International Journal of Research in Orthopaedics

Return to sport after arthroscopic Bankart repair in contact athletes: recurrence risk, surgical strategy and sport-specific considerations

Elena Albertazzi, Victoria Teufel — Mon, 01 Jun 2026 00:00:00 +0530

Arthroscopic Bankart repair (ABR) is widely used for anterior shoulder instability, particularly in athletes. However, outcomes in contact athletes remain controversial due to higher functional demands and increased recurrence risk. To critically review current evidence on return to sport (RTS), recurrence, rehabilitation strategies, and surgical decision-making after ABR, with specific focus on contact athletes and sport-specific insights from ice hockey. A focused narrative review of recent systematic reviews, meta-analyses, cohort studies, and sport-specific investigations related to RTS, recurrence, rehabilitation, and surgical strategy after ABR was performed. RTS rates after ABR are high (≈79-91%), with 60-70% returning to preinjury level. Contact athletes demonstrate similar RTS rates compared to non-contact athletes but significantly higher recurrence rates (≈17% vs 8%). Objective functional and psychological criteria improve outcomes compared to time-based protocols. Sport-specific data from ice hockey demonstrate excellent RTS rates despite persistent concerns regarding recurrence and long-term durability. Although ABR enables high rates of RTS in contact athletes, RTS alone may overestimate surgical success, as recurrence risk remains substantially elevated in high-demand populations. Risk-stratified surgical selection and criteria-based rehabilitation are therefore essential.

The silent musculoskeletal burden: orthopaedic manifestations and management challenges of neglected tropical diseases in India

Shaik Rizwana, Shahnawaz Hussain Rajavali, Yenni Lavanya Kumari, Nakka John Leo — Thu, 25 Jun 2026 00:00:00 +0530

Neglected tropical diseases (NTDs) represent a heterogeneous group of 20 chronic, debilitating infections that disproportionately plague poor populations within the endemic regions of India. Despite the systemic and dermal manifestations of these diseases being well characterized, the severe and often delayed orthopedic and musculoskeletal (MSK) sequelae remain poorly appreciated and result in late diagnosis, loss of function, and permanent disability. The article provides a review of the specific orthopedic pathology associated with four key NTDs endemic to India, namely LF, Leprosy, OATB, and Mycetoma. It synthesizes data on the clinical presentation, pathology, functional outcomes, and the surgical challenges presented by such complex infections in resource-constrained settings. Orthopedic manifestations vary from acute infective arthritis and osteomyelitis (Mycetoma, OATB) to chronic, secondary deformities resulting from nerve damage, chronic lymphedema, and muscle paralysis. These often necessitate complex, multistage reconstructive surgery, including arthrodesis, tendon transfers, and extensive soft-tissue management, which push the limits of the available surgical infrastructure. The NTDs pose a significant, yet "neglected" orthopedic burden in India, and need early diagnosis, robust primary care integration, and the development of specialized orthopedic-plastic surgery protocols to mitigate the severe long-term disability and restore function in these affected patients.

Neuraxial versus general anaesthesia in total joint arthroplasty: perioperative outcomes, selection bias and contextual decision-making: a narrative review

Thu, 25 Jun 2026 00:00:00 +0530

Total hip and knee arthroplasty volumes are increasing worldwide and neuraxial anaesthesia is often preferred over general anaesthesia because of perceived perioperative benefits. However, much of the available evidence is derived from observational studies and may be influenced by selection bias and confounding by indication. This narrative review synthesised contemporary literature from PubMed and Google scholar up to December 2025, focusing on large cohort, registry and administrative database studies comparing the two techniques in primary THA and TKA. Across multiple datasets, neuraxial anaesthesia was associated with lower mortality, fewer complications, reduced transfusion requirements and shorter hospital stay. However, patients receiving general anaesthesia consistently had higher baseline risk profiles, including older age, higher ASA status and greater comorbidity burden, along with more frequent contraindications to neuraxial techniques. Although multivariable adjustment and propensity score matching reduced the magnitude of these differences, the overall trends favouring neuraxial anaesthesia persisted. Importantly, residual confounding from unmeasured factors such as frailty, spinal pathology and institutional practices remains a key limitation. Overall, while neuraxial anaesthesia appears to offer favourable perioperative outcomes, the evidence is largely observational and should be interpreted with caution. Anaesthetic choice should be individualised and context-specific, especially in resource-limited settings and future research should focus on randomised trials and risk-stratified decision-making approaches.

Surgical management of proximal humeral fractures in a resource-limited setting: a retrospective cohort study

Fri, 29 May 2026 00:00:00 +0530

Background: The management of proximal humerus fractures (PHF) remains controversial, particularly in resource-limited settings where access to modern implants is limited. This study aimed to evaluate the surgical outcomes of PHF in adults in Yaoundé and to identify factors influencing prognosis.

Methods: We conducted a retrospective cohort study of adult patients who underwent surgery for hip fractures between 2015 and 2020 at three specialist hospitals in Yaounde (the Yaoundé Central Hospital (YCH), the Yaoundé Emergency Centre (YEC) and the Yaoundé Military Hospital (YMH)). Data were collected on demographic characteristics, fracture characteristics, surgical techniques and outcomes. Functional outcomes were assessed using the disabilities of the arm, shoulder and hand (DASH) and Constant-Murley scores, and radiological outcomes were assessed at follow-up.

Results: A total of 47 patients were identified, of whom 28 were included in the final analysis. The mean age was 44±16 years, with a predominance of males (61%). Most fractures were two-part fractures according to the Neer classification (80.5%) and type A fractures according to the AO/OTA classification (78.1%). Plate fixation was used in 61% of cases, exclusively with non-locking implants. Anatomical reduction was achieved in 28.6% of patients. Bone union was observed in 85.7% of cases. Complications included malunion (35.7%), avascular necrosis (7.3%) and post-traumatic osteoarthritis (10.7%). The mean Constant and DASH scores were 63.3 and 33.2, respectively.

Conclusions: Despite limited technical resources and the use of non-locking implants, surgical treatment of hip fractures in this setting yields acceptable functional outcomes. However, complication rates remain high, highlighting the need to improve surgical facilities and the availability of implants.

Postoperative morbidity and mortality in patients with vertigo undergoing elective laminectomy

Fri, 05 Jun 2026 00:00:00 +0530

Background: Vertigo is frequently encountered in patients undergoing elective spine surgery, yet its association with postoperative morbidity and mortality after laminectomy remains poorly defined. We evaluated short- and long-term postoperative outcomes among patients with preoperative vertigo undergoing elective laminectomy after rigorous adjustment for comorbid disease burden.

Methods: We performed a retrospective propensity score-matched cohort study comparing adults undergoing elective laminectomy with preoperative peripheral vertigo to those without. Vertigo was identified using ICD-10 codes (H81.x), excluding central neurologic, cerebrovascular, autonomic, traumatic, and infectious etiologies. Cohorts were matched 1:1 (6,031 per group) on demographics, comorbidities, laboratory values, and medication exposures. Outcomes were assessed at 90 days and 1 year with falls serving as the primary outcome. To account for multiple secondary outcome comparisons, a Bonferroni correction was applied, with statistical significance set at p<0.002.

Results: Postoperative falls was significantly elevated at 90 days (OR=1.97) and 1 year (OR=1.75). Among secondary outcomes, the vertigo cohort demonstrated significantly higher rates of stroke (OR=2.31 at 90 days; OR=2.33 at 1 year), nausea or vomiting (OR=1.86; OR=1.98), fall-related fractures (OR=1.70 at 90 days), somnolence or stupor (OR=2.44; OR=2.21), myocardial infarction (OR=1.85 at 1 year), urinary tract infection (OR=1.57 at 1 year), amnesia (OR=2.36 at 1 year), and emergency department utilization (OR=1.45 at 1 year). Trends toward elevated venous thromboembolism, myocardial infarction at 90 days, and all-cause mortality at 1 year (OR=1.52; p=0.0037) were observed.

Conclusions: Preoperative peripheral vertigo is associated with increased postoperative morbidity across neurologic, cardiovascular, functional, and healthcare utilization domains following elective laminectomy, with a trend toward elevated 1-year mortality. These findings suggest vertigo may represent a clinically meaningful risk modifier and support prospective evaluation of enhanced preoperative optimization and fall-prevention protocols in this population.

Demographic and clinical profiles of patients with intertrochanteric hip fractures in Jordan

Thu, 25 Jun 2026 00:00:00 +0530

Background: Intertrochanteric hip fractures are a common injury in elderly patients and are associated with significant morbidity and healthcare burden. Understanding patient characteristics and fracture patterns is important for improving management strategies.

Methods: This retrospective descriptive study was conducted at Jordan University Hospital and included 80 patients with intertrochanteric hip fractures managed between January and December 2023. Data were collected from medical records. Variables included demographic characteristics, comorbidities, fracture patterns, and treatment methods. Data were analyzed using descriptive statistics.

Results: The mean age was 74.8±12.3 years. Patients aged ≥70 years represented 70.0% of the cohort. Female patients accounted for 56.3%. Low-energy falls were the cause of injury in 96.3% of cases. Simple fracture pattern was observed in 60.0% of patients. Hypertension (52.5%) and diabetes mellitus (35.0%) were the most common comorbidities. All patients were managed surgically. Proximal femoral nail was used in 62.5% of cases, while dynamic hip screw was used in 37.5%. Surgery within 48 hours was performed in 67.5% of patients. The mean hospital stay was 6.8±2.4 days.

Conclusions: Intertrochanteric hip fractures in this cohort mainly affected elderly patients with multiple comorbidities and were predominantly caused by low-energy falls. Most fractures were simple, and surgical fixation was performed in all patients, with proximal femoral nail being the most commonly used method.

Use of tranexamic acid in primary hip arthroplasty: a retrospective audit of blood loss and transfusion rates

Harin R. R., Aditya Doshi, Won Yong Shon — Thu, 25 Jun 2026 00:00:00 +0530

Background: Tranexamic acid (TXA) is an anti-fibrinolytic agent that has shown promise in reducing blood loss during total hip arthroplasty (THA). Several studies have reported the significance of blood loss reduction and the reduction in the number of blood transfusions, thereby reducing transfusion- related injuries and enhancing patient recovery. The concern about the use of tranexamic acid is the venous thromboembolic effect it may possess. We aimed to study the efficacy and safety of this anti-fibrinolytic medication in primary total hip arthroplasty.

Methods: We conducted a retrospective chart review of 130 primary total hip arthroplasty (THA) performed from June 2023 to June 2025 at a single arthroplasty centre in South Korea by a single renowned arthroplasty surgeon. Surgical patients received 1 g intra-venous (IV) TXA half hour before the surgery followed by 2g intra-articular (IA) TXA during the surgery through a hemobag line. We analysed differences in haemoglobin (Hb), haematocrit (Hct), blood loss (BL), and adverse events in these patients.

Results: The mean age was 61.3 years, and the mean BMI was 21.5 kg/m². All patients received 3g TXA. The mean blood loss was 550 ml, and mean hemoglobin drop after surgery was 1.13 g/dl. Strong positive correlation was found between blood loss and transfusions (r=0.726, p<0.001). Twenty-one adverse events were reported.

Conclusions: Administration combined intravenous (IV) and intra-articular (IA) TXA does not appear to increase rates of adverse events and may be effective in minimizing blood loss, thereby minimizing the number of blood transfusions as reflected by Hb and Hct values following THA.

Utilization of traditional massage by patients with low back pain

Harcourt S. L., Brownson N. E. — Thu, 25 Jun 2026 00:00:00 +0530

Background: Low back pain (LBP) is among the most popular musculoskeletal disorders in present day society and accounts for most health care usage. Patient adopt several strategies as of treatment in our environment including local massage.

Methods: This was a prospective study of all outpatients that presented to the orthopaedic unit with complaints of LBP was undertaken to determine those that have used or were using traditional massage as form of treatment for their LBP. A structured interviewer-administered questionnaire was used to collect all required information from the study participants. Demographic data and medical information were analysed using descriptive statistics and Chi-square test by SPSS 25.

