International Journal of Research in Orthopaedics

The mechanical-vascular hypothesis of Sudeck’s atrophy: venous outflow obstruction

Majid Negari — Wed, 28 Oct 2026 00:00:00 +0530

Complex regional pain syndrome (CRPS), historically termed Sudeck’s atrophy, is traditionally classified as a neurogenic and sympathetically mediated disorder. However, purely neurological models fail to fully account for the rapid trophic changes of the skin and nails or the profound impact of mechanical factors observed in clinical practice. In this paper, we propose a novel mechanical-vascular hypothesis suggesting that the primary initiating driver of Sudeck’s atrophy is not neural dysfunction, but rather a mechanical venous outflow obstruction. This condition is primarily driven by the synergistic effect of rigid external cast compression and internal tissue edema following trauma. This mechanical bottleneck leads to persistent venous stasis, elevated compartmental pressure, microvascular fatigue, and rapid regional bone demineralization, while drawing a compelling pathological parallel with post-thrombotic syndrome. Importantly, this paradigm does not dismiss standard orthopedic care; rather, it integrates existing practices-such as effective pain management, targeted regional blocks to facilitate physical therapy, and muscle pump activation-with a renewed focus on early anti-edema measures and venous path clearance. Rigorous longitudinal Doppler assessments and clinical evaluations are proposed to validate this framework, offering a comprehensive dual approach to halt disease progression.

The well-aligned yet painful total knee arthroplasty: a timeline-based diagnostic approach to persistent postoperative pain

Wed, 28 Oct 2026 00:00:00 +0530

Persistent pain following technically successful total knee arthroplasty (TKA) affects 10–20% of patients despite satisfactory implant alignment and stability. Conventional diagnostic algorithms predominantly emphasize structural pathology while often under-recognizing extra-articular and centralized pain mechanisms, contributing to delayed diagnosis and unnecessary revision surgery. This narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed, Embase and the Cochrane Library were searched from database inception to June 2026 for studies addressing persistent pain after primary TKA. Evidence was synthesized across four domains: intra-articular pathology, extra-articular/referred causes, centralized and psychosocial pain mechanisms, and existing diagnostic algorithms. Based on the available literature, a timeline-stratified diagnostic framework was developed. Persistent pain after well-aligned TKA arises from three principal mechanistic categories: intra-articular, extra-articular/referred, and centralized pain. The differential diagnosis evolves with postoperative timing, with structural complications predominating early, instability and patellofemoral disorders emerging during intermediate follow-up, and aseptic loosening alongside centralized pain becoming increasingly relevant later. The proposed algorithm prioritizes systematic exclusion of infection, targeted assessment of mechanical pathology, evaluation of hip, spine and hindfoot disorders, and mandatory screening for central sensitization and neuropathic pain before considering revision surgery. Persistent pain following well-aligned TKA is multifactorial and requires a structured, timeline-based diagnostic strategy that integrates structural, extra-articular and centralized pain mechanisms. This comprehensive approach may facilitate earlier diagnosis, reduce unnecessary investigations and revision procedures, and support more individualized management while providing a practical framework for future prospective validation.

Osteochondroma of the calcaneus

Wed, 28 Oct 2026 00:00:00 +0530

Osteochondroma is a benign osteocartilaginous lesion characterized by a bony projection covered by a cartilage cap. Although it is one of the most common benign bone tumors, its occurrence in the calcaneus is uncommon. A lesion arising from the posterosuperior calcaneus may clinically resemble a Haglund deformity and may remain difficult to distinguish from other causes of posterior heel prominence. We report the case of a patient with insulin-treated diabetes mellitus and diabetic peripheral neuropathy with neuropathic osteoarthropathy who presented with painless, progressive deformities of both feet evolving over six years. The most prominent lesion was located on the posterosuperior aspect of the right calcaneus and caused difficulty wearing shoes because of mechanical conflict. Plain radiography demonstrated marked hypertrophy of the posterosuperior calcaneus without bone lysis or sclerosis. Computed tomography demonstrated an osseous formation measuring approximately 30 mm in anteroposterior diameter. Magnetic resonance imaging showed a lobulated osteocartilaginous-appearing formation measuring approximately 28 × 16 mm arising from the posterosuperior calcaneus and extending anteriorly, with enlargement around the insertion of the Achilles tendon. The imaging characteristics were considered most compatible with an osteochondroma. Calcaneal osteochondroma is a rare cause of posterior heel deformity and may mimic a Haglund deformity or another calcaneal exostosis. Cross-sectional imaging, particularly MRI, is useful for characterizing the lesion and assessing its relationship with adjacent soft tissues. In an asymptomatic patient with diabetes and peripheral neuropathy, conservative management with appropriate footwear and regular skin surveillance may be preferable when there is no ulceration, infection, significant pain, or radiological evidence of aggressive behavior.

Multifocal recurrent atraumatic acute compartment syndrome in an adolescent

Matthew A. Majer, Jaxon Boley, Jennifer Acevedo, Fengju Xun, Angel F. San Roman — Wed, 28 Oct 2026 00:00:00 +0530

Recurrent, atraumatic acute compartment syndrome (ACS) is an uncommon and poorly understood phenomenon. We report a female in her teens who experienced two distinct episodes of atraumatic ACS. The first episode involved the right lower extremity, and the second, the right upper extremity. Each case required emergent fasciotomy and involved postoperative complications, requiring repeat surgical intervention and vacuum-assisted closure. Extensive multidisciplinary evaluation, including rheumatologic, hematologic, and genetic testing, failed to identify an etiology. Given the recurrence and localization to separate limbs, a focal vascular abnormality is suspected, supported by comparison with a similar reported case successfully treated with angiographic embolization. This case underscores the importance of prompt surgical intervention and multidisciplinary evaluation and highlights the potential role of vascular malformations in cases of unexplained compartment syndrome.

Circular external fixation for reverse sural flap protection after partial calcanectomy in a diabetic heel with distal tip necrosis

Wed, 28 Oct 2026 00:00:00 +0530

Reverse sural artery flaps are susceptible to venous congestion, while posterior heel coverage requires strict protection from pressure. A 48-year-old woman with poorly controlled type 2 diabetes, anaemia and chronic calcaneal osteomyelitis had a persistent 4×5 cm left heel defect. Magnetic resonance imaging showed acute-on-subacute osteomyelitis with an intraosseous abscess. After multidisciplinary preparation, partial calcanectomy and a pedicled reverse sural flap with split-thickness skin grafting were performed. A circular external fixator was configured to suspend the heel, protect the pedicle and permit wound surveillance. The flap remained viable, but repeated supine positioning was followed by congestion and, at one month, 1 cm distal tip necrosis that was debrided and resutured. At 10 weeks, the flap was well settled with a residual 2×4 cm healing distal wound. Circular fixation can provide contact offloading and access, but does not replace positioning, congestion surveillance, metabolic optimisation and structured follow-up.

Conservative management of a displaced femoral shaft fracture in an 8 year-old child with excellent functional outcome: a case report

Jishnu Shilu, Mohammad Sageer — Wed, 28 Oct 2026 00:00:00 +0530

Flexible stable intramedullary nailing with titanium elastic nailing system (TENS) is commonly accepted as a preferred treatment in diaphyseal fractures of femur in children aged 6-12 years. However, in cases with significant anaesthetic risk due to medical comorbidities conservative management can be considered. An eight year old boy from a rural area in Kerala with an unrepaired congenital atrial septal defect sustained a displaced, closed mid-shaft fracture of the right femur following a road traffic accident. TENS was recommended for the fracture but surgical intervention was not accepted by the parents because of concerns regarding anaesthesia-related cardiac risk. Hence, the child was managed conservatively with skin traction followed by hip spica cast application. Serial radiographs were then taken which showed evidence of delayed union with progressive callus formation, attaining near-complete union by eight months, with residual angulation and approximately 2 cm limb shortening. Even though these radiological findings were present, child attained an excellent clinical outcome, with painless full weight-bearing, normal hip and knee range of motion, and the ability to squat comfortably. This case shows that conservative management of paediatric femoral shaft fractures may be appropriate in meticulously selected high-risk patients. Functional recovery and patient safety may be considered as a superior factor than radiographic perfection, especially in children with ampleremodelling potential.

Subacute volar lunate dislocation with multi-ligamentous disruption and anterior interosseous nerve involvement: a case report highlighting the consequences of delayed diagnosis

Wed, 28 Oct 2026 00:00:00 +0530

Volar lunate dislocation is an uncommon but severe carpal injury resulting from high-energy trauma, often associated with ligamentous disruption and acute median nerve compression. Delayed presentation increases the risk of chronic carpal instability, avascular necrosis, and persistent neuropathy. A 41-year-old male presented with pain and swelling of the left wrist for 2 weeks following a bike-to-bike road traffic accident. Clinical examination revealed wrist swelling, tenderness over the carpal bones, hypoesthesia over the lateral three and a half digits, and positive Durkan’s and Phalen’s tests suggestive of median nerve compression. Benediction sign, Froment’s sign, and impaired OK sign were noted. Radiographs (PA view) demonstrated volar lunate dislocation. CT scan confirmed volar displacement of the lunate with an associated linear undisplaced fracture at its distal pole. MRI revealed near complete tear of the dorsal intercarpal ligament, scapholunate ligament, and lunotriquetral ligament complex. The patient underwent urgent open reduction, carpal tunnel decompression, repair of disrupted intercarpal ligaments, and temporary K-wire stabilization. Postoperative immobilization was followed by supervised rehabilitation. At follow-up, the patient demonstrated improved wrist alignment and progressive recovery of median nerve symptoms. Volar lunate dislocation with associated ligamentous disruption and median neuropathy represents a surgical emergency. Early recognition with advanced imaging and timely surgical intervention are essential to restore carpal stability and prevent long-term complications.

Waardenburg syndrome associated with unicameral bone cyst of the proximal humerus: a rare case

Samarth L., Seenappa T. S., Sheethal K. S. — Wed, 28 Oct 2026 00:00:00 +0530

Waardenburg syndrome (WS) is a rare hereditary neurocristopathy characterized by congenital sensorineural hearing loss and pigmentary abnormalities involving the skin, hair, and eyes. Orthopaedic manifestations are uncommon and association with benign bone lesions is exceedingly rare. Unicameral bone cyst (UBC) is a benign intramedullary cystic lesion commonly involving the proximal humerus in skeletally immature individuals. A 34-year-old female presented with pain in the right shoulder and wrist. Clinical examination revealed heterochromia iridis, dystopia canthorum, and congenital sensorineural hearing loss suggestive of Waardenburg syndrome. Radiographs, MRI, and CT imaging demonstrated a well-defined intramedullary cystic lesion involving the proximal humerus suggestive of unicameral bone cyst. The patient underwent curettage and bone grafting. Histopathological examination confirmed unicameral bone cyst. Postoperative recovery was uneventful with satisfactory radiological incorporation of graft and good functional outcome at six-month follow-up. Association of Waardenburg syndrome with unicameral bone cyst is extremely rare. Reporting such uncommon musculoskeletal associations contributes to better understanding of syndromic skeletal manifestations and their management.

Genotype-phenotype correlations in a case of fibrodysplasia ossificans progressiva: a case report

Saswati Mukhopadhyay — Wed, 28 Oct 2026 00:00:00 +0530

Fibrodysplasia ossificans progressiva (FOP) is an ultrarare autosomal dominant genetic disorder. Most of the musculoskeletal characteristics of FOP are related to dysregulated chondrogenesis. Activating mutations of activin receptor A type I (ACVR1), a bone morphogenetic protein (BMP) type I receptor, are responsible for the skeletal and nonskeletal features. Characteristic features include congenital bilateral hallux valgus malformation and early-onset heterotopic ossification occurring spontaneously or, more frequently, precipitated by trauma. As disease progresses, thoracic insufficiency syndrome appears, with respiratory distress, pneumonia and right-sided heart failure. Diagnosis is confirmed by the identification of a heterozygous pathogenic variant in the ACVR1/ALK2 gene. Avoiding unnecessary surgical procedures, prescribing prophylactic corticosteroids, preventing falls represent essential interventions for care management.

