Gamma Nail fixation for proximal femur fractures at Elhadra University Hospital between January 2023 and January 2024. Exclusion criteria were polytrauma patients and those younger than 60 years. Data collected included patient demographics (age, sex), preoperative medical history (comorbidities, previous surgeries, drug use), and functional status assessed using the Parker mobility score. The American society of anesthesiologists (ASA) classification and Nottingham hip fracture score (NHFS) were also recorded. Postoperative complications, including co-morbidities, intensive care unit (ICU) admissions, and mortality rates (both within 30 days and one year), were analyzed.

Results: The mean age of the patients was 70.98 years, with a slight majority being female (53.64%). Intertrochanteric fractures were the most common (85%), followed by subtrochanteric fractures (15%). Preoperative activity levels varied, with the majority reporting moderate activity. Cardiovascular diseases were the most prevalent comorbidity, affecting 66.33% of patients. Mortality rates were high, with 30.45% of patients dying during the study period, 8.64% of whom died within the first month. The study found that advanced age, higher ASA scores, low mobility scores, and cardiovascular comorbidities significantly correlated with higher mortality rates. Additionally, patients with higher NHFS scores (≥5) and those requiring postoperative ICU care had a significantly higher mortality risk.

Conclusions: The study concluded that gamma nail fixation is effective for treating proximal femur fractures in elderly patients, but mortality remains high, particularly in patients with advanced age, poor preoperative functional status, and significant comorbidities such as cardiovascular diseases. The identification of high-risk patients using tools like the ASA score, NHFS, and Parker mobility score can help guide perioperative management and improve patient care. Postoperative complications, including ICU admissions, were also strongly associated with increased mortality. Further research focusing on risk factor modification and enhanced perioperative care is essential to reduce mortality in this vulnerable patient population.

Outcomes of percutaneous endoscopic lumbar discectomy via transforaminal approach in stable low-grade single level lumbar spondylolisthesis: a retrospective study

Thippatai Chaichompoo, Woraphot Wichan, Siravich Suvithayasiri — Tue, 24 Feb 2026 00:00:00 +0530

Background: Lumbar spondylolisthesis (LS) is a common degenerative spinal disease treated by fusion. Percutaneous endoscopic lumbar discectomy (PELD) reduces damage to tissues, blood loss, and hospital stay. Transforaminal PELD in stable low-grade LS has limited clinical and radiological outcomes, and inpatient department (IPD) cost comparisons with transforaminal lumbar interbody fusion (TLIF) are rare. This study evaluated clinical and radiographic outcomes and PELD versus TLIF IPD cost.

Methods: This retrospective study included 24 patients with stable low-grade single-level LS who underwent transforaminal PELD between December 2021 and November 2022. Clinical outcomes were assessed using visual analogue scale (VAS), Oswestry disability index (ODI), modified MacNab criteria, walking distance improvement, and patient satisfaction. Radiographic outcomes were evaluated by percentage slip preoperatively and at final follow-up. IPD costs were compared between PELD and TLIF.

Results: The mean age was 52 years, and L4-5 was the most common level. All patients had Grade 1 spondylolisthesis. Mean operative time was 53.17±26.14 minutes, blood loss was 8.29±10.45 mL, hospital stay was 2.96±1.16 days, and follow-up was 6.7 months. VAS, ODI, and walking distance improved significantly (p<0.001). Modified MacNab outcomes were excellent in 75% and good in 20.8%. Mean slip percentage showed no significant change (p=0.458). Mean IPD cost was 64,785.95 THB (1,754.69 EUR) for PELD and 98,392.36 THB (2,664.90 EUR) for TLIF.

Conclusions: Transforaminal PELD is a safe and effective minimally invasive option for stable low-grade single-level LS, providing favorable short-term outcomes without radiographic progression and lower IPD cost than TLIF.

Outcomes of surgical excision versus aspiration for wrist ganglion cysts: a comparative cohort study

Ahmed A. Al-Safar, Laith K. Al-Ashou, Abdulhadi A. Abdulmawjod — Tue, 24 Feb 2026 00:00:00 +0530

Background: To compare recurrence rates and clinical outcomes after open surgical excision versus needle aspiration in patients with wrist ganglion cysts.

Methods: We analyzed 84 consecutive patients treated for wrist ganglion cysts between Jan 2019 and Jan 2023 at a single center. Fifty-three patients underwent open excision of the ganglion, while 31 underwent cyst aspiration plus steroid injection. Patients were followed for 12 months, with assessment of cyst recurrence (by clinical examination and confirmed by ultrasound), pain (visual analog scale) and patient satisfaction. Group comparisons were performed using χ² or t-tests.

Results: Demographic variables (age, sex, cyst location) were similar between groups. Recurrence occurred in 11 of 53 excision patients (20.8%) versus 18 of 31 aspiration patients (58.1%) (p<0.001). Surgical excision significantly reduced the risk of recurrence compared with aspiration. Mean pain scores improved in both groups, with a greater reduction after excision (mean VAS reduction 5.6 vs 3.5, p=0.01). Most patients in both groups were satisfied: 94.3% after excision versus 77.4% after aspiration (p=0.045). Complications were few (3.8% overall), occurring only in the excision group (5.7% versus 0%, p=0.46).