Results: The 63 (31.3%) acknowledged the use of traditional massage out of 201 patients, which was made up of 38 females and 25 males. Those aged between 41-60 years had the highest number of participants that used traditional massage. Hand massage (HM) was the commonest form with 74.6%. Factors such as age, gender, educational level, occupation, cause of the back pain, and duration, did not influence choice of massage. Only 24% experienced good relief after traditional massage, with 43% reported to have been pre-informed before administration of the massage, 35% reported otherwise and 22% remained unresponsive.

Conclusions: This study highlights the high prevalence of the use of traditional massage by back pain sufferers, and shows the need for physicians, health policy makers, and carers for back pain sufferers to be aware of this fact.

Long-term clonidine and fracture risk in children with attention-deficit hyperactivity disorder: multicentre electronic health record evidence

Thu, 25 Jun 2026 00:00:00 +0530

Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience elevated injury rates. Clonidine is commonly prescribed for ADHD, yet its association with fracture risk has not been well defined.

Methods: Retrospective study using TriNetX. Patients (6-18 years) with ADHD (ICD-10-CM F90) were classified as clonidine-exposed if they had a prescription within 6 months before or on the ADHD index date; controls had no clonidine exposure. Matching yielded 73,141 patients per cohort. Follow-up began 1 day after the index and extended through available records, up to 20 years. Primary outcomes were distal radius (S52.5), clavicle (S42.0), and supracondylar humerus (S42.41) fractures.

Results: After matching, 133,630 patients were included (66,815 per cohort). Thirty-day postoperative infection occurred in 1.03% (690/66,815) of SSRI users versus 1.44% (963/66,815) of non-SSRI controls (risk difference-0.41 percentage points; RR 0.71, 95% CI 0.64-0.78; HR 0.69, 95% CI 0.62-0.76; p<0.001). No statistically significant differences were observed for delayed wound healing, wound dehiscence, hematoma, seroma, nausea, or sepsis.

Conclusions: Clonidine exposure was associated with lower risks of distal radius, clavicle, and supracondylar humerus fractures. Findings support prospective studies to confirm causality and explore mechanisms.

Vitamin D receptor gene polymorphism in patients with aseptic necrosis of the femoral head: a comparative cross-sectional study

Thu, 25 Jun 2026 00:00:00 +0530

Background: This study explored the correlation of the Met1Thr (rs2228570) polymorphism of the vitamin D receptor (VDR) gene with aseptic necrosis of the femoral head (ANFH).

Methods: This comparative cross-sectional study consisted of 74 patients divided into group 1 of 44 patients with ANFH and group 2 of 30 patients with hip osteoarthritis stage 3 by Kellgren-Lawrence classification. The VDR genotyping was conducted on venous blood samples. Serum vitamin D₃ and osteocalcin were quantified via enzyme immunoassays. Statistical analyses consisted of χ² tests for genotype distribution and Mann-Whitney U-tests for biochemical parameters, considering for non-normal distributions.

Results: There were no statical significant differences were observed in Met1Thr genotype distribution between ANFH and osteoarthritis groups (χ²=2.081; p=0.353). The carriers of the G (Thr) allele revealed a non-significant pattern toward elevated ANFH risk (OR=2.16; 95% CI 0.74-6.31). Both groups showed severe vitamin D deficiency (median 25(OH)D<30 ng/ml) and significantly reduced osteocalcin levels, reflecting reduced bone turnover rate. No statistically significant differences in Vitamin D₃ or osteocalcin levels were noted between groups.

Conclusions: Severe vitamin D deficiency and suppressed osteoblastic activity distinguished both ANFH and osteoarthritis. Although the Met1Thr VDR polymorphism was more common in ANFH patients, its connection with disease risk was not statistically significant. These findings suggest vitamin D deficiency as a key risk factor and highlight further research on VDR polymorphisms in larger cohorts.

Consanguinity and family history as risk factors for developmental dysplasia of the hip in Omani children

Thu, 25 Jun 2026 00:00:00 +0530

Background: Developmental dysplasia of the hip (DDH) is a multifactorial disorder influenced by genetic and environmental factors, with variation in risk profiles across populations, particularly in regions with high consanguinity rates. This study aimed to evaluate risk factors associated with DDH among Omani children.

Methods: This retrospective hospital-based case-control study included children born at Khoula Hospital between 2009 and 2019. Of 567 screened children, 100 confirmed DDH cases were included. A control group of 200 children was matched for age and sex. Univariable and multivariable logistic regression analyses were performed.

Results: Family history (OR 4.38, 95% CI 1.81–10.55; p=0.001) and consanguinity (OR 2.02, 95% CI 1.19–3.46; p=0.010) were independent predictors of DDH. Other factors were not statistically significant.

Conclusions: Family history and consanguinity are significant independent risk factors for DDH in this population, supporting targeted screening strategies.

Predictors of junctional failure following pedicle fixation in thoracolumbar spine in traumatic spinal cord injury at the National Orthopaedic Hospital Dala Kano, Nigeria

Thu, 25 Jun 2026 00:00:00 +0530

Background: Junctional failure (JF) is a known complication after posterior pedicle screw fixation for traumatic thoracolumbar fractures, yet its predictors in low‑resource settings remain undefined. This study aimed to identify risk factors for JF following pedicle fixation in patients with traumatic spinal cord injury.

Methods: A retrospective cohort study of 172 patients who underwent posterior pedicle screw fixation for acute traumatic thoracolumbar fractures (T10–L3) between January 2020 and December 2025 at the National Orthopaedic Hospital Dala, Kano. JF was defined as proximal or distal junctional kyphosis >10° or implant failure within 24 months. Multivariate logistic regression identified independent predictors.

Results: Mean age was 39.4±13.8 years; 68% male. JF occurred in 31 patients (18.0%) at mean 11.2±4.5 months post‑surgery. Independent predictors were: age >50 years (OR 3.2, 95% CI 1.6–6.4), fusion length ≥4 levels (OR 2.8, 95% CI 1.4–5.6), preoperative local kyphosis >25° (OR 2.5, 95% CI 1.2–5.2), screw density <0.8 (OR 2.1, 95% CI 1.0–4.3) and osteoporosis (OR 3.0, 95% CI 1.5–6.0). Revision surgery was required in 14 patients (45.2% of JF). Patients with JF had worse functional outcomes (ODI 48.2 vs. 32.5, p<0.001).

Conclusions: Junctional failure after thoracolumbar pedicle fixation is common (18%) in this Nigerian cohort. Older age, longer fusion, inadequate screw density, severe preoperative kyphosis and osteoporosis are independent predictors. Strategies to reduce JF include optimising bone health, limiting fusion length and achieving high screw density.

Determinants of low back pain in Port Harcourt

Brownson Ekwogo Niabari, Harcourt Somiari Lucky — Thu, 25 Jun 2026 00:00:00 +0530

Background: There are several known risk factors of low back pain. In Port Harcourt traditional beliefs/myths about low back pain aetiology exist, hence the need for this study. The objectives of this study are to determine the risk factors for low back pain, validate or debunk traditional beliefs and propose preventive measures where possible.

Methods: This was a questionnaire based cross-sectional study design carried out in Port Harcourt. Study population were 411 residents 18 years and above who gave verbal consent. Data were analysed using IBM SPSS version 25.

Results: The point prevalence of low back pain was 78%. The male to female ratio of the respondents was 1:1.25 with 61.1% of ages 20-45years. Low back pain was commoner, 91.7% among participants 65 years and above. Several variables, age (p value 0.014), pregnancy and delivery (p value 0.001), frequent sexual intercourse (p value 0.003), occupation as a trader ((p value 0.034), improper sitting posture (p value 0.008), been married (p value 0.003) and use of mattresses (p value 0.001) were associated with low back pain.

Conclusions: This study debunked the association of vaginal delivery, epidural analgesia, family history and parity with low back pain. It validates the belief that pregnancy and delivery, frequent sexual intercourse, occupation, improper sitting posture and use of soft mattresses were associated with low back pain. We propose use of firm mattresses and proper sitting posture as preventive measures for low back pain.

Outcome of management of gunshot injury following the July revolution in Bangladesh by the Ilizarov method

Thu, 25 Jun 2026 00:00:00 +0530

Background: Gunshot injuries (GSIs) are a major contributor to the global burden of injury, frequently resulting in severe fractures, extensive soft tissue damage and long-term disability, particularly among young adult males in both civilian and military settings. The purpose of this study is to evaluate the clinical and functional outcomes of patients with extremity gunshot injuries sustained during the July revolution in Bangladesh who were managed using the Ilizarov method.

Methods: This prospective observational study at the Department of Orthopedics, National institute of traumatology and orthopaedic rehabilitation (NITOR), Dhaka, Bangladesh, from July 2024 to December 2025 included 30 patients with gunshot-induced extremity fractures from the July revolution, all managed with the Ilizarov external fixator and followed for at least 18 months. Outcomes assessed were fracture union, anatomical and functional results (ASAMI criteria), and treatment-related complications, analyzed using descriptive statistics.

Results: In 30 patients (mean age 25.0±10.4 years, 96.7% male), 66.7% had high-velocity injuries and 70.0% were potentially lethal. Tibial fractures predominated (60.0%) with 86.7% open fractures. Primary fixation was done in 73.3%. At 18 months, 90.0% achieved union, 70.0% had minimal deformity, 60.0% had no shortening, and 80.0% had satisfactory or good functional outcomes, with manageable complications.

Conclusions: The Ilizarov method provides effective anatomical restoration and functional recovery in complex gunshot injuries sustained during the July revolution in Bangladesh.

Short-term follow-up of anterior cruciate ligament reconstruction using rectus femoris autograft: a retrospective cohort study

Chowdhury I. Mahmud, Abu Z. M. Selimullah, M. Alinoor — Thu, 18 Jun 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) reconstruction is widely performed to restore knee stability and function following ACL injury. Although hamstring tendon, bone-patellar tendon–bone, and quadriceps tendon (QT) autografts are commonly used, interest in rectus femoris graft (RFG) has recently increased because of its favorable graft characteristics and potentially lower donor-site morbidity. This study evaluated the short-term clinical and functional outcomes of arthroscopic ACL reconstruction (ACLR) using rectus femoris autograft.

Methods: This retrospective cohort study included 36 patients with isolated ACL injuries who underwent arthroscopic ACLR using rectus femoris autograft. Patients (n=36) aged 18-45 years were included. Functional outcomes were assessed using the Tegner-Lysholm knee score and visual analogue scale (VAS). The mean follow-up duration was 16.28 months.

Results: The mean age of the patients was 28.47 years, with males comprising 78% of the cohort. Sports injuries were the most common cause of ACL tears. The mean graft length was 30.72 cm, and mean graft diameter was 8.19 mm. The mean Lysholm score improved significantly from 57.17±7.11 preoperatively to 89.23±2.53 at 12 months (p<0.001). Mean VAS score decreased from 3.17±1.07 preoperatively to 0.71±0.70 at 12 months. Mild quadriceps weakness was observed in four patients and improved with physiotherapy.

Conclusions: Arthroscopic ACLR using rectus femoris autograft demonstrated favorable short-term functional outcomes with low complication rates. Further prospective studies with larger sample sizes and longer follow-up are needed to validate these findings.

Patient characteristics and outcomes following ACL reconstruction surgery: a cross-sectional descriptive study

Thu, 25 Jun 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) injuries are common among young and active individuals. Patient-reported outcomes are important in evaluating the success of ACL reconstruction surgery.

Methods: This cross-sectional descriptive study included 100 patients who underwent ACL reconstruction surgery at a single-center teaching hospital in Jordan between January 2022 and December 2024. Data on patient characteristics, clinical presentation, surgical details and patient-reported outcomes were collected and analyzed using descriptive statistics.