Blisters, biology and rings: single-stage Ilizarov fixation for a high energy AO/OTA 42C3 tibial shaft fracture in an octogenarian: a case report

Wed, 28 Oct 2026 00:00:00 +0530

High-energy tibial shaft fractures in geriatric patients present significant challenges due to osteoporotic bone, compromised soft tissues and multiple medical comorbidities. Conventional fixation methods may be limited in the presence of fracture blisters or poor physiological reserve, making minimally invasive strategies increasingly relevant. An 88-year-old previously independent male with hypertension and prior cerebrovascular accident sustained a high-velocity road traffic injury resulting in an AO/OTA 42C3 comminuted tibial shaft fracture and 4F2B fibula fracture with ipsilateral rib fractures. Early circumferential fracture blebs precluded plating and staged external fixation was avoided due to advanced age and comorbidities. A single-stage four-ring Ilizarov circular fixator was applied using tensioned wires and selective Schanz pins, prioritizing biological fixation and soft-tissue preservation. Postoperatively, the patient followed a staged rehabilitation protocol with adjunctive teriparatide therapy. Radiographs demonstrated progressive callus formation and fracture union at one year with acceptable varus and recurvatum alignment. The postoperative course was uneventful and implant removal was performed after consolidation. Functional outcomes beyond one year could not be assessed due to loss to follow-up. Single-stage Ilizarov circular fixation can be an effective definitive option for complex high-energy tibial fractures in medically complex elderly patients when conventional fixation is contraindicated. Careful consideration of soft-tissue status, comorbidities and biological fixation principles is essential to optimize outcomes.

Surgical correction of club hand by radialization of ulna and leaving distal epiphysis in situ: a case study

Wed, 28 Oct 2026 00:00:00 +0530

Radial club hand is a very rare congenital anomaly which gives deformity as well as functional disability. A 2-year-old female child presented with a radially deviated wrist and an absent thumb on the left side. She was unable to use her left hand. We performed the surgery by radialization of the ulna, leaving the distal epiphysis of the ulna in situ. The leftover distal epiphysis of the ulna started growing proximally and joined the radialized ulna, which provided additional stability to the wrist. The outcome of the procedure was successful, with improved functionality and cosmesis. The procedure was deemed safe with no recurrence in the short term for one year. Further research and long-term follow-up are needed to assess any potential complications associated with this procedure. This case is reported to enlighten the readers about the new technique for treating a rare disorder.

Surgical giant cell tumour of the distal ulna managed by en bloc resection, ipsilateral fibular grafting and distal radioulnar ligament reconstruction using palmaris longus tendon: a rare case report

Wed, 28 Oct 2026 00:00:00 +0530

Giant cell tumour of bone is a benign but locally aggressive skeletal tumour, most commonly involving the epimetaphyseal region of long bones around the knee. Involvement of the distal ulna is rare and poses a reconstructive challenge because of its relationship with the distal radioulnar joint, triangular fibrocartilage complex, ulnocarpal articulation, and surrounding tendons. We report a case of a 25 year old female who presented with a gradually progressive swelling over the right wrist for six months. Clinical examination revealed a large globular swelling over the distal ulna with painful restriction of wrist motion and intact distal neurovascular status. Radiographs showed a large expansile multiloculated lytic lesion involving the distal ulna with cortical breach. MRI demonstrated a 7.8×8.4×9.6 cm expansile heterogeneous lesion involving the epimetadiaphyseal region of the distal ulna, with extensive cortical destruction, articular extension, and displacement/encasement of adjacent tendons. Fine needle aspiration cytology showed mononuclear stromal cells with numerous osteoclast-like multinucleated giant cells, suggestive of giant cell tumour. The patient underwent en bloc resection of the distal ulna with a 2 cm healthy bony margin, followed by reconstruction using a 12 cm ipsilateral fibular graft. Distal radioulnar joint stabilization was performed using palmaris longus tendon graft based on the Adams–Berger anatomical reconstruction principle, and fixation was reinforced with Kirschner wires and a dynamic compression plate. Early follow-up at one and three months showed satisfactory wound healing, maintained limb alignment, and useful active limb positioning. This case highlights that aggressive distal ulna giant cell tumour can be managed by wide resection with fibular graft reconstruction and soft-tissue stabilization, aiming to achieve local tumour control while preserving wrist and forearm function.

Solitary osteochondroma of the left scapula in an adolescent male: a rare case report

Wed, 28 Oct 2026 00:00:00 +0530

Osteochondroma is the most common benign bone tumor; however, involvement of the scapula is uncommon. Scapular osteochondromas may present with swelling, painless, no restricted shoulder movements, snapping scapula, or pseudo-winging, often mimicking neuromuscular causes. We report a case of a 14-year-old male who presented with a gradually progressive swelling over the left scapular region for 5-6 months, associated with pseudo-winging. On examination, a bony hard, non-tender swelling fixed to the scapula was noted, without neurovascular deficit. Radiographs revealed a bony exostotic lesion arising from the left scapular blade. The patient underwent complete surgical excision through a posterior approach. Histopathological examination confirmed osteochondroma, demonstrating a cartilage cap with underlying trabecular bone and marrow elements. At 1-month follow-up, the patient showed satisfactory wound healing, significantly improved shoulder function, and resolution of pseudo-winging, with no evidence of early complications or recurrence. Scapular osteochondroma is a rare cause of pseudo-winging in adolescents and should be considered in the differential diagnosis of scapular asymmetry. Careful clinical and radiological evaluation helps differentiate it from true neuromuscular winging. Complete surgical excision provides excellent symptomatic relief and favorable functional outcomes.

Recurrent lateral proximal interphalangeal joint dislocation of the fifth toe in adult-why and when to operate

Ashish Jacob Mathew, Georgy J. Kuruvila — Wed, 28 Oct 2026 00:00:00 +0530

Recurrent lateral proximal interphalangeal (PIP) joint dislocation of the 5^th-toe is a rare injury and is debilitating unless the appropriate treatment is provided. We report the case of a 32-year-old woman who presented with a history of multiple dislocations of the PIP joint of right 5^th toe, over the past 10 years following trivial trauma, treated conservatively via strapping every time. This has eventually resulted in a painful, chronic, irreducible dislocation of the PIP joint of the fifth toe. The joint was accessed via a dorsal incision and it was found that the joint capsule and medial collateral ligament were interposed in the PIP joint space. The capsule and medial collateral ligament were reconstructed, and stabilized by a transarticular Kirschner wire for 6 weeks. The joint was found to be stable, anatomically-aligned and pain-free at the end of 12-months post-surgery. While PIP dislocations are generally managed conservatively via closed reduction and strapping, in certain cases this method fails due to soft tissue interposition in the affected joint. Such cases need to be managed surgically. This approach provides a good and functional outcome even in cases of long-standing injury.

High-centre total hip arthroplasty with acetabular augment for massive acetabular bone loss following two-stage management of an infected, chondrolysed hip after fracture-dislocation of the acetabulum: a case report

K. Bala Kondaiah, P. Ramanaidu, S. Rajkumar Yadav — Wed, 28 Oct 2026 00:00:00 +0530

Post-traumatic septic arthritis of the hip following surgical fixation of an acetabular fracture is an uncommon but devastating complication that can progress to rapid chondrolysis of the femoral head and, if unchecked, massive acetabular bone loss. Management requires a staged strategy combining infection eradication with later reconstruction. We report a 55-year-old man who sustained a traumatic hip fracture-dislocation with an undisplaced acetabular fracture, initially treated elsewhere with closed reduction followed by open reduction and internal fixation (ORIF) with plating. Three months later he presented with a discharging sinus at the surgical site and radiographic evidence of near-total chondrolysis of the femoral head. He was managed with implant removal, thorough debridement and insertion of antibiotic-loaded cement beads (Girdlestone-type resection arthroplasty), followed by culture-directed systemic antibiotics. Although the infection resolved and the wound healed, the patient remained symptomatic with persistent hip pain. Repeat imaging showed complete loss of the femoral head, proximal femoral migration and near-total acetabular bone loss, confirmed on computed tomography. He subsequently underwent total hip arthroplasty (THA) with a high hip centre construct and an acetabular augment to compensate for the posterior and superior acetabular defect encountered intraoperatively. A staged protocol of aggressive debridement and antibiotic cement spacing, followed by high hip centre THA with augment support, is a viable salvage strategy for infected, chondrolysed hips with severe acetabular bone loss, and can restore a functional, pain-free joint when anatomic reconstruction is not feasible.

Idiopathic Preiser disease managed with cyst excision, distal radius bone grafting, and headless compression screw fixation: a case report

Karn Maheshwari, Happy Sathwata, Hiren Patel, Kana Musar, Nikita Bhimani — Wed, 28 Oct 2026 00:00:00 +0530

Preiser disease is an uncommon disorder characterized by idiopathic osteonecrosis of the scaphoid without preceding fracture. Owing to its rarity and nonspecific symptoms, diagnosis is frequently delayed, and the optimal management remains challenging. A 47-year-old right-hand-dominant male presented with a three-year history of progressively worsening left wrist pain, reduced grip strength, and functional limitation without previous trauma. Clinical examination demonstrated localized scaphoid tenderness with restricted wrist motion. Plain radiographs showed cystic changes without fracture, while magnetic resonance imaging (MRI) demonstrated diffuse marrow signal alteration consistent with idiopathic scaphoid osteonecrosis without carpal collapse or degenerative arthritis. The patient underwent excision of the scaphoid cyst, autologous cancellous bone grafting from the distal radius, and fixation with a 2.4-mm headless compression screw. The postoperative period was uneventful. At one-month follow-up, radiographs demonstrated satisfactory screw position, maintained scaphoid alignment, stable graft incorporation, and no evidence of hardware failure or carpal collapse. Clinical recovery progressed as expected with immobilization followed by supervised rehabilitation. This report highlights the importance of considering Preiser disease in patients with persistent wrist pain despite the absence of trauma. MRI plays a crucial role in early diagnosis, and joint-preserving reconstruction using cyst excision, distal radius cancellous bone grafting, and headless compression screw fixation may provide encouraging early clinical and radiographic outcomes in appropriately selected patients.

Tumor induced osteomalacia: a rare case report

Sharvari Varute, Sanjay Patil, Gopal Pundkare — Wed, 28 Oct 2026 00:00:00 +0530

Tumor-induced osteomalacia is a rare paraneoplastic syndrome caused by excessive fibroblast growth factor 23 (FGF23) secretion from phosphaturic mesenchymal tumors, leading to hypophosphatemia and osteomalacia. We present a 36-year-old female with progressive bilateral hip pain and pathological femoral neck fractures without trauma history. Despite being treated for hyperparathyroidism, she developed progressive mobility decline, becoming bedridden. Laboratory investigations revealed persistent hypophosphatemia (1.1-1.8 mg/dl) and elevated FGF23 levels (131.50; normal: 23.20-95.40). Parathyroid scanning was negative, but Ga-68 DOTA scan identified a somatostatin receptor-expressing lesion in the left superior gingivobuccal sulcus. Following complete surgical excision and endocrine treatment, serum phosphorus normalized (3.8 mg/dl), fractures healed progressively, and the patient regained independent mobility within seven months. This case emphasizes the importance of considering tumor-induced osteomalacia in adults with unexplained bone pain, pathological fractures, and hypophosphatemia, highlighting the diagnostic value of FGF23 measurement and functional imaging for successful management.