Conclusions: Open surgical excision of wrist ganglia yields markedly lower recurrence than aspiration, with high patient satisfaction in either group. Aspiration is less invasive but is associated with a significantly higher recurrence rate. Open excision should be preferred for durable cure, although aspiration may still be considered for selected patients.

Patients with primary thrombophilia on anticoagulation face increased mortality, thromboembolic events, and neurologic complications after laminectomy: a propensity-matched analysis

Naasik Syed, Zuhair Zaidi, Muaz Wahid, Ronak Desai — Tue, 24 Feb 2026 00:00:00 +0530

Background: Inherited thrombophilias are known risk factors for venous thromboembolism (VTE). The impact of thrombophilia on spine surgery outcomes, especially laminectomy, remains poorly defined, particularly in the context of chronic anticoagulation.

Methods: Using the TriNetX Research Network, we conducted a retrospective cohort study of adult patients undergoing laminectomy between 2004–2025. Patients with primary thrombophilia on ≥6 months of anticoagulation prior to surgery were identified and propensity score–matched 1:1 to controls without thrombophilia or anticoagulation. Outcomes assessed at 90 days and 1 year included mortality, VTE, systemic complications, neurologic deficits, and hospitalizations.

Results: A total of 3,812 matched patients were analyzed. At 90 days, thrombophilia patients had significantly higher rates of mortality, deep vein thrombosis (DVT), sepsis, and hospitalizations. At 1 year, rates of mortality remained elevated, as did DVT, hospitalizations, and new or worsening neurologic deficits. Other systemic and surgical complications were not significantly different.

Conclusion: Patients with inherited thrombophilia on anticoagulation face substantially higher risks of morbidity and mortality following laminectomy. These findings underscore the need for careful perioperative anticoagulation strategies and individualized risk assessment in this high-risk surgical population.

Clinical outcome of lumbar microdiscectomy in patients with prolapsed lumbar intervertebral disc

Tue, 24 Feb 2026 00:00:00 +0530

Background: Prolapsed lumbar intervertebral disc (PLID) is a common cause of low back pain and radiculopathy, often requiring surgical intervention when conservative management fails. Lumbar microdiscectomy is a widely accepted minimally invasive procedure for symptomatic relief, yet long-term outcome data in Bangladeshi populations remain limited.

Methods: This retrospective observational study was conducted across multiple orthopedic centers in Rangpur City, Bangladesh, from January 2010 to December 2024. A total of 500 patients with clinically and radiologically confirmed PLID who underwent lumbar microdiscectomy were included. Demographic, clinical, radiological, operative and postoperative data were collected and analyzed using SPSS version 25. Outcomes assessed included pain relief, neurological recovery, complications and length of hospital stay.

Results: The mean age of patients was 45.1±9.3 years, with males predominating (63.4%). Manual laborers comprised the largest occupational group (36.6%). Low back pain and leg pain/radiculopathy were the most common presenting symptoms (100% and 93.6%, respectively), while sensory disturbances were reported in 61.4% and motor weakness in 27.8%. MRI showed L4-L5 as the most commonly affected level (57.4%), with disc extrusion predominating (51.8%). Unilateral microdiscectomy was performed in 90.4% of cases, with a mean operative time of 56.1±11.9 minutes and mean blood loss of 82.7±26.4 ml. Postoperatively, excellent and good pain relief was achieved in 69.4% and 22.6% of patients, respectively. Complete neurological recovery occurred in 75.4%, with a low complication rate. The mean hospital stay was 3.5±1.5 days.

Conclusions: Lumbar microdiscectomy is a safe and effective procedure for PLID, providing substantial pain relief and neurological improvement with minimal complications and short hospitalization.

Impact of triangular fibrocartilage complex injury in distal radius fracture on functional outcome

Nikhil S. Singh, Pankaj Dagar, Akhil Shetty, Aniket Naik, Nishad Goda — Tue, 24 Feb 2026 00:00:00 +0530

Background: There is limited clinical data suggesting whether triangular fibrocartilage complex (TFCC) injury, associated with distal radius fracture (DRF), should be diagnosed and treated regularly. This study was conducted to identify the incidence of TFCC injury in DRF and its effects on outcome after fracture healing.

Methods: This was a prospective cohort study wherein patients treated for DRF were evaluated for TFCC injury. Data collected at 3 and 6 month follow up included grip strength, range of movement and Patient Rated Wrist Evaluation (PRWE) score. Data from 24 patients with TFCC injury and 26 patients without TFCC injury was analyzed.

Results: Out of the total 50 patients with DRF, 48% were diagnosed with TFCC injury using wrist arthrography. Most (58.33%) of which were associated with fractures due to road traffic accidents. A significantly higher proportion of patients reported pain on ulnar deviation (p=0.035) and positive press test (p<0.001) in those with compared to without TFCC injury. The mean PRWE score in those with and without TFCC injury were 27.92±17.61 and 21.15±12.79 respectively. An associated ulnar styloid fracture was observed in ⁓46% patients. There was no statistically significant difference in the outcome measures between the two groups.