Results: The mean age of patients was 27.8±6.4 years, with most patients being male (72%). The majority of injuries were sports-related (65%). The most common presenting symptom was knee instability (78%). Hamstring graft was the most commonly used graft (68%). Most patients reported improvement in pain (76%) and good functional outcomes (70%). Return to previous level of activity was achieved in 62% of patients.

Conclusions: ACL reconstruction showed generally good patient-reported outcomes. However, not all patients returned to full sport’s activities. Patient characteristics and associated injuries may affect outcomes. Further studies are recommended to improve understanding of recovery after ACL reconstruction.

A prospective comparative analysis of functional outcomes and recurrence rates in wrist ganglion cysts: excision versus aspiration versus threading

Sanjay Barnwal, Tejas Sanghavi, Pramod Shekade, Niranjan S. Ghag — Tue, 09 Jun 2026 00:00:00 +0530

Background: Wrist ganglion cysts are recognized as the most common benign soft-tissue tumors of the hand and wrist. Despite multiple available treatment modalities, there is no consensus regarding the optimal approach, particularly in resource-limited settings. This study aims to evaluate and compare the functional outcomes, complication profiles, and recurrence rates of three common treatments: surgical excision, aspiration, and threading.

Methods: This prospective observational comparative study included 91 patients with symptomatic wrist ganglion cysts treated at a rural tertiary care teaching hospital. Based on patient preference and feasibility, participants were categorized into three intervention groups: surgical excision (n=37), aspiration (n=26), and the threading/transfixation technique (n=28). Outcomes were assessed using visual analog scale (VAS) pain scores, a 5-point patient satisfaction scale, recurrence rates, and operative parameters such as procedure time.

Results: All treatment modalities achieved a significant reduction in postoperative pain, indicating comparable short-term symptomatic relief. However, long-term efficacy varied significantly; excision demonstrated the lowest recurrence rate at 5.4%, followed by threading at 14.3%, while aspiration showed a highly significant recurrence rate of 65.4%. Patient satisfaction was highest following excision (mean 4.86) and threading (4.68), and comparatively lower for aspiration (4.11). While excision required a longer procedural time (11.2 minutes), threading and aspiration were minimally invasive and faster (4.7 and 4.8 minutes, respectively).

Conclusions: Surgical excision provides the highest patient satisfaction and lowest recurrence rate, reaffirming it as the definitive gold standard for treating wrist ganglion cysts. However, the threading technique emerges as a highly practical, minimally invasive alternative that successfully balances low recurrence with feasibility, making it especially valuable in resource-constrained environments. Aspiration, due to its significantly higher recurrence rates, is limited in its role as a definitive long-term treatment.

Functional outcome of discectomy (endoscopic vs open) for single level lumbar disc herniation

Mohammed Faisal, Vikas Atram, Himanshu Ganwir, Padmanabh Kukde, Harsh Jogi — Thu, 25 Jun 2026 00:00:00 +0530

Background: Lumbar disc herniation is a major cause of low back pain and radiculopathy in the working population. Open discectomy has been the gold standard surgical approach, but with advances in minimally invasive techniques, endoscopic discectomy is increasingly being adopted. This study aimed to compare the functional outcomes of endoscopic and open discectomy in patients with single level lumbar disc herniation.

Methods: A prospective comparative study was conducted on patients with clinically and MRI-confirmed single level lumbar disc herniation refractory to conservative management. Patients were allocated to two groups: Group A underwent conventional open discectomy, and Group B underwent endoscopic discectomy. Outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI). Patients were followed at 1 month, 3 months and 6 months. Statistical analysis was performed to compare intergroup differences.

Results: A total of 30 patients were enrolled, with no significant difference in baseline demographics. Both groups showed statistically significant improvement in ODI scores at all follow-up points (p<0.05). Endoscopic discectomy resulted in shorter hospital stay, less blood loss, and earlier return to work compared with open discectomy. However, there was not much significant difference inn VAS scores (p>0.05).

Conclusions: Both open and endoscopic discectomy provide effective pain relief and functional improvement in single level lumbar disc herniation. Endoscopic discectomy, however, offers advantages of minimal invasiveness, faster recovery, and reduced hospital stay, supporting its role as a favorable alternative to conventional open discectomy.

Efficacy of bisphosphonates as adjuvant therapy in surgically treated giant cell tumours of bone: a randomized comparative study

Akash Singhal, Vicky Kumar, Devarsh Goyal, Raj Kumar Harshwal — Thu, 25 Jun 2026 00:00:00 +0530

Background: Giant cell tumor (GCT) of bone is a locally aggressive neoplasm with high recurrence rates following surgical treatment. Bisphosphonates have emerged as potential adjuvant agents that may reduce recurrence by inducing apoptosis in osteoclast-like giant cells and neoplastic stromal cells through inhibition of the RANK/RANKL pathway.

Methods: This prospective randomized double-blind study enrolled 60 patients with histologically confirmed GCT of extremities at SMS Medical College, Jaipur, from January to December 2024. Group A (n=30) received surgery plus oral Alendronate 10 mg daily for 6 months; Group B (n=30) underwent surgery alone. Outcomes were assessed using radiological evaluation (NCCT), VAS for pain, and MSTS functional score at 1, 2, 3, and 6 months.

Results: Recurrence was significantly lower in the bisphosphonate group (03.33% vs 16.67%, p=0.085). At 6 months, Group A showed superior pain relief (VAS 1.70±0.84 vs 2.97±0.89) and functional recovery (MSTS 26.9±1.53 vs 23.4±1.87). Complications were fewer in Group A (06.67% vs 20.00%). Radiological monitoring revealed 96.67% disease-free status in Group A versus 83.33% in Group B.

Conclusions: Adjuvant oral bisphosphonate therapy following surgical treatment of GCT of bone effectively reduces recurrence rates and improves functional outcomes. It represents a safe, affordable, and accessible option for enhancing disease control in GCT management.

Does geography influence wound healing following revision total hip arthroplasty for periprosthetic joint infection? A retrospective comparative cohort study

Thu, 25 Jun 2026 00:00:00 +0530

Background: Periprosthetic joint infection (PJI) after revision total hip arthroplasty (THA) poses significant wound-management challenges. Outcomes following vacuum-assisted closure (VAC) therapy vary and may be influenced by regional microbiology and host soft-tissue characteristics.

Methods: This retrospective comparative cohort study (2019-2025) included adults undergoing revision THA for chronic PJI at a tertiary center. Patients were grouped by geographic origin: India (n=20) and Democratic Republic of Congo (DRC; n=18). Demographics, microbiology, postoperative wound gaping, debridement and VAC sessions, soft-tissue reconstruction, and time to complete wound healing were analysed using non-parametric statistics.

Results: The Indian cohort was younger (60.3 vs 67.8 years; p=0.010) but required more debridement’s (3.1 vs 2.3; p=0.031), VAC sessions (2.7 vs 1.6; p=0.003), and flap reconstructions (70% vs 22%). Initial wound gaping occurred at a similar postoperative interval in both cohorts; however, healing time was significantly longer in Indian patients (36.8 vs 18.2 days; p=0.002). Klebsiella predominated in the Indian cohort, whereas Pseudomonas was more common in DRC patients.

Conclusions: Geographic differences in wound behaviour following revision THA for PJI suggest that regional microbiology and host soft-tissue factors influence VAC effectiveness and healing outcomes, supporting population-specific wound management strategies.

Study of functional outcome in proximal tibia fracture fixation using three column concept

Deepak D. Chitragar, S. Kavin, V. Atchutha Ramaiah — Thu, 25 Jun 2026 00:00:00 +0530

Background: Proximal tibia fractures are complex intra-articular injuries often resulting from high-energy trauma. Traditional classification systems like Schatzker and AO/OTA rely on anteroposterior radiographs and may overlook posterior column injuries. The Three-column classification, introduced by Luo et al, utilizes computed tomography (CT) to address multiplanar fractures, particularly those involving the posterior column.

Methods: A prospective study was conducted on 80 patients with closed tibial plateau fractures at a tertiary care centre from January 2021 to January 2022. Fractures were classified using the Three-column concept. All patients underwent Open reduction and internal fixation (ORIF) using column-specific approaches. Functional outcomes were assessed after a minimum follow-up of 6 months using the modified Rasmussen clinical score.

Results: The mean age was 37.88±8.79 years, with a male preponderance (86.2%). Road traffic accidents were the most common mode of injury (88.7%). Two-column fractures were the most frequent (46.2%), followed by three-column fractures (32.5%). Functional outcomes were excellent in 17.5%, good in 68.7%, fair in 11.3%, and poor in 2.5% of cases. The mean Rasmussen score was significantly higher for one-column medial fractures (28±0) compared to two-column (24.05±1.54) and three-column fractures (24.80±1.35). Complications included superficial infection (11.3%), knee stiffness (8.7%) and screw pull-out (7.5%).

Conclusions: The Three-column concept provides a comprehensive understanding of fracture morphology, facilitating precise surgical planning for complex multiplanar injuries. Fixation based on this concept yields satisfactory functional outcomes, although multi-column injuries inherently carry a prognosis of lower functional scores compared to isolated column fractures.

The radiological prevalence and co-pathology associations of acromioclavicular joint arthritis in symptomatic shoulders: preliminary observations from an MRI-based study

Thu, 25 Jun 2026 00:00:00 +0530

Background: Acromioclavicular joint (ACJ) arthritis is a frequent but often overlooked cause of shoulder pain in older adults. Differentiating symptomatic ACJ degeneration from incidental, age-related changes is challenging, particularly when other conditions such as rotator cuff (RC) tears are present.

Methods: Forty-eight patients (mean age 61.6 years) with shoulder pain underwent standardized shoulder MRI. Three independent, blinded radiologists graded ACJ arthritis severity using the Shubin-Stein system. Inter-rater reliability was assessed with Fleiss’ kappa. Associations with RC tears, glenohumeral (GH) arthritis, labral pathology, and biceps tendon pathology were analyzed.

Results: ACJ arthritis (grade ≥2) was found in 93.8% of patients, with 54.2% showing moderate-to-severe changes. The prevalence observed was higher than that reported in several asymptomatic cohorts. Inter-rater agreement for the Shubin-Stein classification was almost perfect (κ=0.821). Increasing age was significantly associated with greater arthritis severity (p=0.003). Severe ACJ arthritis was strongly correlated with full-thickness or massive RC tears (p=0.001), but not with GH arthritis, labral pathology, or biceps pathology.

Conclusions: MRI-detectable ACJ arthritis is highly prevalent in symptomatic shoulders over age 50 and often coexists with significant RC pathology. The Shubin-Stein classification system shows high inter-rater reliability, supporting its clinical utility. These findings demonstrate the need for comprehensive shoulder evaluation, as concurrent ACJ pathology can affect diagnosis and intervention.

Patterns of meniscal tears in patients with anterior cruciate ligament injury

Jerin Jose, Ibin Varghese, Nadir Shajan Abdin, Abhijith Gopinathan — Thu, 25 Jun 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) injuries are among the most common intra-articular knee injuries and are frequently associated with meniscal tears. The menisci play a crucial role in load transmission, stability, and joint congruency, and their injury in ACL-deficient knees accelerates degenerative changes and worsens functional outcomes. Understanding the pattern and distribution of meniscal tears in ACL injuries is essential for early diagnosis, appropriate surgical planning, and prevention of long-term osteoarthritis. Objectives were to evaluate the pattern of meniscal tears in patients with ACL injury.

Methods: This observational study was conducted in the Department of Orthopaedics, Government Medical College, Kottayam, over a period of 1.5 years from June 2024 to December 2025. A total of 272 patients aged ≥18 years with clinically and radiologically confirmed ACL injury were included. Patients with associated posterior cruciate ligament (PCL), medial collateral ligament (MCL), or lateral collateral ligament (LCL) injuries without ACL involvement, previous knee surgeries, or advanced osteoarthritis (Kellgren-Lawrence grade >3) were excluded. All patients underwent detailed clinical evaluation, magnetic resonance imaging (MRI) of the knee, and diagnostic arthroscopy where indicated. Data regarding the presence, type, and anatomical location of meniscal tears were recorded and analysed using SPSS version 26.