Subtalar dislocation with ipsilateral shaft of femur fracture: a case report

Wed, 28 Oct 2026 00:00:00 +0530

Fractures and ligamentous injuries of the foot are significant and challenging injuries in the context of orthopaedic trauma. Foot fractures & dislocations are regarded as the most frequently missed extremity injuries. Subtalar dislocations account for about 1% of total dislocations & when combined with ipsilateral femur shaft fractures makes them even rare and with more associated complications. Subtalar joint stability is determined by its ligamentous structures. These dislocations involve dislocation of talocalcaneal and talonavicular joints. AVN, Arthritis and chronic instability may arise post reduction and are dreaded long term complications and hence emphasis on timely reduction.

Foot progression angle in knee osteoarthritis – a modifiable lever for medial knee load or an oversimplified therapeutic target

Aavrati Rastogi, Roop B. Kalia, Pradeep K. Meena, Rajkumar Yadav — Wed, 28 Oct 2026 00:00:00 +0530

Knee osteoarthritis (OA) is no longer viewed solely as a degenerative disorder, but as a mechanically driven disease in which aberrant joint loading dictates both symptom progression and structural decline. Within this framework, the foot progression angle (FPA) has emerged as a clinically accessible and modifiable biomechanical parameter that may influence medial knee joint loading.

Medial opening-wedge high tibial osteotomy with dynamic axial external fixation in varus knee osteoarthritis: a prospective case series

Amaresh Jena, K. Prakhar Naidu, Arun Kumar Naik — Mon, 05 Oct 2026 00:00:00 +0530

Varus malalignment in medial compartment osteoarthritis increases load transmission through the diseased compartment, accelerating symptomatic and structural degeneration. High tibial osteotomy remains a joint-preserving option in carefully selected younger and active patients, and dynamic axial external fixation permits gradual, controlled correction while avoiding retained internal implants. This prospective case series included 10 patients (8 women and 2 men) aged 35-55 years with symptomatic medial compartment osteoarthritis and varus deformity. All patients underwent medial opening-wedge high tibial osteotomy below the tibial tuberosity, stabilized with a dynamic axial external fixator. Gradual correction was initiated on postoperative day 7 at approximately 1 mm/day, typically through four incremental adjustments of 0.25 mm every 6 hours, and patients were mobilized early with walker support. Clinical outcomes were assessed using the visual analog scale for pain, the knee injury and Osteoarthritis Outcome Score pain and function subscales, and the Oxford knee score, with a minimum follow-up of 12 months. The mean correction achieved was 8-10 degrees of valgus, with radiological union occurring within 8-12 weeks. The mean VAS pain score improved from 6.8±0.9 preoperatively to 1.6±0.7 at 12 months; KOOS pain improved from 54.2±6.1 to 82.4±5.8, KOOS function from 51.6±5.4 to 79.7±6.2, and the Oxford knee score from 19.4±3.2 to 39.6±3.5. No pin-tract infection, fixation failure, loss of correction, or neurovascular injury was observed. One patient sustained a lateral cortex fracture classified as Takeuchi type II, without compromise to eventual union or need for conversion to alternative fixation. This case series describes an initial experience with dynamic axial external fixator-assisted high tibial osteotomy, demonstrating controlled correction, radiological union within the observed period, and a limited complication profile in this selected cohort; larger studies with longer follow-up and complete patient-level radiographic data are warranted.

Functional outcomes of portal-matched tibial intramedullary nailing in Fraser type I floating knee injuries: a retrospective case series

Wed, 28 Oct 2026 00:00:00 +0530

Floating knee injuries are high-energy injuries with considerable functional morbidity. In Fraser type I injuries, dual intramedullary nailing permits early stabilization and mobilization. While suprapatellar nailing offers technical advantages for proximal-third tibial fractures, its role within floating knee injuries remains inadequately described. This study evaluated functional recovery following portal-matched tibial nailing in Fraser type I floating knee injuries. A retrospective case series of seven adults with Fraser type I floating knee injuries treated with dual intramedullary nailing between February 2022 and February 2026 was conducted at a tertiary care centre. Five patients with diaphyseal tibial fractures underwent infrapatellar nailing, while two with proximal-third fractures underwent suprapatellar nailing. Functional outcome was assessed using the International Knee Documentation Committee (IKDC) subjective score at 6 weeks, 6 months and 2 years. Pain, radiological union and complications were also recorded. Outcomes were analysed descriptively given the small and imbalanced subgroups. The COHORT comprised five males and two females, with a mean age of 33.6±7.2 years. Mean IKDC scores improved progressively from 61.54±2.15 to 82.42±2.46 and 86.70±1.30 at 6 weeks, 6 months and 2 years, respectively, in the infrapatellar group. Corresponding scores in the suprapatellar group were 60.30±0.85, 82.85±1.34 and 86.80±0.57. No clinically meaningful difference in functional recovery was observed. No non-union, malunion or implant failure occurred. Portal-matched tibial nailing demonstrated favourable and comparable functional recovery across diaphyseal and proximal-third fractures in Fraser type I floating knee injuries. Larger prospective studies are required to validate these findings.

Elbow reconstruction in pediatric missed monteggia lesions: revisited

Gaurav Garg, Tarunika Garg — Wed, 28 Oct 2026 00:00:00 +0530

Monteggia fractures are unusual injuries in children and adolescents age group wherein the radial head gets dislocated in combination with proximal ulna fractures. Various surgical treatment options are described in the literature to reconstruct these lesions for improvising the limb function. A retrospective study on thirteen patients with missed Monteggia fractures who underwent surgical intervention between 2021 to 2023 at our hospital was done. Patients underwent ulnar distraction angulation osteotomy with or without open reduction of the radial head. Patients were analysed on the visual analogue scale (VAS) for pain; mean VAS 1.9 (range 0 to 5) and functional assessment. There was a significant improvement in rotational movements of the hand after surgery. However, restriction of supination and pronation was observed in 3 patients at the last follow-up. Two patients reported radial head subluxation in last follow-up x-ray out of which one patient has associated elbow stiffness along with the re-dislocation of radial head. Missed Monteggia lesions if identified early can be treated successfully by ulnar angulation osteotomy and reduction of radio-capitellar joint. Good to excellent clinical and radiological outcomes can be expected in those with lesser age and lesser the interval between duration and surgery.

Surgical use of intramedullary k-wires in the fixation of fifth metacarpal neck fracture

Prathap Urumkar Surendrakumar, Rajendra Fiske, Keshava Murthy Doddaveere Gowda — Wed, 28 Oct 2026 00:00:00 +0530

This is a study report of 20 patients, having fracture of fifth metacarpal neck, also called as Boxer’s fracture, treated with closed reduction with JHASS maneuver and internal fixation with two antegrade intramedullary K-wires, to verify the functional outcomes with this treatment modality. All patients were followed up at least for six months (range 6-12 months, mean 8.85 months). Radiological outcomes were assessed based on AP and Oblique roentgenograms. All patients had bone union and underwent removal of K-wires in outpatient department at the end of 4 weeks. Pre-operative mean angular deformity was 61.75⁰(range 43⁰ to 73⁰) which was corrected to acceptable level; post-operative mean angular deformity was 18.05⁰ (range 15⁰ to 20⁰). Patients were assessed for functional outcomes at the end of six months using Mayo wrist score. At the end of six months of follow up 18 patients (90%) had excellent functional outcome whereas 2 patients (10%) had good functional outcome. No patient had poor or fair functional outcome. None of the patients had post-operative rotational deformity. 1 patient developed superficial skin infection which was treated with oral antibiotics. We recommend this treatment modality for the treatment of Boxer’s fracture, as it is percutaneous, day care and easy to perform procedure with excellent functional outcomes, with minimal complications.

Surgical site infection and associated risk factors in elderly patients undergoing hip arthroplasty: a systematic review and meta-analysis

Debjita Debnath, Anindya Debnath — Wed, 28 Oct 2026 00:00:00 +0530

Fracture of the femoral neck, prevalent among the elderly, is typically managed through total hip arthroplasty or hemiarthroplasty. In this demographic, there is an increased risk of surgical site infections (SSIs), contributing to extended hospital stays, increased morbidity, and mortality. This study aims to determine the incidence rate of SSIs following hip surgery in the elderly and to identify associated risk factors. A comprehensive search of MEDLINE/PubMed, Embase, and the Cochrane Library was conducted for relevant studies published up to May 2024. Observational studies reporting the incidence rate of SSIs and associated risk factors were included in this analysis. The primary outcome was the incidence rate of SSIs post-hip surgery, along with potential risk factors. This study is registered with PROSPERO (ID: CRD42024583178) and adheres to the PRISMA guidelines. Seven studies were included in the analysis. The pooled incidence rate of hip SSIs was 1.98% (95% CI: 0.96-4.11). Analysis of risk factors revealed that patients with a BMI≥35 had a significantly increased risk of SSIs in the hip joint [OR 4.01 (95% CI: 2.55-6.31)]. However, the pooled analysis indicated that diabetes mellitus [OR 1.65 (95% CI: 0.80-3.39)] and age≥67 years [OR 1.85 (95% CI: 0.29-11.75)] were not significantly associated with an increased risk of hip SSIs. Our study concludes that obesity is a significant risk factor for the development of surgical site infections in elderly patients following hip surgery.

Construct validity of the Moroccan KOOS via SF-36 correlations in patients with knee disorders

Wed, 28 Oct 2026 00:00:00 +0530

Background: The knee injury and osteoarthritis outcome score (KOOS) is a widely used patient-reported measure of knee pain, symptoms, function, and quality of life (QoL). This study aimed to evaluate the construct validity of the Moroccan KOOS by examining its convergent and divergent validity with SF-36 dimensions.

Methods: A cross-sectional study was conducted including patients with knee disorders in Morocco. Participants completed the Moroccan version of the KOOS and the SF-36 health-related QoL questionnaire. Construct validity was evaluated by examining correlations between the five KOOS subscales (Pain, Symptoms, Activities of Daily Living (ADL), Sport/Rec, and QoL) and the eight SF-36 dimensions.

Results: Strong positive correlations were observed between KOOS subscales and SF-36 Physical Functioning (D1) and Role Physical (D2), particularly for Pain, ADL, Sport/Rec, and QoL (r=0.405 – 0.769, p<0.01), supporting convergent validity. Significant positive correlations were found between KOOS subscales and SF-36 Bodily Pain (D3) (r=0.283 to 0.698, p<0.01). Positive correlations were also observed with Vitality (D5) and Role Emotional (D7), whereas weak or non-significant correlations with General Health (D4) and Social Functioning (D6) supported divergent validity. Additionally, negative correlations with Mental Health (D8) were observed for most KOOS subscales, further confirming construct distinctiveness.

Conclusions: The Moroccan version of the KOOS demonstrated very good construct validity, consistent with findings from other cross-cultural validations, confirming its relevance and robustness in the Moroccan population with knee disorders.

COVID-19 immune history and post-PRP injection reactions in knee osteoarthritis

Wed, 28 Oct 2026 00:00:00 +0530

Background: Intra-articular platelet-rich plasma (PRP) is a widely used orthobiologic treatment for knee osteoarthritis (OA). Whether COVID-19 vaccination history or prior SARS-CoV-2 infection influences local post-injection reactions has not been studied.

Methods: This exploratory retrospective cohort study included 57 patients who underwent 166 intra-articular PRP injection sessions for knee OA (March 2024–January 2026). Two per-patient outcomes were defined: pain rate (proportion of sessions with VAS pain>0) and swelling rate (proportion of sessions with recorded swelling). Patients with a single injection and no follow-up were excluded. Four Spearman correlations between vaccination dose count, prior infection count, and both outcomes were computed with bootstrapped 95% BCa confidence intervals (1,000 samples) and Holm correction applied across the four p values. Subgroup analyses used the Kruskal-Wallis test. The analytical sample comprised 40 complete cases.