Conclusions: In our study, the incidence of TFCC injury in DRF was 48%. There was no significant effect of TFCC injury on the functional outcome of wrist after DRF healing. We thereby conclude that routine diagnosis and treatment of TFCC injury in DRF is not essential.

Outcome of femoral neck system for the management of femoral neck fractures

Tue, 24 Feb 2026 00:00:00 +0530

Background: Femoral neck fractures present significant challenges in orthopedic practice, necessitating effective surgical interventions for optimal recovery. This study aims to evaluate the outcomes of femoral neck fracture fixation using the femoral neck system (FNS).

Methods: This quasi-experimental study at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, from March 2022 to September 2024 included 45 patients with femoral neck fractures. Patients aged 18-65 years with fractures within 14 days were treated using the FNS after preoperative assessment and prophylactic antibiotics. Postop care involved exercises, progressive weight-bearing, radiographic follow-up, and Harris hip score (HHS) evaluation. Data were analyzed using SPSS 26; ethical approval and informed consent were obtained.

Results: In 45 patients undergoing femoral neck fixation with FNS, mean age was 41.8±9.3 years, with 78% males. Road traffic accidents caused 60% of fractures; 53% involved the right femur. Surgery occurred at 4.6±1.8 days post-injury, with a mean hospital stay of 9.6±1.8 days. At final follow-up, 62% reported slight pain, 80% had no limping, and 13% experienced complications. Radiological union was achieved in 96% at 13.3±1.6 weeks. Mean HHS was 86.1±8.8, with 85% showing excellent or good functional outcomes.

Conclusions: FNS fixation of femoral neck fractures is a safe and effective approach, yielding high rates of healing, functional recovery, and minimal complications.

A comparative study of titanium elastic nailing and plate osteosynthesis for pediatric both-bone diaphyseal forearm fractures

Gopabandhu Patra, Alok Prusty, Anil Kumar Sahu — Wed, 07 Jan 2026 00:00:00 +0530

Background: Both-bone diaphyseal forearm fractures are common in children and require stable fixation for optimal functional recovery. Plate osteosynthesis (PO) and titanium elastic nailing (TEN) are widely used surgical techniques. Comparative evidence on outcomes between these methods remains limited.

Methods: This multicentric, comparative study included 70 children aged 5-15 years with diaphyseal both-bone forearm fractures. Thirty-five patients underwent PO and 35 underwent TEN. Functional outcomes were assessed using the price criteria, and radiological union and radial bow restoration were evaluated. Operative duration, hospital stay, and complications were also recorded.

Results: Operative time and hospital stay were significantly shorter in the TEN group compared to PO. Functional outcomes were predominantly excellent in both groups, with no significant difference. Radiological union times and restoration of radial bow were comparable between groups. Complication rates were low and similar in both groups.

Conclusions: TEN provides equivalent functional and radiological outcomes to PO, with shorter surgery and hospitalization.

Enhancing patient safety through effective materiovigilance system: a prospective observational study on adverse events reporting for medical devices in surgical and orthopaedic departments at a multispecialty hospital

Dhandapani C., Sudharson I., Boobalan T. — Tue, 24 Feb 2026 00:00:00 +0530

Background: Medical device-associated adverse events (MDAEs) pose serious risks to patient safety, still its underreporting. The Materiovigilance Programme of India (MvPI) was established to systematically monitor and improve the safety of medical devices. The objective of this study was to enhance patient safety by identifying and analyzing adverse events associated with medical devices and to evaluate healthcare professional’s knowledge about materiovigilance.

Methods: A 6-month prospective observational study was conducted at Kovai Medical Centre and Hospital, Coimbatore. MDAEs were recorded and classified under MDR 2017 guidelines. Causality, severity, and risk class were analyzed. A structured questionnaires assessed knowledge, perception, and barriers among 121 healthcare professionals.

Results: Among 40 MDAEs, 52.5% involved class C (high-risk) devices like orthopaedic implants, all classified as serious. Significant correlation was found between device class and severity (p=0.0001). Causality assessments showed most events were probable or related. Survey results showed 78.5% awareness of MvPI, yet only 34.7% had reported MDAEs.

Conclusions: The study emphasizes the need for improved training, simplified reporting procedures, and institutional support to enhance materiovigilance. Strengthening MvPI with user-friendly tools, confidentiality measures, and feedback systems is crucial to ensuring safe medical device usage.

Hypovitaminosis D in adult patients scheduled for orthopaedic surgery: a cross-sectional and observational study

Tue, 24 Feb 2026 00:00:00 +0530

Background: Hypovitaminosis D is a common yet underdiagnosed nutritional deficiency with significant implications for orthopaedic surgical patients. Vitamin D plays a critical role in calcium homeostasis, bone metabolism, and muscle function—factors influencing bone healing, infection risk, and postoperative rehabilitation. Although global studies report high prevalence, limited Indian data exist for orthopaedic surgery patients.