Results: Meniscal injury was present in 202 patients (74.3%). Isolated medial meniscus tears were the most common (58.4%), followed by combined medial and lateral meniscus tears (26.7%), while isolated lateral meniscus tears were least frequent (14.9%). The posterior horn of the medial meniscus was the most commonly involved site (65.3%), followed by the posterior horn of the lateral meniscus (24.3%). The body of the lateral meniscus was the least affected region (6.9%).

Conclusions: The study demonstrates a high prevalence of meniscal tears in ACL-injured knees, with predominant involvement of the medial meniscus, especially its posterior horn. Early detection and timely management of ACL injuries are essential to prevent secondary meniscal damage and long-term degenerative changes of the knee joint.

Reconstruction of aseptic humerus non-union with compression plating and cortico-cancellous bone grafting

Thu, 25 Jun 2026 00:00:00 +0530

Background: Managing humeral shaft nonunion requires a comprehensive approach. Key factors include infection, prior surgeries, and severe bone loss. Treatment is challenging due to various surgical options, a lack of clear protocols, and limited evidence-based guidelines.

Methods: Forty-four adults with humeral shaft nonunion (not caused by infection) were treated over 8 years from January 2012 to December 2020. Seven cases were particularly stubborn. Cases were excluded if they involved open fractures, infections, breaks with big gaps, bone disease, or other upper limb injuries. Treatment included removing unhealthy bone and tissue, correcting bone shape, using the patient’s own bone to help healing, and fixing the bone with a strong plate. Outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score at baseline and at least 24 months later.

Results: Patients were followed for an average of 75 months. All patients healed. On average, healing took about 6 months (ranging from 4 to 12 months). Four patients (11.1%) had temporary nerve problems that fully recovered within 6 months. Two patients (5.5%) had mild wound infections. Arm function scores improved from an average of 76 before treatment to 7 at the end, showing excellent recovery.

Conclusions: Our study shows that open surgery with a locking plate, supplemented with additional bone when needed, is very effective for healing stubborn humeral shaft fractures. Careful steps, such as gentle tissue handling, maintaining a healthy blood supply, and fully removing the bad tissue, are key to success.

Optimizing soft tissue balance through medial tibial reduction osteotomy in tight varus deformity during total knee replacement

Ashok J. Sampagar, Praful R. Gombi, Tamizhvel, Siddharth Lad — Thu, 25 Jun 2026 00:00:00 +0530

Background: Achieving appropriate soft-tissue balance during total knee replacement (TKR) in varus deformities is essential to prevent instability and optimize surgical outcomes. Medial tibial reduction osteotomy (MTRO) serves as a bony technique to reduce the need for extensive medial soft-tissue release in knees with tight varus deformity.

Methods: This prospective clinical study involved patients with osteoarthritic knees and significant varus malalignment scheduled for TKR. After initial bone cuts, persistent medial tightness prompted MTRO by removing a portion of the medial tibial plateau. The extent of resection was guided by intraoperative gap balancing aiming for equalized flexion and extension gaps. Deformity correction was assessed using clinical examination and postoperative radiographs. Functional outcomes were measured via the Knee Society Score (KSS) preoperatively and at follow-up.

Results: Fifty knees underwent MTRO with an average medial bone resection of 7.4±2 mm, resulting in an average varus correction of 3.4°±1°. A positive correlation was noted between the degree of osteotomy and varus correction, especially in knees with deformities less than 15°. MTRO effectively enabled balanced joint gaps without extensive medial ligament release. Mean KSS improved significantly from 47±9 before surgery to 93±3 postoperatively. There were no increased rates of complications or joint instability.

Conclusions: MTRO is a valuable adjunct technique for correcting deformity and balancing soft tissues in tight varus knees during TKR, yielding favorable clinical results and minimal complications.

Functional outcome, disability and quality of life after primary total hip arthroplasty: a prospective cohort study from North India

Vaibhav, Lokesh Thakur, Vipan K. Dumpha, Jasbir Singh, Rajat — Thu, 25 Jun 2026 00:00:00 +0530

Background: Total hip arthroplasty (THA) is an established intervention for end-stage hip diseases. While functional outcomes are well documented, there are limited Indian data comprehensively evaluating disability and quality of life using validated patient-reported outcome measures (PROMs). This study aimed to prospectively assess functional outcomes, disability, and quality of life following primary total hip arthroplasty in a North Indian population.

Methods: In this prospective cohort study, 56 patients who underwent primary THA at Dr. Rajendra Prasad Government Medical College during the period of January 2022 to October 2023 were evaluated preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months,1 year and 1.5 years postoperatively. Functional outcomes were assessed using the Harris hip score (HHS), disability using the World Health Organization (WHO) disability assessment schedule 2.0 (WHODAS 2.0), and quality of life using the WHOQOL-BREF. Statistical analysis was performed using a paired t-test. Statistical significance was set at p<0.05.

Results: The mean HHS improved from 48.25 preoperatively to 89.25 at the final follow-up, representing an improvement of 86% in function. The mean WHODAS score decreased from 37.6 to 5.58 at the final follow-up, representing an 85% reduction in disability. All WHOQOL-BREF domains showed significant improvement.

Conclusion: Primary THA significantly improves hip function, reduces disability, and enhances the quality of life. A Comprehensive PROM -based assessment provides a multidimensional evaluation of surgical outcomes in the Indian population.

Epidemiology and injury patterns of musculoskeletal trauma at a rural level II trauma centre: a prospective observational study

Thu, 25 Jun 2026 00:00:00 +0530

Background: Musculoskeletal trauma represents a major cause of morbidity and disability worldwide and places a considerable burden on healthcare systems, particularly in resource-limited settings. Rural and hilly regions may demonstrate distinct injury patterns owing to environmental conditions, occupational exposure, and increasing vehicular traffic. However, prospective epidemiological data describing musculoskeletal trauma in such settings remain limited. This study aimed to evaluate the demographic characteristics, mechanisms of injury, anatomical distribution, treatment modalities, and outcomes of patients presenting with musculoskeletal trauma to a Level II trauma Centre in rural North India.

Methods: A prospective observational study was conducted at a Level II trauma centre serving a predominantly rural and hilly population in North India from April 2023 to March 2024. All consecutive patients presenting with musculoskeletal trauma during the study period were included. Demographic characteristics, mechanisms of injury, anatomical distribution of injuries, treatment modality, and discharge outcomes were recorded. Descriptive statistics were used to summarize injury patterns. The association between the mechanism of injury and the occurrence of fractures was analysed using odds ratios.

Results: A total of 1,657 patients were included in the study. Most patients were men and belonged to the 14–44-year age group. Falls were the most common mechanism of injury, followed by road traffic accidents. Fractures constituted the majority of musculoskeletal injuries, with the upper extremity being the most frequently involved anatomical region. An analytical evaluation demonstrated that road traffic accidents were associated with a higher odd of fractures than fall-related injuries.

Conclusions: These findings provide insights into musculoskeletal trauma patterns in rural trauma settings and may help inform future research and trauma care planning in similar environments.

Accuracy of physical examination against magnetic resonance imaging in subacromial impingement syndrome

Shubham Gupta, Anurag Anand, Yagya Vohra, Rahul Kumar — Thu, 25 Jun 2026 00:00:00 +0530

Background: Subacromial impingement syndrome (SIS) is a leading cause of shoulder pain, accounting for nearly half of all shoulder complaints. Accurate diagnosis is essential, yet challenging due to anatomical complexity and overlapping symptoms. While physical examination (PE) remains crucial, magnetic resonance imaging (MRI) offers superior soft tissue assessment. This study aimed to evaluate the diagnostic accuracy of specific PE tests for SIS in comparison with MRI.

Methods: A cross-sectional study was conducted on 38 patients with shoulder pain presenting to the Department of Orthopaedics, Era’s Lucknow Medical College and Hospital, Lucknow, from May 2022 to May 2024. Patients underwent a series of PE manoeuvres including Passive abduction, Neer, Hawkins, Yocum, Jobe, Patte, Gerber, and Resisted abduction tests. MRI of the symptomatic shoulder was performed within five days of PE and interpreted by a blinded radiologist. Diagnostic performance of each PE test was evaluated using MRI as the reference standard.

Results: The mean participant age was 48.6 years; 63.16% were male. SIS was confirmed via MRI in 55.26% of participants. Among the PE tests, Passive abduction demonstrated the highest accuracy (68.42%), with sensitivity 72.00% and specificity 61.54%, and was the only test with statistically significant correlation to MRI (p=0.0448). Other tests such as Hawkins, Yocum, and Neer showed high sensitivity but lower specificity. The Patte test had the lowest diagnostic accuracy.

Conclusions: The Passive abduction test was the most reliable for diagnosing SIS. While some tests showed reasonable sensitivity, low specificity limited their overall accuracy. PE remains valuable but is best used in conjunction with MRI for optimal diagnosis.

A prospective randomized comparative study of platelet-rich plasma and corticosteroid injections in adhesive capsulitis of the shoulder

Mayank Kumar, Harpreet Singh, Sangam Tyagi, Chandresh Choudhary — Thu, 25 Jun 2026 00:00:00 +0530

Background: Adhesive capsulitis is a fibro-inflammatory condition causing progressive pain and stiffness. Corticosteroid injections offer rapid short-term symptom relief, while Platelet-rich plasma (PRP) is emerging as a regenerative biological therapy option. This study compares the effectiveness of single intra-articular PRP versus single long-acting corticosteroid injection in adhesive capsulitis.

Methods: A prospective randomized comparative study involving 50 patients with primary adhesive capsulitis was conducted. Patients were randomly divided into two groups: group A received 20 mg intra-articular triamcinolone hexacetonide and group B received a single PRP injection prepared using the double-spin method. Pain and functional outcomes were assessed using the Visual analogue scale (VAS) and Oxford shoulder score (OSS) at baseline, 4,8 and 12 weeks.

Results: Both treatments improved pain and function significantly. The corticosteroid injection produced faster early improvement at 4 weeks. PRP showed superior improvement at 8 and 12 weeks, with final mean VAS of 0.9 (PRP) vs 2.1 (steroid) and OSS of 49.7 (PRP) vs 45.1 (steroid). Range of motion (ROM) improvements were also better in the PRP group.

Conclusions: Corticosteroids provide rapid short-term relief, while PRP yields better mid-term and overall functional recovery. PRP may be considered a superior long-term treatment option for adhesive capsulitis.

Clinical and functional outcome of malunited distal radius fractures: a single-centre observational study from a tertiary care hospital in Northern India

Ashutosh Yadav, Sachin Kumar Yadav, Ajay Kumar Yadav — Thu, 25 Jun 2026 00:00:00 +0530

Background: Distal radius fractures are among the most common skeletal injuries encountered in orthopedic practice. Malunion is a recognized complication resulting in altered wrist biomechanics and functional impairment. Epidemiological and outcome data from tertiary care hospitals in North India remain limited.

Methods: This hospital-based, single-centre, observational descriptive study was conducted in the Department of Orthopaedic Surgery, Balrampur Hospital, Lucknow, over six months (February-July 2025). Fifty-eight adult patients with radiologically confirmed distal radius malunion were enrolled. Clinical assessment included pain evaluation on a Visual analogue scale (VAS), wrist range of motion measured with a goniometer, and grip strength measured using a hand dynamometer. Radiological parameters—dorsal/volar tilt, radial height, radial inclination, and ulnar variance—were measured on standard wrist radiographs. Functional outcomes were assessed using the Disabilities of the arm, Shoulder and hand (DASH) score, Patient-rated wrist evaluation (PRWE) score, Modified mayo wrist score (MMWS), and the Gartland–Werley demerit score. Pearson and Spearman correlation coefficients were used to assess associations between radiological and functional parameters; p<0.05 was considered statistically significant.