Results: All quantitative variables except age were non-normally distributed (Shapiro-Wilk p<0.001). After Holm correction, none of the four primary correlations reached statistical significance. The strongest directional signal was an inverse association between prior infection count and swelling rate (ρ=−0.339, Holm-adjusted p=0.132, BCa 95% CI (−0.560, −0.064), n=40). Post-injection pain (VAS>0) occurred in 20 of 72 assessed sessions (27.8%); swelling in 8 of 75 (10.7%). No febrile reactions were documented.

Conclusions: Prior SARS-CoV-2 infection count showed a directional inverse association with post-PRP swelling rate that did not survive Holm correction for multiple comparisons. These findings are exploratory and hypothesis-generating only, and do not support clinical recommendations at this stage.

Functional outcome of cemented hemiarthroplasty in elderly patients with fracture neck of femur

M. Mobaraque Hossain, A. B. M. Rashedul Amir, M. Zahurul Islam — Wed, 28 Oct 2026 00:00:00 +0530

Background: Fracture of the neck of the femur in elderly patients is a major cause of morbidity, mortality, and functional dependency. Due to osteoporosis and poor bone quality, displaced intracapsular fractures are commonly managed with arthroplasty rather than internal fixation. Cemented hemiarthroplasty provides immediate stability, early mobilisation, and improved functional recovery in osteoporotic bone. This study aimed to evaluate the functional outcome of cemented hemiarthroplasty in elderly patients with fracture of the neck of the femur.

Methods: This descriptive observational study was conducted in two healthcare centres in Rangpur, Bangladesh, involving 40 elderly patients aged 60-80 years with displaced femoral neck fractures managed with cemented hemiarthroplasty. Patients with pathological fractures, multiple injuries, or medical unfitness for surgery were excluded. Data were collected through clinical evaluation, radiological confirmation, and postoperative follow-up. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Functional outcome was assessed using the Harris hip score and overall functional grading, classified as excellent, good, fair, or poor.

Results: The mean age was 71.4±6.2 years, with a female predominance. Most fractures were Garden type III and IV. The mean Harris Hip Score was 85.6±8.3. Functional outcome was excellent in 45%, good in 35%, fair in 12.5%, and poor in 7.5% of patients. Overall, 80% of patients achieved good to excellent results. Complications were observed in 15% of cases, and the mortality rate was 7.5% at follow-up. The mean hospital stay was 9.5±3.2 days.

Conclusions: Cemented hemiarthroplasty was associated with satisfactory short-term functional recovery and acceptable complication and mortality rates in elderly patients with displaced femoral neck fractures. It appears to be a reliable surgical option for carefully selected patients with osteoporotic hip fractures.

Cost-effectiveness of the arthroscopic Bankart procedure versus open Latarjet in the treatment of anterior shoulder instability

Wed, 28 Oct 2026 00:00:00 +0530

Background: The objective of this study was to evaluate the cost-effectiveness of the Latarjet procedure compared to arthroscopic Bankart repair as first-line treatment for recurrent shoulder instability in patients with ISIS greater than 3. It was hypothesized that the Latarjet procedure is more cost-effective due to its lower recurrence rate in patients who participate in high-demanding shoulder activities. Mean age was 32.42±12.11 years (15-40).

Methods: Retrospective, comparative cohort study including 33 patients (33 shoulders) with anterior shoulder instability treated with arthroscopic Bankart or Latarjet repair between 2018 and 2024. Patients aged 18 to 45 years with a minimum follow-up of 1 year, impact sports activity, and ISIS score >3 were included. Postoperative constant and Rowe scores were evaluated, and procedure costs were obtained from hospital administration. Cost-effectiveness analysis was performed using the ICER index.

Results: The sample population included 27 male patients (81.8%), 6 female patients (18.2%), with mean age of 24.62 (range from 18 to 45 years); a total of 33 shoulders, The study compared the costs of arthroscopic Bankart surgery ($ 25,481) and open Latarjet surgery ($19,019), showing a significant difference (p<0.001). The cost of devices was higher for Bankart procedure ($11,399 versus $2,940 p<0.01); two anchors were used in most Bankart cases, while two titanium screws were used in all Latarjet cases.

Conclusions: The Latarjet procedure, although less expensive than arthroscopic Bankart surgery, shows a clinically and statistically significant improvement in postoperative constant and Rowe scores. With no significant difference in hospitalization costs and a lower rate of recurrence of instability. Both procedures are effective in improving anterior shoulder instability.

Outcome of paediatric dynamic hip screw fixation for the treatment of proximal femoral fracture in the age group of 6-16 years

Wed, 28 Oct 2026 00:00:00 +0530

Background: Pediatric proximal femoral fractures continue to be a topic of great interest because of their rarity, related complications and morbidity, and variation in treatment methods. Recently, paediatric Dynamic Hip Screw (DHS) has got popularity by the orthopaedic surgeon which is biomechanically more stable construct with fewer complication rates.

Methods: A prospective observational study was conducted at NITOR from January 2020 to December 2021. Paediatric patients in above age group with Delbet type III, IV and subtrochanteric fractures meeting the selection criteria were study population. Total 36 patients were included in the study. Cases were evaluated by clinical findings, imaging by X-ray and HHS. Twenty-four weeks follow up was done with clinical, functional and radiological assessment.

Results: In this study, the mean age was 10.1±3 years with a male predominance (72.2%). In 28 cases of Delbet type III and IV fracture closed reduction could be done but in 8 cases of subtrochanteric fracture open reduction was needed. The mean HHS was 89.9±12.1 at last follow up. Finally, out of 36 cases, 20 (55.56%) were excellent, 10 (27.8%) were good, 4 (11.1%) were fair and the rest 2 (5.6%) was poor.

Conclusion: Delbet type III and IV fracture and subtrochanteric fracture can be effectively treated with paediatric DHS in paediatric age group with a good safety profile.

Initial prior authorization denial is associated with increasingly prolonged approval times in outpatient orthopaedic surgery: a 2017-2022 comparative cohort study

Rachel M. Bougazzoul, Carsten Schmidt, Miguel A. Schmitz — Wed, 28 Oct 2026 00:00:00 +0530

Background: Prior authorization (PA) is widely used by insurers to manage healthcare costs but may delay care, especially after an initial denial. While physician surveys report rising administrative burden from PA, objective data quantifying how denials affect approval timelines remain limited. This study evaluated whether an initial PA denial was associated with longer approval times for outpatient orthopaedic surgery, and whether this delay in care worsened between 2017 and 2022.

Methods: We conducted a retrospective cohort study of PA processing timelines for outpatient shoulder, elbow, hip, and knee surgeries performed by a single orthopaedic surgeon in 2017 and 2022. Cases were categorized as Denial (initial denial followed by eventual approval) or No Denial (approved without appeal or not requiring PA). Welch's two-sample t-tests with 95% confidence intervals compared approval wait times between groups and years.

Results: A total of 169 surgeries were included (58 in 2017, 111 in 2022). The Denial group had significantly longer approval times than the No Denial group in both 2017 (58.7 vs. 10.4 days; p=0.012) and 2022 (132.2 vs. 11.9 days; p<0.001). Among denied cases, mean approval time rose significantly from 2017 to 2022 (58.7 vs. 132.2 days; p=0.014); non-denied cases showed no change.

Conclusions: Initial PA denial was associated with substantially prolonged approval times for outpatient orthopaedic surgery, and delays more than doubled from 2017 to 2022. These findings suggest the burden of PA appeals may be rising and underscore the need for larger multicenter studies to characterize insurer-related delays.

Outcome of subtrochanteric fracture of femur treated with proximal femoral nail

Wed, 28 Oct 2026 00:00:00 +0530

Background: Subtrochanteric fractures of the femur are difficult injuries to manage due to high mechanical stress and deforming muscular forces. Proximal femoral nail (PFN) has become a preferred treatment option as it provides stable fixation with minimal soft tissue disruption and allows early mobilization. To evaluate the clinical, radiological, and functional outcomes of subtrochanteric femur fractures treated with proximal femoral nail.

Methods: This prospective study was conducted in the Department of Orthopaedic Surgery, Dhaka Medical College Hospital, over 12 months (January 2023 to December 2023). A total of 25 patients with subtrochanteric femur fractures meeting inclusion criteria were managed with PFN. Patients were followed for 6–12 months. Outcomes were assessed using radiological union time and Harris Hip Score. Data were analyzed using descriptive statistics.

Results: The mean age of patients was 41.7±18.1 years, with male predominance (76%). Road traffic accident was the most common cause (52%). Type III fractures were most frequent (44%). Mean injury to surgery interval was 8.44±2.72 days. Mean radiological union time was 16.84±4.33 weeks. Complication rate was low, with failure of closed reduction being the most common (16%). Functional outcome was excellent in 64%, good in 28%, and fair in 8% of patients.

Conclusion: PFN is an effective and reliable method for managing subtrochanteric femur fractures, providing good fracture union, early rehabilitation, and excellent functional outcomes.

Outcome of arthroscopic anterior cruciate ligament reconstruction by hamstring and medial collateral ligament reconstruction by peroneus longus autograft in anteromedial knee instability

Wed, 28 Oct 2026 00:00:00 +0530

Background: Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are a common cause of anteromedial knee instability and often require surgical reconstruction to restore function and stability. This study evaluated the functional outcomes, knee stability and complications following arthroscopic ACL reconstruction using a hamstring autograft and MCL reconstruction using a peroneus longus autograft.

Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from September 2021 to March 2024. A total of 23 patients with combined ACL-MCL injuries underwent reconstruction and were evaluated preoperatively and at 9 months postoperatively using Lachman’s test, valgus stress test, Lysholm Knee Score and knee flexion range of motion (ROM). Postoperative complications, including surgical site infection, donor site morbidity and residual instability, were also assessed.

Results: Significant improvements in knee stability and function were observed at 9 months postoperatively (p<0.001). Lachman’s test was negative in 86.96% of patients, while valgus stress testing demonstrated medial stability in 82.61%. The mean Lysholm Knee Score increased from 52.83±9.11 preoperatively to 87.30±6.30 postoperatively (p<0.001). Normal knee flexion was achieved in 82.61% of patients. Complications were minimal, including surgical site infection in 4.35%, donor site morbidity in 13.04% and residual instability in 13.04% of patients.

Conclusions: Hamstring autograft ACL reconstruction combined with peroneus longus autograft MCL reconstruction provides excellent functional recovery and knee stability with minimal complications. Larger studies with longer follow-up are needed to confirm these findings.

Pedicle screw dimension in young patients at the national orthopaedic hospital Dala Kano Nigeria

Wed, 28 Oct 2026 00:00:00 +0530

Background: Paediatric spine surgery requires meticulous preoperative planning to select appropriate pedicle screw dimensions, as the immature spine presents unique anatomical challenges. This study aimed to determine the pedicle screw sizes and lengths used in young patients at a Nigerian tertiary hospital and evaluate the influence of preoperative CT-based planning on outcomes.

Methods: A retrospective review of 97 patients aged 6 to <18 years who underwent pedicle screw instrumentation at the National Orthopaedic Hospital Dala, Kano, from January 2019 to December 2025 was conducted. Indications included spinal infection (n=68, 70.1%), trauma (n=21, 21.6%) and scoliosis (n=8, 8.2%). Preoperative CT was used to measure pedicle transverse diameter, pedicle length and vertebral body dimensions to guide screw selection. Outcomes assessed included screw accuracy using the Gertzbein-Robbins classification, complications and need for revision.