Methods: A cross-sectional observational study was conducted in the Department of Orthopaedics, Government Medical College, Jammu, from September 2023 to February 2024. Fifty adult patients (>20 years) scheduled for elective orthopaedic surgery were included. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured preoperatively using liquid chromatography–tandem mass spectrometry. Deficiency was defined as <20 ng/ml, insufficiency as 20–30 ng/ml, and optimal as >30 ng/ml. Demographic and clinical variables (age, sex, BMI) were recorded. Ethical clearance was obtained from the Institutional Ethics Committee (approval no. GMCJ/IEC/2023/241).

Results: Mean age was 56.17±15.23 years; 58% were male. Mean body mass index (BMI) was 25.61±4.21 kg/m², with 38% overweight. Vitamin D deficiency was present in 30% of patients, insufficiency in 40%, and optimal levels in 30%. Deficiency was more prevalent among males and overweight individuals, and highest in the 61–70-year age group (38%).

Conclusions: Hypovitaminosis D is highly prevalent among adults undergoing orthopaedic surgery. Overweight status and male gender were associated with higher risk. Routine preoperative screening and supplementation could improve surgical outcomes and reduce complications.

Functional and radiological outcomes between cemented and uncemented partial hip replacement in the elderly

Ajinkya Pravin Darak, Amit Mahajan, Snehal Hedgire — Tue, 24 Feb 2026 00:00:00 +0530

Background: Hemiarthroplasty (HA) is the treatment of choice for displaced intracapsular femoral neck fractures (FNFs) in elderly patients. However, the optimal method of fixation-cemented or uncemented-remains controversial, particularly in the Indian population. This study aimed to compare the functional and radiological outcomes of cemented versus uncemented HA (UCHA) in elderly patients.

Methods: A retro-prospective comparative study was conducted at a tertiary care centre from January 2021 to September 2024. Sixty-seven patients aged above 60 years with intracapsular FNFs treated with HA were included. Patients were divided into cemented (n=44) and uncemented (n=23) groups. Functional outcome was assessed using the Harris hip score (HHS), and radiological evaluation focused on prosthetic subsidence at 6 months postoperatively. Statistical analysis was performed using SPSS version 29.0 with p<0.05 considered significant.

Results: The mean age of patients was 72.37±8.1 years, with females comprising 55% of the cohort. At 6 months, no statistically significant difference was observed in HHS between the cemented and uncemented groups (p=0.132). Good functional outcomes were seen in 52.6% of the cemented group and 54.5% of the uncemented group. Prosthetic subsidence was higher in the uncemented group (13.04%) compared to the cemented group (2.63%), though the difference was not statistically significant (p=0.135). No major complications were reported.

Conclusions: Cemented and UCHA showed comparable short-term functional outcomes. However, uncemented fixation demonstrated a higher trend toward prosthetic subsidence. Larger studies with longer follow-up recommended.

Correlation between hamstring flexibility and incidence of low back pain in physiotherapy students

Subashini A., Kirthiga A., Kushmitha B., Jeyanthi S. — Tue, 24 Feb 2026 00:00:00 +0530

Background: Due to mobile phones and other devices, students are becoming more sedentary these days. Their muscles become rigid as a result of their inactivity. Therefore, our study must analyze the problem of hamstring flexibility and determine the prevalence of low back discomfort among students. The current study aimed to observed the difference in hamstring muscle flexibility. The difference between dominant and non-dominant legs and to determine the correlation between low back pain and hamstring muscle flexibility.

Methods: One hundred students both male and female with hamstring flexibility of at least 150 have been included in this study. Hamstring muscle shortening was examined by the active knee extension test and straight leg raising test, While the low back disability stage was assessed by Oswestry disability index.

Results: The straight leg rising and the active knee extension test (AKE) of the right leg were significantly more flexible than the left side. There was a weak positive non- significant correlation between ODI and AKE of the; right side (r=-0.133, p=0.70) and the left side (r=-0.119, p=0.80). There was weak negative non- significant correlation between ODI and straight leg raising test (SLR) of the right side. There was a weak positive non-significant correlation between ODI and SLR of the right and left side.

Conclusions: The results of this study should demonstrate a negative correlation and no discernible link between LBP and hip and knee hamstring flexibility.

Efficacy of intra-operative adductor canal block in total knee arthroplasty: a prospective observational study

Karthik V., Rajavarman S., Subhash Janghid — Tue, 24 Feb 2026 00:00:00 +0530

Background: Effective postoperative pain control after total knee arthroplasty (TKA) remains a clinical challenge. This study aimed to evaluate the efficacy of intraoperative adductor canal block (ACB) in providing pain relief and preserving quadriceps function.

Methods: This prospective observational study included 92 patients undergoing primary TKA. Intraoperative ACB was administered by the operative surgeon, and outcomes assessed included pain scores (visual analogue score (VAS) at multiple time points), quadriceps muscle power, complications, and postoperative analgesic use. Statistical associations were evaluated using Chi-square and t-tests with p<0.05 as significant.

Results: Most participants reported mild pain at 6–8 hours, with moderate pain predominating at 24–48 hours and during mobilization. Quadriceps strength was preserved in nearly half the patients. Analgesic consumption correlated with higher VAS at 48 hours (p=0.001). Age was associated with reduced quadriceps strength (p=0.011). Longer preoperative pain duration was significantly linked to higher postoperative pain at 24–48 hours.