Results: The mean age of participants was 44.6±12.8 years, with a male predominance (62.1%). The most common injury mechanisms were fall on an outstretched hand (46.6%) and road traffic accident (41.4%). Mean dorsal tilt was 18.6±5.2°, radial shortening 6.4±1.9 mm, and positive ulnar variance +3.1±1.2 mm. Affected wrist grip strength was reduced by approximately 25% relative to the contralateral limb. Mean VAS pain score was 5.6±1.8. Mean DASH and PRWE scores were 42.3±11.7 and 48.9±13.4, respectively, indicating moderate-to-severe functional disability. Significant correlations were demonstrated between dorsal tilt, radial shortening, and ulnar variance with both DASH and PRWE scores (r=0.42–0.51; p<0.01).

Conclusions: Malunited distal radius fractures produce significant functional impairment that correlates meaningfully with radiographic deformity. Combined radiological and patient-reported outcome assessment is essential for informed management planning. Early recognition of unacceptable fracture alignment and timely intervention may prevent long-term disability.

Periarticular local infiltration analgesia and early recovery after primary total knee arthroplasty: a prospective observational study

E. Venkateshulu, Salman P., Albin Geo Babu — Thu, 25 Jun 2026 00:00:00 +0530

Background: Postoperative pain after total knee arthroplasty (TKA) may delay mobilization and increase opioid use. Periarticular local infiltration analgesia (LIA) is a motor-sparing technique. This study evaluated pain relief and functional recovery after a periarticular LIA protocol in primary TKA.

Methods: This prospective observational study included 40 patients aged >45 years with grade IV osteoarthritis undergoing primary TKA from May 2023 to November 2024. Deep injection before cementation contained bupivacaine 0.5% 24 ml, morphine 8 mg/ml 0.8 ml, methylprednisolone 40 mg/ml 1 ml, cefuroxime 750 mg in saline 10 ml, saline 22 ml, and epinephrine 1:1000 0.3 ml. Superficial injection before closure contained bupivacaine (0.5%) 20 ml and saline 20 ml. The primary outcome measure was postoperative pain intensity, assessed using the visual analogue scale (VAS) at 6, 12, and 24 hours.

Results: Mean age was 60.4±7.8 years; 55% were female. Mean VAS scores were 3.1±1.2, 2.4±1.1, and 1.8±0.9 at 6, 12, and 24 hours. Mean rescue opioid use was 4.2±3.3 mg intravenous morphine equivalents; 70% required ≤5 mg. Assisted ambulation within 12 hours occurred in 87.5%, unassisted straight-leg raise within 24 hours in 72.5%, mean knee flexion at 48 hours was 82°±12°, and mean hospital stay was 5.7±1 days. Knee society score improved from 45±8 to 78±7 at 6 weeks and 85±6 at 3 months.

Conclusions: A two-stage periarticular LIA protocol with a total volume of 98.1 ml was associated with low early pain scores, modest opioid use, early mobilization, and favorable recovery after primary TKA.

Patterns of musculoskeletal complaints in family medicine clinics at a tertiary center in Jordan

Thu, 25 Jun 2026 00:00:00 +0530

Background: Musculoskeletal (MSK) complaints are commonly encountered in family medicine clinics. They represent a frequent cause of pain, functional limitation, and healthcare visits. Understanding their clinical patterns in primary care is important for improving management and resource planning.

Methods: This cross-sectional descriptive study was conducted at Jordan University Hospital from January to December 2025. A total of 100 adult patients presenting with MSK complaints were included. Data were collected through patient interviews and medical records. Variables included demographic characteristics, comorbidities, anatomical site of pain, pain severity, functional status, and disability. Only descriptive statistical analysis performed.

Results: The mean age was 44.8±14.6 years, and 60% of patients were female. Low back pain was the most common complaint (26%), followed by knee pain (22%) and shoulder pain (14%). The mean pain score was 6.9±1.8. Mean functional status score was 6.8±2.1, and the mean disability score was 5.9±2.3. Females reported higher pain scores, while males showed higher disability levels. Comorbidities such as hypertension (24%) and diabetes (20%) were common.

Conclusions: MSK complaints in primary care commonly involve the lower back, knee, and shoulder. Patients present with moderate to high pain levels and varying degrees of functional limitation. These findings provide a clear overview of MSK presentations in family medicine clinics in Jordan and may support improvements in clinical practice.

Influence of femoral posterior condylar offset on functional outcomes following posterior-stabilized fixed bearing total knee arthroplasty: a prospective observational study

Thu, 25 Jun 2026 00:00:00 +0530

Background: Total knee arthroplasty (TKA) provides effective pain relief and functional improvement in advanced osteoarthritis; however, suboptimal postoperative knee flexion persists in some patients. Femoral posterior condylar offset (PCO) is an important determinant of femoral rollback, flexion gap balance and quadriceps efficiency, particularly in posterior-stabilised (PS) TKA. Evidence regarding its influence on functional outcomes remains inconsistent, with limited data from the Indian population.

Methods: A prospective observational study was conducted in 21 patients aged 50–80 years with Kellgren–Lawrence grade 3 or 4 osteoarthritis undergoing posterior-stabilised, fixed-bearing primary TKA between April 2024 and September 2025. Preoperative and postoperative PCO and posterior condylar offset ratio (PCOR) were measured using true lateral radiographs. Functional outcomes were assessed using the Knee Society Score (KSS) at 6 weeks, 3 months and finally at 6 months. Statistical analysis evaluated the association between PCO changes and functional outcomes.

Results: The mean age was 66.81±5.56 years. KSS showed significant improvement over time (p<0.001). Most patients demonstrated minimal changes in PCO (0–2 mm). Patients with preserved or minimally increased PCO had significantly higher Knee Society Scores and better functional outcomes, whereas those with PCO reduction >2 mm had inferior outcomes (p<0.001).

Conclusions: Preservation of femoral PCO is associated with improved functional outcomes following PS TKA. As a modifiable surgical parameter, accurate femoral sizing and posterior condylar resection are essential to optimise postoperative knee function.

Acetabular cup positioning in primary routine total hip arthroplasty

Anshuman Sahoo, Biplabi Sarangadhar Das, Soma Suprava — Thu, 25 Jun 2026 00:00:00 +0530

Background: Correct location of the acetabular cup is essential for stability, wear patterns, and functional results after primary Total hip arthroplasty (THA). Even with improvements in implant design and surgical methods, improper placement of the acetabular component is still a common cause of problems after surgery.

Methods: This prospective observational study included 2,400 patients undergoing primary routine total hip arthroplasty from October 2022 to May 2024. We examined postoperative radiographs to assess the inclination and anterior displacement of the cup. We kept track of clinical outcomes and issues during the follow-up.

Results: Most of the acetabular components were placed in the radiographic safe zone that is generally acknowledged. Cups that were not positioned correctly were strongly linked to greater risks of dislocation, pain from impingement, and early revision. Patients with cups that were positioned just right had better functional outcomes.
Conclusions: Proper location of the acetabular cup is very important for getting good early results after primary THA. Regular evaluation and compliance with established orientation criteria may mitigate issues and enhance patient satisfaction.

One-stage management of bilateral polymicrobial tibial fracture-related infection using Ilizarov fixation and staged reconstruction

Thu, 25 Jun 2026 00:00:00 +0530

Fracture-related infection (FRI) is a serious complication of high-energy open tibial fractures, particularly Gustilo–Anderson type IIIb injuries. Simultaneous bilateral tibial FRI caused by multidrug-resistant (MDR) gram-negative organisms is exceptionally rare and poses major reconstructive challenges. We report a 34-year-old obese male smoker who developed acute bilateral tibial FRI following bilateral Gustilo IIIb tibial fractures and a displaced left femoral-neck fracture that had been initially stabilized elsewhere using temporary monolateral external fixation. During a single hospital admission at our tertiary center, management included radical bilateral debridement with multiple deep-tissue cultures, high-volume irrigation, and application of bilateral Ilizarov circular external fixation, followed by early split-thickness skin grafting, culture-directed intravenous antibiotics with subsequent oral therapy, and delayed cementless total hip arthroplasty (THA). Deep cultures from both tibiae grew MDR Klebsiella pneumoniae and Acinetobacter baumannii, both sulbactam-susceptible, fulfilling the confirmatory criteria of the FRI Consensus Group. The patient received five weeks of intravenous cefepime–sulbactam followed by seven weeks of oral levofloxacin (total 12 weeks). The Ilizarov frames provided stable fixation and supported mobilization, and THA at week eight restored limb length and hip function. The frames were removed at six months, and radiographs confirmed complete bilateral union at one year. At two years, the patient remained infection-free, had returned to full work duties, and demonstrated excellent functional outcomes (Harris Hip Score 93; AOFAS Ankle–Hindfoot 88 and 90), with only minor pin-site infections managed conservatively. This case adds evidence that coordinated single-admission staged reconstruction can achieve durable infection eradication, fracture union, and high functional recovery even in bilateral MDR tibial FRI.

Intravascular ultrasound-guided mechanical thrombectomy for venous thoracic outlet syndrome presenting as Paget-Schroetter syndrome: a case report

Jaxon S. Boley, Matthew Majer, Nick Abedi — Thu, 25 Jun 2026 00:00:00 +0530

Paget-Schroetter syndrome is an uncommon but important manifestation of venous thoracic outlet syndrome, typically affecting young or physically active individuals and presenting with acute upper extremity swelling and pain due to effort-related subclavian vein thrombosis. Delayed recognition may result in persistent venous obstruction, recurrent symptoms, and long-term functional morbidity. We present the case of an otherwise healthy, physically active middle-aged male who developed acute right upper extremity swelling and pain secondary to extensive subclavian and axillary vein thrombosis. Initial duplex imaging demonstrated acute deep venous thrombosis involving the subclavian, axillary, and brachial veins. Despite anticoagulation and catheter-directed thrombolysis, the patient experienced persistent venous hypertension. He subsequently underwent intravascular ultrasound (IVUS)-guided mechanical thrombectomy using the RevCore and ClotTriever systems, with restoration of venous patency and confirmation of persistent subclavian vein compression at the thoracic outlet. The patient experienced rapid symptomatic improvement and later underwent definitive thoracic outlet decompression with first rib resection and scalenectomy two months later, without reported complications. This case highlights the importance of recognizing Paget-Schroetter syndrome as a compression-related upper extremity disorder, the value of intravascular ultrasound in defining the underlying anatomic lesion, and the role of mechanical thrombectomy followed by definitive decompression in management.

Proximal humerus fracture-dislocation in a pediatric patient: a case report

Monica R. Pech Lizarraga, Aaron I. Pacheco Güemez — Thu, 25 Jun 2026 00:00:00 +0530

Proximal humerus fractures in pediatric patients have a low incidence, accounting for less than 1% of all pediatric fractures. The association between a proximal humerus fracture and ipsilateral glenohumeral dislocation has an even lower incidence, particularly in patients under 5 years of age. We report the case of a 4-year-old female patient who presented with a proximal humerus fracture associated with an ipsilateral glenohumeral dislocation after falling from a height of 1.5 meters. A surgical procedure was performed under general anesthesia, consisting of closed reduction and percutaneous fixation of the fracture with two 1.6 mm k-wire. The fracture was protected with a universal shoulder immobilizer. Adequate clinical and radiological evolution was observed after one year of follow-up. Proximal humerus injuries in pediatric patients, given their low incidence, require expertise for proper diagnosis and management. Repots in the literature are scare, and therefore, a clear consensus on a treatment has not been reached. However, our treatment with a less aggressive approach compared to others reported in the literature showed adequate clinical and radiological results.

Outcome of segmental distal 1/3rd humeral fracture with radial nerve palsy managed by triple plate fixation in a resource-limited

Tadesse Debrye Belay, Dawit Asmamaw Kifle — Thu, 25 Jun 2026 00:00:00 +0530

Distal humerus fractures caused by high energy injury is not uncommon with radial nerve palsy, but distal 1/3rd segmental humeral fracture extremely rare presentation and management is challenging, especially in resource-limited settings. This case report showed that a 28-year-old male daily laborer by occupation presented with distal 1/3rd segmental humeral fracture with radial nerve palsy post RTA managed by single paratricipital approach combined with available triple plate fixation. This case contributes to the literature by demonstrating that thoughtful surgical planning, creative use of available implants and preserved extensor mechanism soft tissue can lead to excellent functional outcome in a resource-limited setting.