Results: A total of 339 pedicle screws were inserted (mean 3.5 screws per patient). Screw diameters ranged from 4.0 mm to 6.5 mm, with 5.0 mm (42.5%) and 5.5 mm (31.0%) being most common. Screw lengths ranged from 25 mm to 45 mm, with 30 mm (34.8%) and 35 mm (29.5%) being most frequent. Preoperative CT measurements demonstrated that pedicle transverse diameter increased with age (r=0.52, p<0.001). Screw accuracy (Gertzbein-Robbins grades A and B) was achieved in 92.6% of screws. Complications occurred in 8 patients (8.2%), including 3 (3.1%) with screw malposition requiring revision. Factors influencing screw dimension included age, level of instrumentation and underlying diagnosis.

Conclusions: Preoperative CT-based planning facilitates appropriate pedicle screw selection in paediatric patients. Screw diameters of 5.0–5.5 mm and lengths of 30–35 mm were most frequently used in this Nigerian cohort. Age and spinal level are important determinants of screw dimension.

Functional outcome of non-cemented total hip arthroplasty for avascular necrosis in adults of below 50 years age group

Wed, 28 Oct 2026 00:00:00 +0530

Background: Avascular necrosis (AVN) of the femoral head is a progressive disorder causing joint destruction and functional impairment, particularly in younger adults. Total hip arthroplasty (THA) is the standard treatment for advanced AVN and non-cemented prostheses are increasingly preferred because of their biomechanical advantages and long-term stability. This study evaluated the functional outcomes of non-cemented THA in AVN patients under 50 years of age.

Methods: A prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. Thirty-four patients with late-stage AVN (Ficat & Arlet Stage III and IV) underwent non-cemented THA. Functional outcomes were assessed preoperatively and postoperatively using the Harris Hip Score (HHS), range of motion (ROM), pain severity, walking distance and need for support. Data were analyzed using SPSS version 25, with p<0.05 considered statistically significant.

Results: The mean age was 35.50±7.01 years and 73.53% were male. Mean HHS improved significantly from 37.12 preoperatively to 91.44 postoperatively (p=0.001), with 61.8% achieving excellent outcomes (HHS >90). Significant improvements were observed in pain severity, limping, support dependency and walking distance (p=0.001). ROM also improved significantly, with 64.71% achieving a postoperative ROM of 161°–210°. Complications were minimal, including superficial surgical site infection in 5.88% and limb length discrepancy in 2.94%.

Conclusions: Non-cemented THA provides significant pain relief and improvement in mobility, ROM and functional outcomes in AVN patients under 50 years, with minimal complications, supporting its use in younger active patients.

Impact of delay from trauma to surgery on radiological and functional outcomes in posterior wall acetabular fractures treated by open reduction and internal fixation

Wed, 28 Oct 2026 00:00:00 +0530

Background: Posterior wall acetabular fractures are the most common acetabular subtype and often result from high-energy trauma in young adults. Surgical timing and reduction quality are thought to influence prognosis, but evidence specific to posterior wall fractures remains limited.

Methods: This prospective observational study included 20 patients with posterior wall acetabular fractures treated by open reduction and internal fixation (ORIF) at Dhaka Medical College Hospital between August 2020 and March 2022. Demographic, injury-related, and operative variables were recorded. Outcomes were assessed using the Matta radiographic criteria and Merle d’Aubigné-Postel functional scores. Statistical associations were analyzed using chi-square or Fisher’s exact tests.

Results: The mean age was 38.3±10.2 years; 90% were male, and 90% sustained injuries from road traffic accidents. The mean trauma-to-surgery delay was 12.8±3.6 days. Anatomical reduction was achieved in 80%. Radiological outcomes were excellent or good in 85%, while functional outcomes were excellent or good in 90%. Overall, 90% achieved satisfactory results. Surgical delay >15 days was significantly associated with poorer functional (p=0.036) and overall outcomes (p=0.012). Anatomical reduction significantly predicted excellent outcomes across all domains (p<0.05). Hip dislocation, gross fragment displacement, and abdominal injury were additional predictors of poor results. Complications were rare (20%).

Conclusions: Early surgical intervention and anatomical reduction are essential for optimizing radiological, functional, and overall outcomes in posterior wall acetabular fractures. Delay beyond two weeks and poor reduction quality substantially compromise recovery.

Simultaneous debridement, soft tissue coverage and application of Ilizarov ring external fixator in the management of open complex limb injuries

Wed, 28 Oct 2026 00:00:00 +0530

Background: Open complex limb injuries with significant bone and soft tissue defects present substantial reconstructive challenges. Traditional staged management prolongs recovery and increases complication risks. This study evaluated the outcomes of simultaneous debridement, soft tissue coverage, and Ilizarov ring external fixation in managing such injuries.

Methods: This quasi-experimental study was conducted at NITOR, Dhaka, from March 2023 to September 2025. Thirty-five patients with open complex limb injuries underwent single-stage debridement, Ilizarov fixation, and soft tissue coverage. Outcomes assessed included radiological union, complications, and bone and functional results using ASAMI criteria.

Results: The mean age was 35.2±10.35 years, with males predominating (89%). Motor vehicle accidents were the leading cause (86%). Radiological union was achieved in 94.3% (n=33) at a mean of 6.61±0.93 months. Complications occurred in 11.4% (n=4), with pin tract infection being most common (8.6%). According to ASAMI criteria, excellent bone outcomes were seen in 60% and functional outcomes in 60%. Complete flap survival was observed in 62.9% (n=22), with no total flap failures. The mean soft tissue defect size was 76.74 ± 34.54 cm².

Conclusions: Simultaneous debridement, soft tissue coverage, and Ilizarov reconstruction is a safe and effective strategy for open complex limb injuries, achieving high union rates, acceptable complications, and favorable functional outcomes.

Primary locked intramedullary nailing versus ilizarov fixation for gustilo type I–IIIA open tibial shaft fractures: a prospective comparative study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Open tibial shaft fractures are challenging injuries with substantial risks of infection, delayed union, and functional impairment. Primary locked intramedullary nailing (PLIN) and Ilizarov fixation are commonly used definitive treatment options. The objective of the study is to compare the clinical, radiological, functional outcomes and complications of these two techniques in Gustilo–Anderson type I–IIIA open tibial shaft fractures.

Methods: This prospective comparative observational study was conducted at Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh, from April 2023 to March 2025. Seventy patients aged 18–65 years were included and equally allocated to PLIN (Group A, n=35) and Ilizarov fixation (Group B, n=35). Operative time, postoperative pain, weight-bearing status, fracture union, complications, and functional outcomes were assessed. Functional outcome was evaluated using the Karlström–Olerud score.

Results: The mean operative time was significantly shorter with PLIN than Ilizarov fixation (71.14±10.92 vs. 101.86±20.51 minutes; p=0.001). At one-month, full weight bearing was achieved in 51.4% of PLIN patients versus 100.0% of Ilizarov patients (p=0.001). At six months, union was achieved in 100.0% and 94.3% of patients, respectively (p=0.493), with mean union times of 18.25±2.17 and 19.42±2.82 weeks (p=0.094). Complications were significantly more frequent with Ilizarov fixation (p=0.002). Good functional outcomes were observed in 77.1% of PLIN and 51.4% of Ilizarov patients (p=0.079).

Conclusions: Both techniques achieved satisfactory outcomes; however, PLIN demonstrated shorter operative time and fewer complications, while Ilizarov fixation provided earlier full weight bearing.

Functional and radiographic outcomes following limited open reduction with ankle-spanning Ilizarov fixation in high-energy tibial pilon fractures

Wed, 28 Oct 2026 00:00:00 +0530

Background: High-energy tibial pilon fractures are complex peri-articular fractures that have significant soft-tissue involvement and are at high risk of complications with immediate internal fixation. This study aimed to assess the functional and radiographic results of limited open reduction with ankle-spanning Ilizarov fixation in high-energy tibial pilon fractures.

Methods: This descriptive observational study was conducted at National Institute of Traumatology & Orthopaedic Rehabilitation, Dhaka, Bangladesh, from May 2017 to August 2019, including 45 patients with high-energy tibial pilon fractures who underwent limited open reduction and ankle-spanning Ilizarov fixation. All enrolled patients had their sociodemographic, injury-related, operative, radiographic, functional and postoperative complication data systematically recorded and analyzed.

Results: The majority of patients were young men, road traffic accidents were the most common mechanism of injury, AO/OTA type 43-C2 (42.2%) and Rüedi-Allgöwer type III (60%) fractures were the most common and 75.6% had an associated fibular fracture. The radiological union was obtained in 93.3% of patients, anatomical or near-anatomical reduction was obtained in 64.4% and an articular step-off less than 2 mm was obtained in 71.1%. The overall functional outcome was satisfactory in 68.9% of patients and the AOFAS ankle-hindfoot score was excellent or good in 68.9% of patients. Superficial pin-tract infection was seen in 33.3% of patients; deep infection, nonunion and secondary procedures were relatively uncommon.

Conclusions: Limited open reduction with ankle-spanning Ilizarov fixation was associated with high rates of union and satisfactory functional outcomes in patients with high-energy tibial pilon fractures and is therefore a reproducible treatment option in this difficult fracture group.

Comparative study of the burden associated with the management of open tibia shaft fractures using Ilizarov frame fixator and linear rail system in a resource poor country

Wed, 28 Oct 2026 00:00:00 +0530

Background: Management of open tibia shaft fractures is frequently laden with complications. Hence this places an enormous burden on the patient and the surgeon alike. The use of Ilizarov frame fixator and Linear rail system [LRS] as the definitive fixation device minimized the number of surgeries, length of hospital-stay and financial burden on the patient whilst achieving fracture union and reduced concomitant complications associated with open fracture care. The study objective is to determine and compare the union rate, non-union rate, associated complications encountered as well as the mean total cost implication in the management of open tibia shaft fractures using the Ilizarov frame fixator and Linear rail system [LRS] in Ibadan, Nigeria.

Methods: This is a follow up study to our previous prospective study involving thirty (30) patients of both sexes, divided into two (2) groups; Ilizarov frame fixator group and LRS group. All patients had open tibia shaft fractures of Gustillo-Anderson Class [GA II-IIIB]. The union rate, non-union rate, associated complications noted while on the respective devices as well as the mean total cost implication of managing these open tibia fractures using the Ilizarov frame fixator and LRS respectively were all assessed.

Results: The union rate in the LRS group was 86.7% while the non-union rate was 13.3%. In the Ilizarov group, the union rate was 93.3% while the non-union rate was 6.7%. In this study, pin tract infection was the most common complication associated with using both devices. The mean cost price for purchasing the LRS was shown to be N175,933.3±12,775.0 while that of the Ilizarov frame fixator was N216,000.00±42,895.0. The mean total cost implication for the management of open tibia shaft fractures using LRS and Ilizarov frame fixators were N455,960.0±46,967.3 and N505,614.3±113,345.9 respectively. There is no significant difference noted in the union rate, non-union rate, associated complications encountered as well as in the mean total cost implication in the management of these open tibia shaft fractures using the fixators under review.

Conclusions: This study has shown that management of open tibial shaft fractures using either Ilizarov frame fixator or Linear rail system [LRS] is very cost effective especially in a resource poor country like Nigeria.

Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis in patients at high risk of rotational instability

Wed, 28 Oct 2026 00:00:00 +0530

Background: Despite advances in anterior cruciate ligament (ACL) reconstruction, residual rotational instability and graft failure remain concerns, particularly in high-risk patients. Lateral extra-articular tenodesis (LET) may improve rotational control and protect the ACL graft. To evaluate clinical outcomes of combined ACL reconstruction and LET using a modified Lemaire technique in patients at high risk of rotational instability.