Conclusions: Intraoperative Adductor canal block is an effective, motor-sparing analgesic option for TKA, supporting early mobilization and reducing dependence on opioids. Further research is warranted to optimize block techniques and adjunct strategies.

Functional outcome of posterior-stabilized total knee replacement in women with primary osteoarthritis of the knee joint

Sudhakar M. V., Acksen Thangaraja, Aysha Sabnam Mohammed Basheer — Tue, 24 Feb 2026 00:00:00 +0530

Background: Osteoarthritis (OA) of the knee is highly prevalent in postmenopausal women, leading to significant pain and disability. Posterior-stabilized total knee replacement (PS TKR) replaces the posterior cruciate ligament (PCL) with a cam-post mechanism to restore stability and motion. However, data specifically addressing functional outcomes in women are limited.

Methods: This prospective observational study was conducted in the Department of Orthopaedics, Dr. SMCSI Medical College Hospital, Karakonam, Kerala, from January 2023 to January 2025. 36 women patients with osteoarthritis knee who underwent PS TKR were included. Functional outcomes were assessed using KSS preoperatively and at 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. The relationship between BMI and KSS was analyzed.
Results: The mean age of female patients was 63.3 years, and mean BMI was 29.4 kg/m². The mean preoperative KSS was 27.6, which improved to 92.3 at 1 year. At final follow-up, 90.5% of women achieved excellent and 9.5% good results. No significant difference in KSS was observed between BMI groups (p>0.05).

Conclusions: Posterior-stabilized TKR offers excellent functional outcomes in women, independent of preoperative BMI. The procedure effectively alleviates pain and restores mobility in postmenopausal women with advanced osteoarthritis.

Push back and pull down to socket manoeuvre – a simple and effective technique to engage graft into the tibial socket in all inside anterior cruciate ligament reconstruction

Sreejith Thundathil, Naveen Madheswaran, Nidhin Sarath, Nihal Suresh — Tue, 24 Feb 2026 00:00:00 +0530

Background: All-inside Anterior cruciate ligament Reconstruction technique is newer technique that has advantages of preservation of cortical bone. The potential for peripatellar soft tissue to become interposed between the bone and the graft has been a significant issue in the technique. Early necrosis of any interposed tissue can compromise the strength of fixation button. Our technique of pushback and pull down to socket manoeuvre avoids this interposition and entanglement. This study was done to know the efficacy of pushback and pull down to socket manoeuvre.

Methods: In our study, 298 cases fulfilling the criteria undergone All inside anterior cruciate ligament reconstruction with push back and pull down to socket manoeuvre and corresponding radiological and functional outcomes were assessed using International Knee Documentation Committee (IKDC) score.

Results: In our study, the mean IKDC score is 83 at 1 year follow-up. There is no radiological widening of both femoral and tibial tunnel during follow up. There is considerable reduction of time for passing graft into the tibial socket. No episodes of entanglement happened in any case during surgery and the success rate was 100 percent.

Conclusions: Push back and pull down to socket manoeuvre is a simple and fail proof technique to avoid peri patellar soft tissue entanglement while managing the engagement of graft into the tibial socket. This technique also helps to save time, improves surgeons comfort.

Efficacy of autologous platelet-rich plasma injection in plantar fasciitis

Pulkit Sharma, Sanjeev Gupta, Nikhil Sharma — Tue, 24 Feb 2026 00:00:00 +0530

Background: Plantar fasciitis (PF) is the most common cause of chronic heel pain in adults, resulting from repetitive micro-trauma and degenerative changes of the plantar fascia. When conservative therapies fail, newer biological modalities such as platelet-rich plasma (PRP) are being explored.

Methods: This prospective study was conducted in the Department of Orthopaedics, Government Medical College, Jammu, over a period of one year in collaboration with the blood bank. Thirty-eight patients with clinically diagnosed plantar fasciitis of ≥3 months’ duration, unresponsive to conservative therapy and with a baseline visual analogue scale (VAS) pain score >7, were included. PRP was prepared using the double-spin centrifugation method from 12 mL of autologous venous blood, and 2 ml of PRP were injected at the maximum tender point using the peppering technique. Patients were followed up at 1 week, 1, 2, 4, and 6 months. Pain relief was assessed using the VAS (0–10).
Results: All 38 patients completed a 6-month follow-up. Mean baseline VAS was 8.68±0.47, which decreased to 7.21±1.63 at 1 month, 5.63±2.55 at 2 months, 5.42±2.16 at 4 months, and 5.03±2.43 at 6 months (p<0.05). The maximum improvement occurred by the second month and was sustained up to six months. Complete pain relief was achieved in 13.2% of patients by two months, while 78.9% experienced <50% pain reduction. No complications were reported.
Conclusions: Autologous PRP injection is a safe, minimally invasive option for chronic plantar fasciitis, providing modest but sustained pain reduction.

Evaluation of clinico-radiological outcomes in the treatment of Lichtman stage upto IIIa Kienböck’s disease by radius core decompression

Akshay Kumar, Narender Saini, Vikas Singh, Banisikha Das, Anil K. Badgotya — Tue, 24 Feb 2026 00:00:00 +0530

Background: Kienböck’s disease is a progressive osteonecrosis of the lunate leading to chronic wrist pain and dysfunction. Radius core decompression (RCD) is a joint-preserving, minimally invasive procedure that aims to improve lunate perfusion by reducing intraosseous pressure. This study evaluates the clinico-radiological outcomes of RCD in patients with Lichtman stage I–IIIa disease.