Surgical management of an exceptionally rare case of symptomatic central polydactyly in an adolescent

Thu, 25 Jun 2026 00:00:00 +0530

Central polydactyly is the rarest form of digital duplication, representing only 5-15% of all cases23-06-2026 15:35:00. We report the case of a 13-year-old girl presenting with symptomatic central polydactyly (Wall type 1 A) with late-onset pain and functional limitation. Radiographic evaluation demonstrated a bifid third metacarpal consistent with Tada type II classification. Surgical management involved resection of the supernumerary digit combined with a subtraction osteotomy of the third metacarpal and intertendinous suturing to restore axial alignment and centralize the extensor mechanism. At 3-year follow-up, the patient demonstrated excellent functional and aesthetic outcomes. This case highlights the importance of addressing both skeletal deformity and tendon imbalance in delayed presentations of central polydactyly.

Assessment of functional outcome of meniscal root repair using pull-out technique

Gunasekaran Rumeshkannan, Adimoolam Manikandan, Adimoolam Manikkumaran — Mon, 04 May 2026 00:00:00 +0530

Meniscal root tears (MRTs) are increasingly identified as an important contributor to knee dysfunction and early osteoarthritis when not managed appropriately. Arthroscopic transtibial pull-out repair has gained acceptance as an effective surgical technique aimed at restoring normal joint biomechanics. This case series evaluates the short-term functional outcomes following this procedure in a tertiary care setting in South India. A retrospective analysis was conducted on 20 patients who underwent meniscal root repair over a two-year period. Functional assessment was performed using the international knee documentation committee (IKDC) score and the visual analogue scale (VAS) before surgery and at 6-12 months follow-up. A statistically significant improvement was noted in IKDC scores, which increased from a median of 28.5 pre-operatively to 59.0 post-operatively (p=0.005). VAS scores showed clinical improvement, although statistical significance was not achieved (p=0.075). These findings suggest that transtibial pull-out repair is associated with favorable short-term functional recovery in patients with MRTs.

Bilateral central bipartite patella in an eight-year-old male: a novel variant challenging existing classification

Thu, 25 Jun 2026 00:00:00 +0530

Bipartite patella is a rare developmental anomaly, often incidentally detected, with an incidence of 1-6% and bilaterality in approximately 50% of cases. The Saupe classification describes three fragment locations inferior, lateral and superolateral but central variants remain unreported. An 8-year-old male presented with right knee pain and swelling following trauma. Radiographs revealed a central bipartite patella. Imaging of the contralateral knee demonstrated a similar bilateral central pattern. There was no prior history of trauma, infection or functional limitation. Symptoms resolved within three days with conservative management and the patient regained full function. This case describes a previously unreported bilateral central bipartite patella, suggesting the need to expand current classification systems to include such variants and avoid misdiagnosis.

Clinical and radiological resolution of multilevel lumbar disc extrusion and spinal stenosis following combinatorial intradiscal bone marrow aspirate concentrate and epidural platelet lysate: a longitudinal case study

Thu, 25 Jun 2026 00:00:00 +0530

Lumbar disc degeneration and spinal stenosis are the leading causes of chronic low back pain and radiculopathy, often resulting in significant functional impairment and the reduced quality of life. Conventional treatments, surgical interventions add genetic predisposition are the confounding variable outcomes. Orthobiologics like bone marrow aspirate concentrate (BMAC), with their inherent mesenchymal stem cells and growth factors, have been promising as a clinical and therapeutic minimally invasive approach in the management of lumbar disc degeneration and spinal stenosis. A 55-year-old male presented with chronic low back pain radiating to the right lower limb, and was refractory to conservative management. Baseline showed moderate pain (NPRS 6/10), mild spinal listing, Grade II tenderness (L3-S1), dermatomal sensory deficits (L3-S1), mild motor weakness (L5-S1) and positive straight leg raise (SLR) and slump tests. The patient underwent fluoroscopy-guided intradiscal BMAC injection at L4-L5 and L5-S1 levels. At six months follow-up, significant improvement was observed, with pain reduced to NPRS 1/10, minimal spinal listing, and decreased add with grade I at L5-S1. Neurological recovery included normalization of motor strength, minimal residual sensory deficit, and negative SLR and slump tests. The present case demonstrates that intradiscal BMAC therapy can result in significant symptomatic, functional and neurological improvement in lumbar disc degeneration with radiculopathy. The study advocates for regenerative therapy with minimal invasive approach and as an alternative to the surgery, however larger controlled studies with long-term follow-up are warranted.

A case of neglected bilateral anterior fracture dislocation of shoulder following seizure episode in a young schizophrenic patient treated with open reduction and internal fixation: a case report

Anand K. Somasundaram, Aiswarya A. Sreeja, Anjali Appukuttan — Thu, 25 Jun 2026 00:00:00 +0530

Bilateral shoulder injuries especially fracture dislocations are rare injuries and pose significant diagnostic and therapeutic challenges, especially in patients with psychiatric comorbidities. This report describes the successful management of bilateral anterior shoulder fracture dislocations with comminuted greater tuberosity and proximal humerus fractures in an adult patient with schizophrenia following the first-episode of a seizure. Even though anterior fracture dislocations with greater tuberosity fractures have been reported, cases of bilateral neglected anterior fracture dislocations involving greater tuberosity and proximal humerus with a displaced humeral head have never been reported. Our case report emphasises the importance of attempting anatomical reduction and stable fixation of both bony and soft tissue elements to achieve good clinical outcomes even in chronic injuries. This patient who was in his late twenties, on regular medication for schizophrenia presented to the Emergency room 10 days following the first episode of a generalised tonic clonic seizure with pain, swelling and deformity of both shoulders. On clinical and radiological evaluation, he had features suggestive of bilateral anterior fracture dislocations. He underwent greater tuberosity avulsion repair using suture anchors on the left and open reduction internal fixation with a PHILOS plate, cannulated screws and additional soft-tissue repairs on the right. The patient went on to have an excellent clinical outcome. This case underscores the importance of high clinical suspicion for bilateral shoulder injuries in patients on psychotropic medication with seizure episodes, meticulous surgical technique and involvement of multidisciplinary care to yield favourable outcomes in rare complex shoulder injury patterns.

Combined acetabulum and femur neck periprosthetic fractures following Birmingham mid-head resection: a case report

Sandeep Sehrawat, B. V. Adhitya, Vijay Kumar — Thu, 25 Jun 2026 00:00:00 +0530

Periprosthetic fractures involving both the acetabulum and femoral neck following Birmingham mid-head resection (BMHR) arthroplasty are extremely rare. We report a case involving both without any evidence of adverse tissue local reaction and metallosis. The patient underwent single-stage revision hip arthroplasty using a cage and bone grafting. At 12-month follow-up, radiographs demonstrated fracture union and a stable implant, with the patient achieving full independent ambulation. Combined acetabular and femoral fractures in BMHR arthroplasty can occur by low energy trauma in rheumatoid arthritis. Revision arthroplasty can yield better results that fracture fixation. BMHR should be avoided in female patients who are on steroid and immunosuppression therapy.

A rare combination of comminuted distal ulna fracture with flexor tendons injury, median nerve injury and ulnar artery injury managed by staged fixation: a case report

Thu, 25 Jun 2026 00:00:00 +0530

Isolated distal ulna fractures are uncommon and the combination with flexor tendon injury, partial median nerve injury, and ulnar artery disruption is exceedingly rare. These injuries present a significant reconstructive challenge requiring careful planning for skeletal stabilization and soft-tissue management. A 44-year-old male sustained high-energy trauma to the right forearm. Clinical evaluation revealed an open injury over the distal forearm with exposed bone and soft tissue, flexor tendon disruption, median nerve sensory-motor deficit and compromised ulnar artery perfusion. Radiographs demonstrated a comminuted distal ulna fracture. Intraoperatively, a partial median nerve injury and ulnar artery injury, flexor digitorum superficialis tendons injury were confirmed, while the ulnar nerve remained intact. Due to extensive soft-tissue compromise, the fracture was initially stabilized using an external fixator. After soft-tissue recovery, staged internal fixation with plate and screws was performed along with ipsilateral autologous fibular bone grafting to restore distal ulna alignment and stability. Radiological union was achieved with satisfactory functional recovery of wrist and finger movements with mild neurological deficits. This case highlights the rarity of combined distal ulna comminution with flexor digitorum superficialis tendon injury, median nerve injury and ulnar artery disruption. A staged approach using temporary external fixation followed by delayed internal fixation can optimize outcomes in complex wrist trauma with significant soft-tissue compromise.

Mature peritrochanteric heterotopic ossification as a mechanical block to intertrochanteric fracture reduction

Thu, 25 Jun 2026 00:00:00 +0530

While heterotopic ossification (HO) around the hip is frequently cited as a late complication leading to stiffness or technical difficulty during reconstructive surgery, its role as a primary mechanical impediment to the reduction of acute intertrochanteric fractures is rarely documented. We present the case of a 45-year-old male with a significant history of polytrauma, traumatic brain injury, and conservatively managed bilateral acetabular fractures. The patient presented with mature peritrochanteric and periacetabular HO and an acute, comminuted right intertrochanteric femur fracture following a low-speed motor vehicle collision. Preoperative imaging confirmed extensive ossification bridging the greater trochanter and lateral acetabulum. Intraoperatively, standard closed reduction on a traction table proved impossible, as the proximal femoral fragment was anchored by a rigid, extra-articular bony block. To achieve reduction, a limited osteotome-assisted release of the obstructing HO bridge was performed without requiring radical excision. This maneuver restored proximal femoral mobility, facilitating successful reduction and internal fixation. The postoperative course was unremarkable; follow-up imaging confirmed fracture union and stable hardware. This case emphasizes that mature periarticular HO can act as a definitive mechanical block to closed reduction. Surgeons should utilize CT-based preoperative planning to identify such obstacles early, allowing for a targeted surgical release when standard reduction maneuvers fail.

Simultaneous bilateral total knee arthroplasty in acute severe gouty arthritis with valgus deformity: a case report

Nikunj Agrawal, Voonna Charan Kumar, Sunil Kumar Sharma, Abhishek Sharma — Thu, 25 Jun 2026 00:00:00 +0530

Gouty arthritis (GA) is a crystal arthropathy that may coexist with osteoarthritis (OA), particularly in large joints such as the knee. We present a 72‑year‑old male with bilateral knee pain, valgus deformity and acute GA superimposed on severe OA. Despite conservative therapy, symptoms persisted. Bilateral total knee arthroplasty (TKA) was performed, with intraoperative findings of urate crystal deposition. Simultaneous bilateral TKA provided pain relief, deformity correction and functional restoration, with no recurrence of gout flares at six months.

Diagnostic dilemma and management of peri-prosthetic joint infection presenting as recurrent dislocation following acetabular fracture fixation: a case report

Thu, 25 Jun 2026 00:00:00 +0530

Peri-prosthetic joint infection (PJI) can often mimic mechanical failure or present subtly following trauma. We present a 60-year-old male with a history of bilateral Total Hip Arthroplasty (THR) who presented with pain and inability to walk two months following a road traffic accident. The patient had previously undergone acetabular plating for a fracture-dislocation of the left hip, followed by a recurrent dislocation treated with closed reduction. On presentation, inflammatory markers were raised (ESR 54, CRP 40). Suspecting infection, we did Synovial fluid aspiration that revealed frank purulence with a WBC count >30,000/mm³ and 99% neutrophils. As per MSIS 2018 Criteria our case had ->6 score. The patient was diagnosed with PJI and underwent a first-stage revision arthroplasty involving implant removal, thorough debridement, and insertion of an antibiotic-loaded cement spacer with absorbable antibiotic beads. This case highlights the importance of ruling out infection in cases of recurrent dislocation and aseptic loosening, even when a clear history of trauma exists. Pre-operative aspiration remains the gold standard for diagnosis.