Methods: This prospective observational study included 30 patients with primary ACL rupture and high-grade (grade 2 or 3) pivot shift treated at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, from July 2022 to June 2025. All underwent arthroscopic ACL reconstruction combined with modified Lemaire LET. Functional outcomes were assessed using IKDC and Lysholm scores, while knee stability was evaluated by pivot-shift and Lachman tests. Preoperative and final follow-up outcomes were compared, with p<0.05 considered statistically significant.

Results: Mean age was 25.8±6.4 years and 66.7% were male. Mean IKDC score improved from 52.6±9.8 to 87.3±7.4 and Lysholm score from 58.9±10.6 to 91.2±6.8 (both p<0.001). At final follow-up, 86.7% had negative pivot-shift and 80.0% negative Lachman tests. Good-to-excellent outcomes were achieved in 86.7% by IKDC and 90.0% by Lysholm criteria. Overall, 83.3% returned to sports or previous activity and graft failure occurred in 3.3%.

Conclusions: Combined ACL reconstruction with modified Lemaire LET provided favorable functional recovery, improved knee stability and low graft failure, supporting its use in appropriately selected high-risk patients.

Sex distribution and bone mineral density by current low-trauma fracture status in a hospital DXA cohort: a retrospective single-centre study

Omar M. Awad, Marek Lacko, Ahmad Gharaibeh, Vladimír Filip — Wed, 28 Oct 2026 00:00:00 +0530

Background: Osteoporosis in men is frequently underrecognized. We compared sex distribution and T-scores from dual-energy X-ray absorptiometry (DXA) in patients with and without a current low-trauma fracture.

Methods: Authors retrospectively analysed 307 hospital DXA reports obtained between September 2025 and September 2026. Patients were classified by recorded diagnosis into a current-fracture group (n=109) or a no-current-fracture group (n=198). Logistic regression evaluated the association of male sex with current-fracture group membership, adjusting for age and lowest available T-score.

Results: Men comprised 22 of 109 patients (20.2%) in the current-fracture group and 13 of 198 (6.6%) in the no-current-fracture group (crude odds ratio (OR) 3.60, 95% confidence interval CI) 1.73–7.48; age- and T-score-adjusted OR 3.70, 95% CI 1.72–7.95). Median lowest T-scores were −1.90 and −1.50, respectively (p = 0.011). Among patients with available T-scores, 33 of 105 (31.4%) in the current-fracture group and 29 of 196 (14.8%) in the no-current-fracture group had values in the osteoporosis range.

Conclusions: Within this selected DXA cohort, men were more frequent in the current-fracture group even after adjustment for age and T-score. Most patients with a current fracture had T-scores above −2.5, emphasizing the need to consider fracture status alongside densitometry.

Clinical and functional outcome of arthroscopic anterior cruciate ligament reconstruction using autologous graft with biodegradable interference screw and adjustable loop endobutton: a prospective study

B. L. Khajotia, Manish Choudhary, Pradeep Singh, Rajendra Meena — Thu, 17 Sep 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) injury is a common cause of knee instability, functional impairment, and increased risk of secondary meniscal injury and early osteoarthritis. Arthroscopic ACL reconstruction is the gold standard treatment for symptomatic ACL tears. Secure graft fixation using an autologous hamstring graft, biodegradable interference screw, and adjustable-loop Endobutton provides stable fixation, promotes graft incorporation, and facilitates early rehabilitation.

Methods: This prospective observational study included 60 patients with symptomatic ACL rupture treated at the Department of Orthopaedics, Sardar Patel Medical College and Associated Group of Hospitals, Bikaner. Preoperative assessment included clinical examination, MRI, Lysholm score, IKDC grading, and stability tests. All patients underwent arthroscopic ACL reconstruction using an autologous hamstring graft with femoral fixation by an adjustable-loop Endobutton and tibial fixation using a biodegradable interference screw. Functional outcomes and complications were evaluated during follow-up.

Results: The mean patient age was 28.9±6.3 years, and 81.7% were male. At final follow-up, 68.3% achieved an excellent Lysholm score, while 46.7% and 40.0% were graded as normal and nearly normal, respectively, on the IKDC scale. Most patients demonstrated restored knee stability with minimal complications. No implant failure, deep infection, or neurovascular injury was observed.

Conclusion: Arthroscopic ACL reconstruction using an autologous hamstring graft with biodegradable interference screw and adjustable-loop Endobutton provides excellent functional outcomes, reliable knee stability, and a low complication rate, making it a safe and effective treatment for symptomatic ACL injuries.

Medical versus surgical management of frozen shoulder: a prospective observational comparative study at 6 months

Aditya Shankar Jena, Pradeep Kocheeppan, Santosh Raju Kumar, Amal S. Plackiel — Wed, 09 Sep 2026 00:00:00 +0530

Background: Frozen shoulder is characterized by pain and progressive restriction of shoulder movement. Conservative treatment is commonly used initially, whereas surgery is considered in selected patients with persistent or severe functional limitation. This study compared outcomes after medical and surgical management at 6 months.

Methods: This prospective observational study included 70 patients with frozen shoulder: 50 received corticosteroid injection with physiotherapy and 20 underwent arthroscopic capsular release followed by physiotherapy. Range of motion (ROM), Constant-Murley score (CMS), DASH score and patient satisfaction were assessed at baseline and 6 months.

Results: Both groups improved significantly at 6 months (p<0.001). CMS improvement was greater in the surgical group than in the medical group (43.05±11.95 vs 25.86±10.05; p<0.001), and DASH reduction was greater after surgery (-38.95±12.57 vs -29.48±13.26; p=0.010). Surgical treatment was associated with greater gains in flexion, abduction and external rotation and higher patient satisfaction (8.45±1.19 vs 6.42±1.16; p<0.001). Similar differences were observed in patients in the freezing and frozen stages.

Conclusions: Both modalities were associated with significant functional improvement at 6 months. In this non-randomized cohort, surgical management was associated with greater improvement in ROM and functional scores, particularly in patients with severe disease.

A functional outcome of lateral end clavicle fractures treated surgically with open reduction and internal fixation

Prabhav P. Tijoriwala, Kashish Shah, Raj Gadhavi, Prakash Chaudhary — Wed, 28 Oct 2026 00:00:00 +0530

Background: Lateral end clavicle fractures represent a clinically significant subset of clavicular injuries due to their inherent instability and higher risk of non-union, particularly in Neer type II fractures. Surgical management using open reduction and internal fixation (ORIF) has gained increasing acceptance to restore anatomical alignment and optimize functional recovery.

Methods: This prospective observational study was conducted in the department of orthopedics at SMIMER, Surat, from February 2023 to October 2024. Thirty patients aged 18-70 years with lateral end clavicle fractures (Neer type II and III) were included. Patients underwent ORIF using locking plates, hook plates, or locking plate with coracoclavicular augmentation based on fracture configuration. Postoperative follow-up was conducted at 6 weeks, 3 months, and 6 months. Functional outcomes were assessed using the QuickDASH score and visual analogue scale (VAS), along with radiographic evaluation of fracture union.

Results: The majority of patients achieved radiological union within 12 weeks. Significant improvement in pain scores and shoulder function was observed across follow-up intervals. Most patients demonstrated good to excellent functional outcomes at six months, with minimal complications. Early surgical fixation provided stable fixation, facilitated early mobilization, and improved overall shoulder performance.

Conclusions: ORIF for lateral end clavicle fractures provides reliable fracture union and favorable functional outcomes. Surgical stabilization is particularly beneficial in displaced and unstable fractures, enabling early return to daily activities with satisfactory shoulder function.

Clinical, radiological and functional outcomes of pediatric diaphyseal long-bone fractures treated with Titanium Elastic Nailing System: a prospective study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Diaphyseal fractures of long bones represent a substantial proportion of paediatric skeletal injuries. The Titanium Elastic Nailing System (TENS) has emerged as a minimally invasive, biologically favourable method of internal fixation that facilitates early mobilization and fracture healing in children. The aim of the study is to assess the clinical, radiological, and functional outcomes of closed diaphyseal long-bone fractures in children aged 5–16 years treated surgically using TENS.

Methods: A prospective interventional study was carried out between July 2020 and August 2022 at Government Medical College, Amravati, Maharashtra, India. Twenty-four children with 31 closed diaphyseal fractures of long bones underwent fixation using titanium elastic nails. Patients were followed at 3, 6, 12, and 24 weeks, and at 9 months postoperatively. Fracture union, alignment, complications, and functional outcomes were evaluated. Final outcomes were graded using Flynn’s scoring criteria (5).

Results: The mean patient age was 12.20±2.58 years. The femur was the most frequently involved bone (37.5%), followed by both-bone forearm fractures (29.17%). The mean time to fracture union was 15.12±8.08 weeks, with 54.84% of fractures uniting by 12 weeks. Based on Flynn’s criteria (5), excellent outcomes were observed in 90.32% of fractures, satisfactory outcomes in 6.45%, and a poor outcome in 3.23%. Complications were minimal (9.68%), consisting mainly of entry-site irritation and one case of delayed union. No deep infections or implant failures were encountered.

Conclusions: Titanium elastic nailing is a safe and effective treatment modality for paediatric diaphyseal long-bone fractures, providing reliable fracture stabilization, early union, favourable functional outcomes, and a low complication rate.

A morphology-based classification system and management strategy for postero-medial tibial plateau fractures

Purushotham Lal Ramachandra, Ihjas Ismail, Ashish Dodiya — Wed, 28 Oct 2026 00:00:00 +0530

Background: Posteromedial tibial plateau fractures represent a distinct subset of proximal tibial injuries, characterized by coronal-plane fracture orientation and complex fragment morphology that may be overlooked on standard radiographs. Earlier classification systems such as the Schatzker and pre-2018 AO/OTA schemes did not adequately describe posterior or posteromedial fracture patterns, limiting their usefulness in surgical planning. However, the revised 2018 AO/OTA classification introduced axial-plane modifiers to specifically identify posteromedial involvement. Despite this advancement, considerable heterogeneity remains in fracture morphology and intraoperative behavior, highlighting the need for a dedicated morphology-based classification that more directly correlates fracture pattern with fixation strategy and clinical outcome.

Methods: Forty adult patients with postero-medial tibial plateau fractures were prospectively studied. Fractures were classified by sagittal position of fracture line (L1-L3), apex orientation on AP view (A1-A2), and displacement on CT (Da <2 mm, Db >2 mm). Surgical approach and fixation strategy were selected accordingly, and intraoperative stability was assessed under fluoroscopy. Outcomes were evaluated with radiographs, range of motion, and Knee Society Score (KSS) at 6 months.

Results: Of 40 patients (mean age 41 years), 24 fractures involved L1, 11 L2, and 5 L3 regions; 27 had medial apex (A1) and 13 lateral apex (A2). L1Db and L2 fractures showed marked instability, while L3Da patterns remained stable through flexion. All unstable patterns required buttress plating, with surgical approach dictated by apex orientation. Radiological union occurred in all cases at a mean of 14 weeks. At 6 months, 85% of patients achieved excellent or good outcomes; complications included stiffness in three cases and ACL laxity in one.

Conclusions: This morphology-based classification reliably correlates fracture patterns with stability, surgical approach, and rehabilitation needs. It offers a practical framework for individualized management of posteromedial tibial plateau fractures and may improve functional outcomes. Further multicenter validation is recommended.

Conventional versus robotic total knee arthroplasty – a comparative study of accuracy, alignment and early functional results

Wed, 28 Oct 2026 00:00:00 +0530

Background: Restoration of mechanical alignment and optimization of functional outcomes are critical for total knee arthroplasty (TKA). Robotic systems aim to improve the accuracy of bone cuts and reduce malalignment. Evidence from Indian populations remains limited.