Methods: A prospective observational study was conducted at the Department of Orthopaedics, SMS Medical College, Jaipur, including 32 patients with Lichtman stage I–IIIa Kienböck’s disease. All patients underwent RCD and were followed for a mean of 16.7 months. Functional outcomes were assessed using the visual analogue scale (VAS), grip strength, and wrist range of motion. Radiological evaluation was done using the modified carpal height ratio (MCHR).

Results: The mean VAS score improved from 7.08 preoperatively to 3.31 postoperatively (p<0.001). Mean grip strength increased from 57.03% to 60.02% of the contralateral hand (p<0.001). There was significant improvement in wrist range of motion, including palmar flexion, dorsiflexion, and ulnar deviation. The mean MCHR stabilized postoperatively (1.55±0.016), indicating maintenance of carpal height. No cases progressed to advanced disease during follow-up.

Conclusions: Radius core decompression is a safe and effective joint-preserving technique for early-stage Kienböck’s disease, providing significant pain relief, functional improvement, and stabilization of radiological parameters. It offers a viable alternative to more invasive revascularization or joint-leveling procedures in Lichtman stage I–IIIa disease.

Functional outcomes of proximal humerus internal locking system plating with tension suture fixation for proximal humerus fractures: a prospective study

Vinu Elias, Deepak Ranjan Patro, Unais T. T. — Tue, 24 Feb 2026 00:00:00 +0530

Background: Proximal humerus fractures are increasingly common injuries, particularly among the elderly osteoporotic population. While the majority of these fractures are undisplaced and can be managed conservatively, displaced fractures often require surgical intervention to restore anatomical alignment and function. The proximal humerus internal locking system (PHILOS) has become a standard implant for these injuries, but outcomes can vary. This study evaluates the functional outcomes of displaced proximal humerus fractures treated with PHILOS plating augmented by tension suture fixation.

Methods: A prospective study was conducted on 30 patients with displaced proximal humerus fractures between September 2020 and August 2022 at a tertiary care centre. Patients underwent open reduction and internal fixation through a deltopectoral approach under fluoroscopic guidance. The surgical technique involved the use of a PHILOS plate combined with tension sutures to stabilise the tuberosities and neutralise the deforming forces of the rotator cuff. Functional outcomes were assessed using the Constant-Murley Score after at least 6 months of follow-up.

Results: The mean age of the study population was 53 years, with a female preponderance (73.3%). The most common injury pattern was Neer’s 3-part fracture (43.3%). The mean Constant Score at the final follow-up was 77.4. Excellent or good functional outcomes were achieved in 83.3% of patients (7 excellent, 18 good). Complications were minimal, with superficial wound infection in 10% of cases and shoulder stiffness in 3.3%.

Conclusions: The combination of PHILOS plating and tension suture fixation provides rigid, stable fixation and allows for early mobilisation. This technique effectively restores the anatomy of the articular surface and the tuberosities, yielding satisfactory functional outcome with a low complication rate, making it a reliable treatment option for displaced proximal humerus fractures in the elderly.

Proof of concept to portray management of early and mid-stage avascular necrosis with bone marrow aspirate concentrate and high concentrate plasma augmentation, post percutaneous core decompression-an ortho biologics approach

Tue, 24 Feb 2026 00:00:00 +0530

Background: Avascular necrosis (AVN) or osteonecrosis of the femoral head portray as a progressive disease affecting hip joints particularly in younger and middle-aged individuals and if left untreated precipitate to secondary complications. Percutaneous core decompression (PCD) has been the first line treatment for AVN in view of its beneficial effects to remove necrotic lesion, non-invasive, compression lessened with revascularization. Ortho biologics explore the application of autologous bone marrow aspirate concentrate (BMAC) and high concentrate platelet rich plasma (HCP) found naturally in body to improve healing, reduce inflammation with very good safety profile and require minimal post-procedural time for recovery. Present study explores the synergistic effect of autologous BMAC and HCP post PCD, as an interventional therapy to treat AVN patients.

Methods: We recruited (prospective study) 45 AVN patients (mean age: 37.8 years, range, 15-52 years, 38 males and 7 females). Treatment included, PCD followed by augmentation with autologous BMAC and HCP injection via fluoroscopy in femoral head guided. The patient’s follow-up was for two years by telephonic survey post therapy (2023-2025) and were assessed using standard Ficat and Arlet scoring.

Results: Patients in stage I (3.8%), stage II (55.7%) and stage III (16.45%) showed greater improvement(s) as very good/good/satisfactory compared to stage IV (12.65%) which required total hip replacement (THR).

Conclusions: We advocate promising line of treatment for management of stage I-III of AVN patients (Ficat and Arlet scoring) using combination of BMAC and HCP augmentation post PCD.