Idiopathic pes calcaneocavus in a young adult: a rare developmental variant with radiographic confirmation

Darren L. Pereira, Ataah S. Qureshi — Thu, 25 Jun 2026 00:00:00 +0530

Pes cavus refers to a spectrum of foot deformities characterized by an abnormally elevated medial longitudinal arch, with the calcaneocavus subtype defined by hindfoot dorsiflexion and a high arch being relatively uncommon and most often associated with underlying neuromuscular conditions such as Charcot–Marie–Tooth disease. Idiopathic presentations are rare, and potential developmental contributors remain poorly understood. We report a 19-year-old male with bilateral symptomatic calcaneocavus presenting with progressive forefoot and heel pain, clawing of toes, and functional limitation. Clinical examination revealed high medial arches, dorsiflexed hindfoot, and a rigid deformity as demonstrated by a positive Coleman block test. Weight-bearing radiographs confirmed calcaneocavus alignment, with Meary’s angle of >8°, calcaneal inclination of 34°28′, and increased talo–first metatarsal angle. Comprehensive neurological evaluation, including detailed clinical examination and electromyography/nerve conduction studies, was normal. The patient had a notable history of prematurity at 34 weeks of gestation without associated neurological sequelae. Conservative management with custom orthoses and targeted physiotherapy focusing on Achilles tendon stretching and intrinsic muscle strengthening resulted in significant symptomatic improvement at 3-month follow-up, with reduced pain and improved functional capacity. This case represents a rare example of radiographically confirmed idiopathic bilateral calcaneocavus in the absence of neurological or known genetic pathology and introduces prematurity as a potential developmental factor influencing foot morphology. While this association tries to associate prematurity as a factor, the report contributes to the limited literature on non-neuromuscular causes of cavus deformity and highlights the need for further studies to better understand this etiological spectrum.

Capsular avulsion of the lateral tibial plateau with 180-degree rotation: a rare case report

Gagan Arora, Anurag Varshney, Surya Vijay Singh, Zeeshan Javed — Thu, 25 Jun 2026 00:00:00 +0530

A 40-year-old man sustained a unique lateral tibia plateau fracture pattern with a 180-degree rotated fragment composed of an intra-articular surface and subchondral bone. At final follow-up, the patient regained pain-free activity. This case represents an undescribed fracture pattern that indicates an associated cruciate injury. A thorough evaluation, including Magnetic Resonance Imaging should be considered. One-stage ORIF with Herbert screw and partially threaded cancellous cannulated screw was done which represents a good treatment option.

Unusual location of osteochondroma over the scapular spine in a 12-year-old boy: a rare case report

Thu, 25 Jun 2026 00:00:00 +0530

Osteochondroma is the most common benign bone tumour, typically occurring in the metaphysis of long bones such as the distal femur, proximal tibia, and proximal humerus. Involvement of flat bones like the scapula is uncommon, and osteochondroma arising from the spine of the scapula is particularly rare. A 12-year-old boy presented with a gradually increasing swelling over the right upper back for one year without history of trauma or systemic illness. Clinical examination revealed a firm, immobile swelling measuring approximately 3×3 cm over the posteromedial aspect of the upper scapula with normal overlying skin and no neurovascular deficits. Shoulder range of motion was full and painless. Radiographs of the right shoulder demonstrated a well-defined bony outgrowth arising from the spine of the scapula. CT scan revealed a lobulated expansile bony lesion measuring 3.1×3.2×2.6 cm in the posteromedial aspect of the scapular spine extending toward the superior angle. MRI showed a cartilage-capped bony projection with continuity of cortex and medullary cavity and a cartilage cap thickness of approximately 5 mm, consistent with osteochondroma. The lesion was excised surgically through a posterior approach. Histopathological examination confirmed the diagnosis of osteochondroma. The postoperative period was uneventful, and the patient regained full shoulder function. Osteochondroma arising from the spine of the scapula is rare but should be considered in adolescents presenting with a painless scapular swelling. Complete surgical excision provides excellent outcomes and prevents recurrence.

Combined arthroscopic anterior cruciate ligament reconstruction and retrieval of an impacted intra-articular metallic fragment: a case of double mechanical derangement

Nakka John Leo, Kanagarla Siva Praful, Shaik Rizwana, V. Nageswara Rao — Thu, 25 Jun 2026 00:00:00 +0530

Intra-articular foreign bodies in the knee are a less common and frequently overlooked cause of mechanical symptoms. In the presence of ligament injuries, intra-articular foreign bodies make up a complex clinical scenario that requires a comprehensive surgical approach. This clinical case describes a 27-year-old male patient with chronic knee instability and true mechanical locking following trauma. Radiographic evaluation revealed a high-grade rupture of the anterior cruciate ligament (ACL) and an impacted intra-articular metallic fragment on the weight-bearing surface of the medial femoral condyle (MFC). The patient underwent a combined arthroscopic procedure for the fluoroscopy-guided removal of the impacted intra-articular metallic body, followed by anatomical ACL reconstruction with a peroneus longus autograft. This clinical case demonstrates the idea of “dual” mechanical derangement, in which both translational instability and mechanical focal attrition coexist due to ACL injury and intra-articular foreign body, respectively. Early recognition and combined treatment of both conditions are crucial to avoid progressive chondral damage and subsequent joint degeneration.

Stem-retaining conversion to total hip arthroplasty after dissociation of a cemented fixed bipolar hemiarthroplasty following failed closed reduction

Chandan Sachdeva, Kunal Arora — Thu, 25 Jun 2026 00:00:00 +0530

Dislocation after bipolar hemiarthroplasty is a known complication, but dissociation of a fixed (non-modular) cemented bipolar prosthesis during attempted closed reduction is extremely rare. Standard management usually requires stem removal and revision total hip arthroplasty (THA), often necessitating extended trochanteric osteotomy (ETO), which increases morbidity in elderly patients. A 78-year-old male underwent cemented bipolar hemiarthroplasty for fracture neck of femur. Following a fall, he presented with painful hip deformity and inability to bear weight. Closed reduction attempted elsewhere failed and resulted in dissociation of the bipolar prosthesis, with separation of the outer cup from the femoral head. Radiographs confirmed dissociation with the stem well fixed in cement mantle. Considering advanced age and stable cemented stem, a stem-retaining conversion THA was planned. Previous operative records revealed a 32-mm head on a 10–12 mm taper. The acetabulum was prepared and a cemented polyethylene acetabular component implanted. Without removing the cemented stem or performing extended trochanteric osteotomy, the hip was reduced using a compatible femoral head. Stable reduction and satisfactory range of motion were achieved intraoperatively. Post-operative radiographs showed well-positioned acetabular component and stable hip joint. The patient was mobilized with walker support. At follow-up, the patient was ambulatory, pain significantly reduced, and no redislocation occurred. Stem-retaining conversion THA is a viable and less invasive salvage option in selected elderly patients with dissociated bipolar hemiarthroplasty when the cemented femoral stem is stable. This technique avoids extended trochanteric osteotomy and reduces surgical morbidity.

Spontaneous pneumoperitoneum in a case of multiple intestinal diverticulosis in an elderly female admitted for intertrochanteric fracture

Vishakha Malhotra, Mukesh Soni, Saakshi Sharma, Arpita Singh — Thu, 25 Jun 2026 00:00:00 +0530

Spontaneous pneumoperitoneum refers to the presence of free intraperitoneal air without perforation of a hollow viscus and accounts for less than 10% of all cases of pneumoperitoneum. It is a rare clinical entity and often poses a diagnostic challenge, especially in elderly patients presenting with signs suggestive of perforation peritonitis. It even more rare to encounter this case on regular rounds in the orthopaedic ward. We report the case of an 85-year-old female admitted for left intertrochanteric femur fracture following a fall, who developed abdominal distension and generalized abdominal pain on the fourth day of trauma. Clinical examination revealed abdominal distension, tenderness and guarding, raising suspicion of perforation. Contrast-enhanced computed tomography demonstrated pneumoperitoneum with multiple diverticula involving the ileum, ascending colon and transverse colon. Emergency exploratory laparotomy was performed due to clinical signs of peritonitis and pneumoperitoneum on CT. Intraoperatively, multiple diverticula were identified in the duodenum, proximal ileum, ascending colon and transverse colon, with inflammatory changes in the omentum and multiple adhesions, but no gastrointestinal perforation was found. This case highlights the importance of considering spontaneous pneumoperitoneum in elderly patients with diverticulosis and emphasizes that surgical exploration may still be necessary when clinical findings strongly suggest perforation despite the absence of an actual bowel perforation.

Ollier’s disease presenting as progressive finger stiffness in an adolescent: surgical management of a dominant enchondroma with one-year follow-up in a resource-limited setting

Chahan M. Pandya, Vishal M. Dindod, Pratik S. Bhabhor, Saurav K. Padval — Thu, 25 Jun 2026 00:00:00 +0530

Ollier’s disease is a rare non-hereditary skeletal disorder characterized by multiple enchondromas that may result in deformity and functional impairment. We report a case of a 13-year-old left-hand-dominant boy presenting with progressive stiffness of the left index finger over two years, leading to difficulty in daily activities. Clinical and radiological evaluation revealed multiple enchondromas, with a dominant lesion in the middle phalanx. Magnetic resonance imaging demonstrated a well-defined lobulated lesion without aggressive features. Histopathological examination confirmed benign enchondroma. Given the functional limitation, surgical curettage of the dominant lesion was performed using a dorsal approach without bone grafting. Postoperative rehabilitation included short-term immobilization followed by physiotherapy. At one-year follow-up, the patient showed significant improvement in grip strength (from 40–50% to 80–85% of the contralateral hand) and near-normal range of motion, with no evidence of recurrence or malignant transformation. This case highlights the importance of early surgical intervention in symptomatic cases, particularly involving the dominant hand, and demonstrates that satisfactory functional outcomes can be achieved even in resource-limited settings.

Osteochondroma of the medial border of the scapula: a rare case report

Viswani P., Mani Kumar C. J., Kiran Kumar M. — Thu, 25 Jun 2026 00:00:00 +0530

Osteochondroma is the most frequently encountered benign bone tumor. It is characterized by a bony protrusion with a hyaline cartilage cap covering it, and it is often referred to as an exostosis. The pathognomonic features of osteochondroma are the presence of both medullary and cortical bone with continuity with the parent bone, which helps in diagnosing the tumor. The most common sites of osteochondromas are the metaphysis of long bones. But the scapula is a rare site of occurrence for an osteochondroma. Radiographic imaging, preferably with MRI or CT, helps confirm the benign nature of the tumor. However, a definitive diagnosis requires a biopsy and histopathological examination. Often, open surgical resection is the definitive treatment modality.

Long-head biceps tendon rupture as a complication of brucellar tenosynovitis: a rare manifestation of multifocal osteoarticular brucellosis

Thu, 25 Jun 2026 00:00:00 +0530

Brucellosis is a major zoonotic infection in endemic regions and can cause focal osteoarticular complications. Spinal involvement and peripheral septic arthritis are recognised manifestations; however, glenohumeral septic arthritis complicated by long-head biceps (LHB) infective tenosynovitis and tendon rupture is exceedingly rare. A 69-year-old immunocompetent man presented with severe low back pain and right shoulder pain without fever. Initial imaging suggested degenerative lumbar disease and the patient was treated conservatively. One week later, he returned with fever, night sweats, anorexia, worsening bilateral sciatica, and markedly restricted shoulder motion. Inflammatory markers were significantly elevated (CRP 121 mg/l; ESR 74 mm/h), and aerobic blood culture grew Brucella spp., with Brucella serology titre of 1:320. He subsequently reported raw camel milk consumption one month prior. MRI demonstrated L5-S1 spondylodiscitis, right glenohumeral joint effusion with synovial thickening, loculated fluid within the LHB tendon sheath, and complete proximal-third LHB tendon rupture. Lumbosacral MRI confirmed spondylodiscitis without epidural abscess or neurological compromise. Spine management was conservative. Arthroscopic shoulder debridement confirmed infective synovitis, yellowish intra-articular fluid, and complete LHB rupture. The patient received intravenous gentamicin, ceftriaxone, oral doxycycline, and rifampicin. At two months, shoulder pain had resolved, range of motion was almost full, back pain had improved, and CRP had normalised with no documented recurrence. This case represents a rare multifocal presentation of osteoarticular brucellosis and highlights the importance of early microbiological investigation in endemic regions when systemic symptoms coexist with severe musculoskeletal pain. Infective tenosynovitis should be considered a potential contributor to tendon rupture in patients with confirmed brucellosis. Multidisciplinary management is essential.