Methods: The present study was a prospective, non-randomized control study. The sample size was 43 knees in each group (robotic and traditional), for a total of 86 knees, using a two-sided α=0.05 and power of 80%. Functional outcomes were evaluated with oxford knee score (OKS) and knee society score (KSS) at 0 weeks, 6 weeks, 3 months and 6 months. Perioperative variables, including operative time, blood loss, length of stay, pain score and complications, were recorded.

Results: Baseline demographic and clinical characteristics were comparable between groups. Robotic TKA demonstrated fewer alignment outliers (11.6% versus 25.6%, p=0.166) and significantly lower mean absolute HKA error (1.4°±1.1 versus 2.4°±1.7, p=0.002). Functional outcomes improved in both groups over time. Robotic TKA showed higher OKS at 6 weeks (32.2±3.5 versus 29.9±4.3, p=0.009) and higher KSS at 6 weeks (75.6±9.7 versus 69.6±7.9, p=0.003) and 6 months (90.3±4.9 versus 85.0±5.6, p<0.001). Robotic TKA required longer operative time (94.2±9.4 versus 81.9±9.7 min, p<0.001) but resulted in lower blood loss (293.9±52.2 versus 350.5±46.3 ml, p<0.001). Length of stay and complication rates were similar between groups.

Conclusions: Robotic TKA improves alignment accuracy and enhances early functional outcomes compared to conventional techniques, with acceptable perioperative safety in Indian settings.

Functional outcome of internal fixation of distal third shaft of fibula by tens nailing in addition to tibia in both bone leg fractures

Venkatesh Mulimani, Pranay Athadkar, Jugal Kishore, Baswaraj Chinchole — Wed, 28 Oct 2026 00:00:00 +0530

Background: The distal tibia and fibula fracture are common orthopaedic injuries resulting from high-energy trauma such as falls, sports-related incidents, and motor vehicle accidents. The optimal fixation strategy for these fractures remains a subject of debate. Traditional methods, such as plating and screw fixation, provide stability but may be associated with complications, including soft tissue compromise and delayed healing. In recent years, elastic nailing has emerged as a minimally invasive surgery alternative for fibular fixation, particularly when performed in conjunction with distal tibial fractures. The study was done to evaluate the functional outcomes of fibular fracture fixation using elastic nails in combination with distal tibial fractures. Key outcome measures include pain levels, range of motion, return to daily activities, and complication rates.

Methods: A prospective cohort of 20 patients with distal tibia-fibula fractures underwent surgical fixation with elastic nails was assessed. Clinical and functional outcomes was evaluated using standardized scoring systems, radiographic assessments, and patient-reported measures at regular follow-up intervals.

Results: Preliminary findings suggest that elastic nailing provides adequate stabilization while minimizing soft tissue disruption. Patients demonstrated satisfactory functional recovery with acceptable pain levels and early mobilization. Complication rates, including non-union and implant-related issues, were comparable to or lower than those associated with conventional fixation methods.

Conclusions: Elastic nailing for fibular fractures, when used in conjunction with distal tibial fracture fixation, appears to be a viable and effective treatment option for bone healing.

Cost-conscious comparison of dynamic condylar screw versus locking compression plate fixation in distal femur fractures: a comprehensive functional and physiotherapy-oriented evaluation

Wed, 28 Oct 2026 00:00:00 +0530

Background: Distal femur fractures are complex injuries associated with substantial morbidity, particularly in comminuted and intra-articular patterns. Locking Compression Plates (LCP) provide angular stability and facilitate early mobilization, whereas Dynamic Condylar Screws (DCS) remain a cost-effective option in resource-limited settings. This study compared radiological, functional, rehabilitation and economic outcomes between LCP and DCS fixation under a standardized physiotherapy protocol.

Methods: A retrospective-prospective observational cohort study was conducted from January 2018 to December 2021 involving 33 adults with AO/OTA 33-A or 33-C distal femur fractures. Eighteen patients underwent distal femur LCP fixation and 15 underwent DCS fixation. All patients followed a structured continuous passive motion (CPM)-assisted rehabilitation program. Outcomes assessed included radiological union, knee range of motion, functional scores, complications, and treatment cost.

Results: The LCP group demonstrated earlier radiological union (approximately 16 to 17 weeks vs. 19 weeks in the DCS group) and superior knee flexion throughout rehabilitation. Final knee flexion ranged from 105⁰ to 122⁰ in the LCP cohort compared with 95⁰ to 112⁰ in the DCS cohort. Functional outcomes, including Knee Society Score, Lysholm score, Neer’s grading, and Timed Up and Go performance, favoured LCP fixation. Varus malalignment and non-union were more frequent in the DCS group. However, LCP fixation incurred 35% to 45% higher direct treatment costs.

Conclusions: LCP fixation provides earlier union, improved range of motion, and superior functional recovery compared with DCS fixation, particularly in comminuted and osteoporotic fractures. Despite higher costs, LCP with structured CPM-assisted rehabilitation may offer better outcomes in selected high-demand patients, while DCS remains a cost-effective option for simpler fracture patterns.

A comparative study of the effect of early versus late dynamization of external fixator in the treatment of compound fracture of tibia: a non-randomized controlled trial

Bojum Leya, Sanjib Waikhom, Vikash Kumar, Hemam Chittaranjan Singh — Wed, 28 Oct 2026 00:00:00 +0530

Background: Dynamization is commonly employed to enhance fracture healing following stabilization with external fixators or intramedullary nails. However, the optimal timing of dynamization remains controversial, with limited consensus in clinical practice. The aim was to compare the radiological and functional outcomes of early versus late dynamization in patients with tibial fractures treated using external fixation and to determine the optimal timing for dynamization.

Methods: This prospective comparative study included 36 patients with open tibial fractures managed with external fixation. Patients were equally divided into two groups: group I (early dynamization, initiated at 2-4 weeks postoperatively) and group II (late dynamization, initiated at or after 4 weeks). Patients were followed up for fracture union, time to union, complications, pain, range of motion, need for secondary procedures, and functional outcome using the Baird and Jackson scoring system. Statistical analysis was performed to compare outcomes between the two groups.

Results: Fracture union was achieved in 94.4% of patients in the early dynamization group compared to 72.2% in the late dynamization group. The mean time to union was significantly shorter in group I (12.65±5.49 weeks) than in group II (18.46±4.61 weeks; p=0.005). Complication rates, including pin tract infection and limb shortening, were lower in the early dynamization group. Functional outcomes were favorable in both groups; however, excellent Baird and Jackson scores were more frequent in the early dynamization group. Pain relief and restoration of joint range of motion were achieved earlier in patients undergoing early dynamization.

Conclusions: Early dynamization within four weeks of surgery results in faster fracture union and better functional outcomes compared to late dynamization. Early dynamization should be considered the preferred strategy in the management of tibial fractures treated with external fixation.

Comparative functional outcomes of distal radius fractures treated with Joshi’s external stabilization system versus volar locking plate fixation: a prospective cohort study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Distal radius fractures are among the most common orthopedic injuries. Joshi’s external stabilization system (JESS) and volar locking plate fixation are widely used surgical options with differing biomechanical principles.

Methods: A prospective cohort study of 94 patients with distal radius fractures was conducted. Patients underwent either JESS or volar locking plate fixation. Functional outcomes were assessed using DASH scores at 6 and 12 months and modified Mayo wrist score (MMWS) at 12 months.

Results: Volar plating demonstrated superior functional outcomes, with significantly better early recovery and consistently improved scores at final follow-up. Patients treated with volar plating achieved better range of motion and grip strength. The JESS group showed gradual improvement over time but did not match the overall functional outcomes of the plating group. Pin tract infections were more common in the JESS group, whereas hardware-related complications were observed in the plating group.

Conclusions: Volar locking plate fixation provides superior functional outcomes in distal radius fractures, both in early recovery and at final follow-up. While JESS remains a viable option in selected cases, volar plating should be preferred where feasible.

Functional outcome of fluoroscopy-guided hydrodilatation in adhesive capsulitis of the shoulder

Kushal N. Parikh, Kamalkumar H. Ninama — Wed, 28 Oct 2026 00:00:00 +0530

Background: Adhesive capsulitis is characterized by shoulder pain and globally restricted movement. While conservative treatments are standard, fluoroscopy-guided hydrodilatation aims to directly enlarge the contracted joint capsule. This study was performed to evaluate the functional outcome, pain relief, and range of motion (ROM) following fluoroscopy-guided hydrodilatation in patients with adhesive capsulitis.

Methods: This prospective interventional study included 52 patients (aged 18-60) with adhesive capsulitis presenting at a tertiary care hospital. Patients underwent fluoroscopy-guided hydrodilatation using a mixture of normal saline, local anesthetic, and steroid, followed by a structured physiotherapy regimen. Outcomes were assessed using the visual analog scale (VAS) for pain, the Oxford shoulder score (OSS), the shoulder pain and disability index (SPADI), and ROM measurements at baseline, 1, 3, and 6 months post-intervention.

Results: The mean patient age was 47.6 years, with a female predominance (65.4%). Post-intervention, significant progressive improvements were observed across all parameters (p<0.001). The mean VAS score decreased from 7.5 pre-intervention to 1.9 at 6 months. Shoulder ROM improved substantially, with abduction increasing from 94.1 to 143.3, and flexion from 97.0 to 147.6. Mean OSS increased from 22.5 to 42.5, indicating restored function. The total SPADI score significantly decreased from 64.98 to 31.00 at the 6-month follow-up.

Conclusions: Fluoroscopy-guided hydrodilatation, followed by structured physiotherapy, is a highly effective intervention for adhesive capsulitis, yielding significant mid-term pain relief, restoration of shoulder mobility, and enhanced functional outcomes.

Evaluation of functional outcome of epidural steroid injection in lumbar canal stenosis

Shripal Doshi, Himanshu Parmar, Viralkumar R. Gamit, Sudhir K. Rawat — Wed, 28 Oct 2026 00:00:00 +0530

Background: Low back ache is common complaint noted in orthopaedic OPDs. Low back pain accompanied by lumbosacral radiculopathy continues to be one of the most challenging musculoskeletal conditions to manage therapeutically, Stenosis manifests with two types of symptoms: neurogenic claudication, which may be unilateral or bilateral, and radiculopathy. The Management of Lumbar canal stenosis (LCS) is most debatable. Epidural injection by using steroid is commonly used treatment options used for chronic lower back pain. The present study evaluates the outcomes of Epidural steroid injection (ESI) in LCS and analyzes their effects on various outcome measures.

Methods: A prospective observational study was conducted on 50 patients diagnosed with LCS. The study was carried out in the Department of Orthopeadics at SBKS Medical Institute & Research Centre Piparia, Vadodara over a three-year period, March-2019 to March 2021. Patients underwent ESI and were followed up for clinical outcomes.

Results: In this study, the 51–60 years age group was most commonly affected, with a predominance of female patients. The L4–L5 levels were most commonly affected, with the majority of patients having a spinal canal diameter between 7–11 mm. The final results showed that 88% of patients had an excellent outcome, while 12% had a fair outcome.

Conclusions: ESI is a safe, cost-effective, and minimally invasive treatment for patients with subacute or chronic low back pain with radiculopathy, reducing the need for analgesics and facilitating an early return to work.

Diagnostic accuracy of high-resolution ultrasonography for detection of rotator cuff tear with respect to magnetic resonance imaging

Syed Athaulla, Atik Ahmed, Mansuri Vahab Mohammedharun, Sayed Hussain — Wed, 28 Oct 2026 00:00:00 +0530

Background: Rotator cuff tears are a common cause of shoulder pain; although magnetic resonance imaging (MRI) is the diagnostic gold standard, this study evaluated high-resolution ultrasonography as a cost-effective, non-invasive alternative for detecting rotator cuff tears.