Deciphering the relationship between age, body mass index, and knee osteoarthritis: a data-driven approach

Aavrati Rastogi, Roop B. Kalia, Pradeep K. Meena — Tue, 24 Feb 2026 00:00:00 +0530

Background: Objectives were to assess the correlation between Western Ontario and McMaster university osteoarthritis index (WOMAC) score, age, and body mass index (BMI) in patients with osteoarthritis knee (OA).

Methods: In this cross-sectional study, diagnosed cases of OA using the EULAR diagnostic criteria 2010 were enrolled. The WOMAC score was used to quantify pain, stiffness, and function in individuals with OA knee. Age, gender, and BMI were also recorded.

Results: A total of 108 knee osteoarthritis patients were enrolled in the study, including 40 men and 68 women. The mean age of the patients was 55.92 years, and their average BMI was 27.24 kg/m². The range of the WOMAC score was 3-12, with a mean of 29.3±1.03. The mean WOMAC scores for pain, stiffness, and functional disability score were 4.574 (1-4), 2.60 (0.12), and 22.20 (0.72) respectively.

Conclusions: Functional status was compared in patients with OA knee, and there was a statistically significant relationship between the age of the patients and the degree of functional impairment caused by the OA knee. Additionally, it was shown that there was a significant negative correlation between age, BMI, and total WOMAC score.

Evaluation of functional outcomes following anterior cruciate ligament augmentation

Tue, 24 Feb 2026 00:00:00 +0530

Background: The anterior cruciate ligament (ACL) is the ligament of the knee, which plays a role for maintaining joint stability, which when damaged causes instability in movements. While ACL reconstruction aims to repair the torn ligament, patients are not confident in the stability and function of their knees. ACL augmentation preserves the neurovascular bundle, which can retain the proprioception and joint sensations. The aim of the study was to evaluate the functional outcome of patients post ACL Augmentation surgery.

Methods: This study was a cross-sectional, survey-based, observational one which included 38 patients who underwent arthroscopic ACL augmentation involving the anteromedial (AM) or posterolateral (PL) bundle. Knee function was assessed using the Lysholm and IKDC scoring systems during follow-up.

Results: Among 38 patients 25 were male and 13 were female with the most common age group being 31 to 40 years followed by 21 to 30 years. In terms of function, both scoring systems showed statistically significant improvement post-surgery.

Conclusions: ACL augmentation has significant positive functional outcomes as demonstrated by remarkable increases in the Lysholm and IKDC scores. These findings support the theoretical benefit that preserving the intact neurovascular fibers is beneficial and augmentation is a successful method for treating partial ACL tears.

Vertebral artery safe zone in anterior odontoid screw fixation

Tue, 24 Feb 2026 00:00:00 +0530

Background: Anterior odontoid screw fixation is a surgical technique for management of Type II odontoid fractures. The vertebral artery (VA) is located near odontoid process, making it more susceptible to injury during screw fixation. So, present study aimed to determine anatomical safe zone, which improves accuracy in screw fixation and enhances operative outcomes.

Methods: This observational study was conducted in the Department of Anatomy at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Total of 10 formalin-fixed cadaver necks were dissected. Inter-VA distances were measured from midline C2 to left and right sides of VA loops. Each measurement was repeated independently, and CT angiographic data were also analysed for comparison with cadaveric findings.

Results: Inter-VA distance in cadavers ranged from 28 mm to 36.1 mm, with a mean of 32.95±2.72 mm. The mean distance from the C2 midline to right VA loop was 15.61±1.25 mm, while left measured 17.24±1.80 mm, indicating a relatively wider zone on left side. CT angiographic measurements demonstrated narrower inter-VA distances (mean 25.3±3.29 mm), significant anatomical variability and differences between in-vivo and cadaveric assessments.

Conclusions: An accurate understanding of inter VA distance at the C2 level is critical for safe anterior cervical surgical approaches. Understanding these morphometric variations enables surgeons to anticipate high-risk areas and determine the optimal screw trajectory and size. As a result, pre-operative CT Angiography examination of the VA path is critical for reducing problems and ensuring optimal surgical outcomes at C2 level.

Study of functional outcome of minimal invasive spine surgery through tubular microdiscectomy with laminotomy in case of single level prolapsed lumbar intervertebral disc

Pratik Sidhdhapuria, Arjun Pathak, Jay Rathod, Pratik Rakholiya — Tue, 24 Feb 2026 00:00:00 +0530

Background: Lumbar disc herniation (LDH) is one of the most common causes of low back pain and radiculopathy. Traditional open discectomy has been effective but is associated with greater tissue disruption, postoperative pain, and longer recovery. Minimally invasive spine surgery (MISS), particularly tubular microdiscectomy with laminotomy, aims to achieve adequate neural decompression while minimizing approach-related morbidity. Aim was to evaluate the functional outcomes of patients undergoing tubular microdiscectomy with laminotomy for single-level prolapsed lumbar intervertebral disc (PLID).

Methods: This prospective observational study was conducted at the Department of Orthopaedics, SMIMER, Surat, from February 2023 to October 2024, involving 25 patients aged 20-70 years with single-level PLID unresponsive to ≥6 months of conservative treatment. All patients underwent tubular microdiscectomy with laminotomy. Clinical assessment included VAS (Visual analogue scale) for pain and ODI (Oswestry disability index) for functional disability. Follow-ups were performed at 6 weeks, 3 months, and 6 months postoperatively. Radiological evaluation confirmed adequate decompression. Compliance rate was 100%.