Nanotechnology-based strategies in orthopaedic surgery: implications for osseointegration, infection prevention and bone regeneration

Thu, 25 Jun 2026 00:00:00 +0530

Orthopaedic surgery continues to face challenges related to delayed bone healing, implant loosening, and implant-associated infection, despite advances in surgical techniques and biomaterials. Conventional implant materials are primarily mechanically reliable but biologically passive, limiting their ability to promote osseointegration or actively resist bacterial colonization. Nanotechnology has emerged as a promising strategy to enhance biological performance at the bone–implant interface by modifying material properties at the nanoscale. A systematic review was conducted to synthesise experimental, translational, and early clinical evidence on nanotechnology-based applications in orthopaedic surgery. A structured literature search was conducted using PubMed, Google Scholar, and Web of Science for studies published between 2015 and 2025. Evidence was thematically analysed and organized into three domains: nanostructured implant surfaces and osseointegration, antimicrobial nanocoatings for infection prevention, and nanofibrous or nanocomposite scaffolds for bone regeneration. Across the reviewed studies, nanoscale surface modifications consistently demonstrated enhanced osteoblast adhesion, early mineralization, and increased bone–implant contact compared with conventional surfaces. Antimicrobial nanocoatings and nanoparticle-based delivery systems showed effective local inhibition of bacterial adhesion and biofilm formation while maintaining cytocompatibility. Nanofibrous and nanocomposite scaffolds that mimic the native bone extracellular matrix support cellular infiltration, osteogenic differentiation, and mineral deposition in preclinical models. However, most available evidence remains preclinical or early translational. Nanotechnology-enabled strategies offer promising biological advantages for enhancing osseointegration, reducing implant-related infections, and promoting bone regeneration in orthopaedic surgery. While current findings support their potential clinical value, widespread adoption is limited by the lack of large-scale clinical trials, long-term safety data, and standardised regulatory pathways. Further high-quality clinical studies are required to validate these technologies and define their role in routine orthopaedic practice.

Periarticular injection cocktails in total knee arthroplasty: composition, dosage and Periarticular injection cocktails in total knee arthroplasty: composition, dosage and technique: a systematic review of randomized controlled trials of randomized controlled trials

Deep Dilip Shah, Chintan H. Patel, Sandeep S. Deshpande — Thu, 25 Jun 2026 00:00:00 +0530

Effective postoperative analgesia is essential in total knee arthroplasty (TKA) to facilitate early mobilization and reduce opioid consumption. A systematic review of 48 studies was conducted in accordance with PRISMA guidelines using PubMed, Embase and Cochrane databases from January 2000 to March 2025, of which 22 studies were included in the quantitative synthesis. Local anesthetics combined with ketorolac and epinephrine form the backbone of periarticular injection. Corticosteroids provide additional early analgesic benefit. Recent randomized controlled trials (2023-2025) support multimodal cocktails and emerging adjuvants such as magnesium sulfate and liposomal bupivacaine. Periarticular injection provides effective postoperative analgesia in total knee arthroplasty, with consistent evidence supporting multimodal regimens incorporating a long-acting local anaesthetic, ketorolac and epinephrine. Corticosteroids offer additional early benefit and structured multi-site infiltration enhances analgesic outcomes. Standardization of composition and technique remains an important area for future research.

Meniscal preservation beyond 40 – outcomes of arthroscopic repair of chronic bucket-handle tears

Thu, 25 Jun 2026 00:00:00 +0530

This case series evaluated the outcomes of arthroscopic repair in five patients aged over 40 years with chronic medial bucket-handle meniscal tears, with a mean symptom duration of nine months. All patients demonstrated intraoperative adhesions (60% classified as major) along with grade 1 to 2 chondral changes. Despite attempted repair, a 100% failure rate was observed within 2 to 5 months, necessitating subsequent meniscectomy in all cases. Functional outcomes, as measured by the IKDC score, showed only modest improvement following repair (38.2%-54.0%), but improved substantially after meniscectomy (77.5% at one year; mean gain of 39.5%). Similarly, pain scores (VAS) demonstrated significant reduction only after meniscectomy (6.6-2.4). These findings suggest that in middle-aged patients with delayed presentation of chronic bucket-handle tears, the likelihood of repair failure is high, and primary or early meniscectomy may represent a more pragmatic treatment strategy.

Rational shoulder dislocation reduction technique: a case series

Majid Negari — Thu, 25 Jun 2026 00:00:00 +0530

Shoulder dislocations are among the most frequent major joint dislocations encountered in emergency orthopedic practice, necessitating prompt intervention to alleviate pain, restore function, and prevent complications. Conventional reduction techniques often require multiple operators or procedural sedation and may involve high-force leverage maneuvers, which can increase the risk of iatrogenic injury. The “rational shoulder dislocation reduction technique” is a novel single-operator approach designed to address these challenges. This case series reports 12 patients with anterior, posterior, or inferior shoulder dislocations resulting from sports injuries, falls, and traffic accidents. Patients were treated using the Rational Technique, involving supine positioning, semi-physiological arm placement (30° abduction, 20° forward flexion, 90° elbow flexion), and gradual axial traction. General anesthesia was preferred when feasible; intra articular local anesthesia was used when general anesthesia was unavailable. The mean reduction time was 95 seconds, and all reductions were successful without complications. Post-reduction, a dedicated shoulder immobilizer was applied. This single-operator method is safe, reproducible, and practical for use in various clinical settings, including emergency departments, sports facilities, and resource-limited environments. Its simplicity and low-force approach make it a viable alternative to conventional techniques, reducing the need for multiple assistants and sedation while minimizing the risk of iatrogenic injury. Keywords: Shoulder dislocation, reduction technique, single-operator, axial traction, muscle relaxation, glenohumeral joint.

Functional outcome of fractures of the hand treated with Joshi’s external stabilization system

Ravish V. N., Bharath Raju G., Sachin Prakash Yadrami — Thu, 25 Jun 2026 00:00:00 +0530

Hand is a distinct organ both for powerful grasp in lifting heavy objects as well as delicate pinch and hook functions. Hand injury is extremely common. Fractures of metacarpals and phalanges are probably the most common fractures in the skeletal system. Some of the causes of hand injuries are crush/compression injuries, blunt trauma, fall, road traffic accidents, sports related activity and explosions/fire arm injuries Various modes of treatment have been used for hand fractures which include K wire fixation, mini plates, external fixator application. We have studied 20 patients with hand fracture treated with Joshi’s external stabilization system (JESS). The study is conducted by the Department of orthopaedics KIMS, Bangalore. Detailed history collected from all patients. Thorough examination and investigations done. X-Ray of hand (AP, and Oblique views). The surgery is performed under regional and local anesthesia patients called for follow up at 4,8, 12 and 24 weeks JESS removal is done at 4-6 weeks depending on the status of fracture healing. In our study the functional outcome is based on the ASSH-TAF rating were predominantly good to excellent with 65% participants having excellent and 45% good outcome JESS is an effective alternative treatment for fractures of the hand. It is cheap and easily available. Technically, it is less demanding. It also reduces surgical trauma and protects the vascular integrity and has good-to-excellent functional outcome.

Using recipient vessels distal to the zone of injury in free flaps for lower limb injuries

Thu, 25 Jun 2026 00:00:00 +0530

This is a retrospective study of free flaps done in injuries of the proximal leg where the microvascular anastomosis was done using recipient vessels “distal” to the defect. 4 of the 5 patients had compound fractures of the upper-middle third of the leg, 1 of the distal third of the femur and 1 patient had a post traumatic unstable leg scar. 3 of the cases were acute, 2 were subacute and 1 was chronic. The anterior tibial and posterior tibial vessels were used in 2 and 4 cases respectively; both the venous and arterial anastomoses were antegraded. The latissimus dorsi was used as the donor flap. There were no flap failures. During the same period there were 34 free flaps for similar defects in the upper third leg or the lower third of thigh, that were done using conventional anastomosis with vessels “proximal” to the defect. The authors review the existing literature and define the indications for safely using a “distally” based micro-anastomosis in compound leg injuries.

V-Y tendon advancement in patients with chronic retracted tendo-Achilles rupture: functional and clinical outcomes

Thu, 25 Jun 2026 00:00:00 +0530

Chronic Achilles tendon rupture is a relatively uncommon disabling condition, often due to delayed diagnosis or missed treatment. Primary repair is often complicated by retraction of the tendon, scar tissue formation and shortening of the gastrocnemius-soleus complex. The V-Y tendon advancement is a useful reconstructive technique that allows reconstruction of tendon continuity without the need for tendon grafts or tendon transfers. In our study we aimed to evaluate the clinical and functional outcome of V-Y tendon advancement in patients with chronic retracted tendo Achilles rupture. We conducted a retrospective observational study of 15 patients treated with V-Y tendon advancement for chronic Achilles tendon rupture from January 2020 to December 2025. Functional results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Achilles Tendon Total Rupture Score (ATRS). Heel-rise ability, ankle range of motion, return to daily activities and postoperative complications were recorded as clinical outcomes. The patients’ mean age was 48.7 years and the mean duration of follow-up was 16.7 months. Average tendon defect after debridement was 5.2 cm. The average AOFAS score improved from 44.3 preoperatively to 88.9 at final follow-up. The average ATRS score was 83.9. Eleven patients (73.3%) were able to repeat a single heel-rise test. The most common complication was mild ankle stiffness. There was no re-rupture of the tendons. Thus, we concluded that, V-Y tendon advancement is a reliable and effective technique for reconstruction of chronic retracted Achilles tendon rupture the procedure leads to satisfactory functional outcome, restoration of gait and low complication rate.

Pain attribution in concomitant rotator cuff tears and proximal humeral enchondromas: outcomes of arthroscopic repair alone at 2-year follow-up — a case series

Thu, 25 Jun 2026 00:00:00 +0530

Enchondromas of the proximal humerus are benign cartilaginous lesions frequently identified incidentally during magnetic resonance imaging (MRI) performed for shoulder pain. Their coexistence with rotator cuff tears, particularly supraspinatus tears, creates diagnostic uncertainty regarding the primary pain generator and may influence management strategies. Evidence guiding treatment in such dual-pathology scenarios remains limited. This case series evaluates five consecutive patients (mean age 47.4 years) presenting with symptomatic full-thickness supraspinatus tears and incidental proximal humeral enchondromas. All patients underwent arthroscopic double-row rotator cuff repair without intervention for the osseous lesion, followed by a standardized rehabilitation protocol. Clinical outcomes were assessed using Visual analog scale (VAS) and Oxford shoulder score (OSS) over a 2-year follow-up period. All patients demonstrated excellent clinical outcomes, with VAS scores improving from 8 to 9 preoperatively to 0 to 1 at final follow-up and mean OSS improving from 24.2 to 46.0. No rotator cuff re-tears or lesion-related complications were observed. Serial imaging confirmed radiological stability of the enchondromas, supporting their benign and incidental nature. These findings suggest that in patients with concomitant rotator cuff tears and proximal humeral enchondromas, symptoms are primarily attributable to rotator cuff pathology. Arthroscopic repair alone yields favourable outcomes, while stable enchondromas can be safely managed with observation. Accurate clinic-radiological correlation is essential to avoid unnecessary surgical intervention for incidental benign lesions.