Results: All patients demonstrated significant postoperative improvement. VAS scores showed progressive reduction in back and leg pain across all follow-up intervals. ODI scores improved markedly, indicating enhanced functional capacity and return to activities of daily living. No major complications, infections, or neurological deterioration were noted. Recovery was rapid, with most patients regaining independent ambulation within days. Cosmetic results and patient satisfaction were high, consistent with the benefits of minimally invasive techniques.

Conclusions: Tubular microdiscectomy with laminotomy is an effective and safe minimally invasive procedure for managing single-level PLID. It offers excellent pain relief, improved functional outcomes, shorter hospital stay, and minimal postoperative morbidity. This technique serves as a reliable alternative to conventional open surgery, particularly in appropriately selected patients.

Perioperative microbiological assessment in open fractures: a prospective comparative study of wound swab and tissue sample cultures

Tue, 24 Feb 2026 00:00:00 +0530

Background: Infection remains a major complication affecting the management and outcome of open fractures. The usefulness of perioperative microbiological cultures in predicting infection has been debated. Commonly used sampling techniques include wound swab (WS) culture and tissue sample (TS) culture. While previous studies have compared swab cultures at different stages of debridement, limited evidence exists comparing WS and TS cultures obtained both before and after debridement in acute open fractures. This study aimed to compare the effectiveness of WS and TS cultures in detecting bacterial contamination during the perioperative period of open fracture management.

Methods: This prospective study included 83 patients presenting with open fractures. WS and TS cultures were obtained from all patients during both pre-debridement and post-debridement phases. The microbiological growth patterns from the two techniques were recorded and compared. The association between bacterial growth and factors such as fracture type, time to hospital presentation, and time to surgery was also analyzed. Postoperative infection rates were correlated with culture results.

Results: TS cultures demonstrated significantly higher bacterial detection rates compared to WS cultures. Higher rates of bacterial contamination were observed in Gustilo-Anderson type III B fractures and in patients with delayed presentation to hospital and operating theatre. Post-debridement TS cultures showed higher sensitivity and specificity in predicting postoperative infections when compared with WS cultures.

Conclusions: TS culture is a more reliable method than WS culture for detecting bacterial contamination in open fracture wounds. Post-debridement TS cultures are particularly effective in identifying patients at risk of postoperative infection and may aid in optimizing infection prevention strategies in open fracture management.

Effect of systematic soft-tissue repair on functional outcomes following posterior approach total hip arthroplasty

Gaurav Vatsa, Dhaval M. Shah, Saurabh Suman — Tue, 24 Feb 2026 00:00:00 +0530

Background: Posterior approach total hip arthroplasty (THA) is widely used but historically has been associated with a higher dislocation risk. Systematic posterior soft-tissue repair (capsule and external rotator reconstruction) can mitigate this instability. However, few studies have assessed this technique alongside validated functional outcomes in routine secondary-care settings.

Methods: In a prospective consecutive case series at rural secondary-care centres in India, 150 patients (age 40-85) undergoing primary posterior-approach THA with systematic posterior capsule and external rotator repair were enrolled (Jan-Dec 2024). All surgeries used a standard Kocher-Langenbeck posterior approach by one surgeon. Functional outcomes were measured preoperatively and at 6 weeks, 3 months, 6 months, and 12 months. Patients were followed for 12 months postoperatively, and all complications were recorded.

Results: Of 150 patients, 138 (92%) completed the 12-month follow-up. Mean Harris Hip Score (HHS) improved from 35.9 preoperatively to 84.7 at 12 months (mean gain ≈49 points). Mean Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) improved from 60.1 to 18.0 (mean reduction ≈42 points). Notably, there were no hip dislocations. The overall complication rate was 13.0% (18/138), predominantly minor (hematoma 6.5%, intraoperative fracture 2.9%), with no major complications.

Conclusions: Systematic posterior soft-tissue reconstruction in posterior-approach THA produced substantial improvements in hip function and effectively prevented dislocation in this series. The favourable outcomes and low complication rate support the efficacy and safety of this technique in routine THA practice, even in secondary-care settings.

Locking plate fixation versus intramedullary nail fixation for the treatment of proximal humerus fracture: a review

Harshad S. Gujar, Vijay Yadav, Jeevan Tonde — Fri, 16 Jan 2026 00:00:00 +0530

Proximal humerus fractures are among the most common fractures in the elderly population, with increasing incidence due to osteoporosis. Surgical management is required in displaced and unstable patterns, with locking plate fixation and intramedullary nailing being two commonly employed techniques. This review summarizes the principles, advantages, limitations, and clinical outcomes of these modalities. Locking plates provide stable fixation, particularly in complex and osteoporotic fractures, while intramedullary nails offer a minimally invasive option with reduced soft tissue trauma. Current evidence suggests comparable union rates and functional outcomes, although complication profiles differ. The choice of fixation should be individualized based on fracture pattern, bone quality, and surgeon expertise.