Methods: A prospective cross-sectional study was conducted at the Department of Radiodiagnosis, Al-Ameen Medical College, Bijapur, from 2023 to 2025. Sixty-five patients aged 18–49 years with suspected rotator cuff injury underwent high-resolution ultrasonography (HRUS) followed by MRI. Findings from both modalities were compared for tendon pathology, including complete and partial tears, tendinosis, and normal appearances.

Results: High-resolution ultrasonography detected partial-thickness rotator cuff tears in 20 patients (20/65, 30.8%) and complete tears in 17 patients (17/65, 26.2%), whereas MRI identified partial tears in 23 patients (23/65, 35.4%) and complete tears in 22 patients (22/65, 33.8%). The supraspinatus tendon was the most commonly involved tendon, affected in 28 patients (28/65, 43.1%). For complete supraspinatus tears, ultrasonography demonstrated high diagnostic performance, with a sensitivity of 83.1%, specificity of 97.4%, positive predictive value of 99.4%, negative predictive value of 96.7%, and a Kappa value of 0.90, indicating almost perfect agreement with MRI. However, ultrasonography showed reduced sensitivity and lower agreement for partial-thickness tears and for infraspinatus tendon involvement.

Conclusion: High-resolution USG is a reliable first-line modality for detecting complete rotator cuff tears, particularly of the supraspinatus and subscapularis tendons; however, MRI remains essential for evaluating partial and posterior tendon tears when USG findings are inconclusive.

Comparative analysis of MPFL reconstruction in recurrent dislocation of patella using peroneus longus graft versus semitendinosus: a retrospective study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Recurrent patellar dislocation is most commonly associated with injury to the medial patellofemoral ligament (MPFL). MPFL reconstruction is the standard treatment. While semitendinosus tendon is traditionally used, peroneus longus tendon has emerged as an alternative graft with potentially less donor-site morbidity. This study aimed to compare functional outcomes, patient satisfaction, complications, and failure rates following MPFL reconstruction using peroneus longus versus semitendinosus tendon.

Methods: A retrospective comparative study was conducted on 30 patients with recurrent patellar dislocation. Group A (n=15) underwent MPFL reconstruction using semitendinosus graft, and Group B (n=15) using peroneus longus graft. Patients were followed for a minimum of 12 months. Outcomes were assessed using Kujala and Lysholm knee scores, range of motion, patient satisfaction rate, donor-site morbidity, and failure rate. Statistical analysis was performed using SPSS.

Results: Both groups showed significant improvement in functional scores (p<0.001). Group B demonstrated significantly higher postoperative Kujala and Lysholm scores, better patient satisfaction, lower donor-site morbidity, and lower failure rate.

Conclusions: Peroneus longus tendon is a safe, reliable, and effective alternative graft for MPFL reconstruction with superior functional outcomes and patient satisfaction compared to semitendinosus tendon.

Functional outcomes of medial parapatellar versus patellar tendon splitting approaches in intramedullary nailing of tibial shaft fractures: a prospective comparative study

Sreerag M. R., Anantha Balaram B., Abdusamad V., Anjana Pillai — Wed, 28 Oct 2026 00:00:00 +0530

Background: Anterior knee pain remains the most common complication following intramedullary nailing of tibial shaft fractures. The surgical approach used for nail insertion is an important factor influencing postoperative knee morbidity.

Methods: This prospective observational study included 42 patients with tibial shaft fractures treated with intramedullary interlocking nailing between April 2024 and March 2026. Patients were managed using either patellar tendon splitting or medial parapatellar approach. Functional outcomes were assessed using Visual Analog Scale (VAS) for pain and Lysholm Knee Score (LKS) at 6 weeks, 3 months, 6 months, and 1 year.

Results: Both groups were comparable in baseline characteristics. Fracture union was achieved in all patients by 6 months. While overall pain prevalence was similar at 1 year (p=0.533), VAS scores were significantly lower in the medial parapatellar group from 3 months onward (p<0.001). The medial parapatellar group demonstrated significantly better knee flexion, reduced extension lag, and higher Lysholm scores at all follow-up intervals (p<0.001).

Conclusions: Both approaches are effective for achieving fracture union; however, the medial parapatellar approach results in superior functional outcomes and lower pain severity. It may be preferred when feasible.

Remote follow-up after total knee arthroplasty: validity of patient-reported outcome measures as a triage tool – a prospective cohort study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Routine in-person review after total knee arthroplasty (TKA) is costly and resource-intensive. Whether remotely-collected patient-reported outcome measures (PROMs) can reproduce the clinician’s follow-up decision-not merely correlate with it-is unknown. We assessed the agreement and triage accuracy of three PROMs against the clinician-administered knee society score (KSS), and whether comorbidity should modify follow-up.

Methods: In this prospective cohort of 96 patients undergoing primary TKA for osteoarthritis, the Oxford knee score (OKS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), short form (SF)-36 and KSS were recorded preoperatively, at 3 weeks and at 1 year. Agreement was assessed by Bland-Altman analysis, triage accuracy by ROC analysis against a clinician-defined suboptimal outcome (lowest-quartile 1-year KSS), and predictors by multivariable regression.

Results: Data were complete for all 96 patients (mean age 66.1 years; 72.9% comorbid; no loss to follow-up). All instruments improved by 1 year (p<0.001). Despite high PROM-KSS correlations (1-year OKS r=0.96), Bland-Altman analysis showed systematic disagreement (WOMAC bias +19.9 standardised points), so the instruments are not interchangeable. A remote OKS <28 identified the suboptimal outcome with area under the curve 0.98, sensitivity 100%, specificity 93%, negative predictive value 100% and kappa 0.88, missing no affected patient. Comorbidity count independently predicted poor outcome (adjusted odds ratio 4.0 per comorbidity, p<0.001); 1-year KSS fell stepwise across strata (p<0.001).

Conclusions: After the 3-week visit, a normal remote OKS reliably excludes a poor clinician-defined outcome, supporting a comorbidity-stratified hybrid pathway: remote follow-up for low-risk patients and in-person review for high-risk patients. External, longer-term validation is required.

Broken heart syndrome-like psychosomatic dysregulation in knee osteoarthritis: a bidirectional analysis of pain-stress coupling

Aavrati Rastogi, Roop B. Kalia, Anindya Das, Mukesh Bairwa — Wed, 28 Oct 2026 00:00:00 +0530

Background: A prominent chronic musculoskeletal condition that is linked to pain, disability, and a lower quality of life is knee osteoarthritis (KOA). A biopsychosocial paradigm, which holds that psychological factors have a major impact on pain perception and functional limitation, is supported by emerging research. This model suggests a reciprocal relationship between emotional and physical health. Objective of the study was to evaluate gender-based variations across radiographic severity classes and to look into the relationship between pain intensity, functional impairment, and psychological distress in people with KOA.

Methods: A cross-sectional observational study was conducted among 108 patients diagnosed with KOA. The WOMAC (modified CRD Pune version) was used to assess clinical severity, while the GAD-7 and PHQ-9 were used to assess anxiety and depressive symptoms. Pain-stress correlations were evaluated using Pearson's correlation, and male and female participants with Kellgren-Lawrence (K/L) grades II and III were compared using independent-samples t-tests.

Results: Clinically significant patterns were found despite the lack of statistical significance (p>0.05). Increased psychological discomfort, especially depressive symptoms, was linked to higher WOMAC scores. In female participants, there was a somewhat favorable correlation between the severity of symptoms and depression (r=0.374, p=0.333), but anxiety exhibited mild correlations in both sexes. Pain, stiffness, function, and overall WOMAC ratings did not differ significantly based on sex across K/L grades (all p>0.05). These results point to a clinically significant connection between emotional discomfort and pain burden.

Conclusions: According to the study, there might be a reciprocal relationship between psychological distress and chronic pain, supporting a biopsychosocial view of KOA. Routine rehabilitation that incorporates psychological evaluation may improve patient results and encourage more thorough, patient-centered care.

Radiological parameters in the evaluation of functional outcomes following locking plate fixation of comminuted proximal humerus fractures

Wed, 28 Oct 2026 00:00:00 +0530

Background: The incidence of PHF is about 5% of all fractures that are clinically treated and is more common in elderly females. Locking plates are commonly used for fracture stabilization and provide stable fracture management. But some problems like reduction loss and varus malunion can have a great effect on functional outcomes. This study aimed to assess the role of radiological parameters-neck-shaft angle (NSA) and humeral head height (HHH)-in predicting functional outcomes in comminuted PHF treated with locking plates.

Methods: A retrospective study was done on 50 patients who were treated at Pradyumna Bal Memorial Hospital, KIMS from July 2018 to July 2019 with a minimum followup of one year. The Constant Shoulder Score (CSS) was used to assess functional outcomes. Radiographic parameters were assessed at 1 month, 3 months, 6 months and 1 year after surgery. Data was analysed using Jamovi software version 2.3.28.

Results: The mean age of the study participants was 54 +/-(19) years, which included 29 (58%) males and 21 (42%) females. The fracture union was obtained in 44 (88%) patients and 6 (12%) patients needed revision surgery. The postoperative NSA was 130° (range 120° to 140°) and was found to be related to the higher CSS scores. Patients with optimal NSA and HHH (44 patients, 88%) had significantly better functional outcome (CSS ~85), while patients with nonunion or suboptimal alignment had lower scores (CSS ~60, p<0.05).

Conclusions: Radiological alignment plays an important role in functional outcome following PHF treated with locked plates. A large NSA (>125°) and adequate humeral head height prevent varus malunion and improve shoulder function after surgery. Optimum recovery will be achieved with careful surgical planning and restoration of anatomical alignment.

Investigating the correlation between facet joint fluid and instability in degenerative lumbar disease on flexion and extension radiographs: a retrospective study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Degenerative lumbar disease is a leading cause of chronic low back pain and disability. While flexion-extension radiographs are traditionally used to assess spinal instability, they can underestimate subtle instabilities. Facet joint effusion detected on magnetic resonance imaging (MRI) has been proposed as a dynamic indicator of biomechanical instability, but its diagnostic utility and practical thresholds require further validation. Objectives were to investigate the correlation between the presence of facet joint fluid and spinal instability in patients with degenerative lumbar disease using dynamic flexion and extension radiographs.

Methods: A retrospective study was conducted involving 132 patients diagnosed with degenerative lumbar disease. Imaging evaluations included supine MRI to assess facet joint fluid and upright flexion-extension radiographs to measure dynamic motion. Radiographic instability was defined as a sagittal translation greater than 3 mm or a segmental angulation greater than 20°. Clinical symptoms, such as pain location and duration, were also evaluated.

Results: Of the 132 patients, 66 (50.0%) exhibited bilateral facet fluid, 32 (24.2%) had unilateral fluid, and 34 (25.8%) showed no facet fluid. Patients with bilateral facet fluid demonstrated the highest facet fluid index (0.58±0.04) and dynamic motion index (5.3±1.2), along with a greater slip percentage in flexion (8.4±1.1%). A striking association was observed between facet fluid presence and radiographic instability. Among patients with bilateral fluid, 93.9% had a sagittal translation >3 mm and 89.4% had an angular motion >20°. Furthermore, facet fluid presence significantly influenced clinical presentation, with 83.3% of patients with bilateral fluid reporting bilateral pain.

Conclusions: The accumulation of facet joint fluid, particularly bilateral effusion, is strongly correlated with measurable radiographic spinal instability and specific clinical symptoms in degenerative lumbar disease. These findings suggest that MRI-detected facet fluid may serve as a useful adjunctive imaging marker of dynamic instability, providing valuable insights for early detection and surgical planning.

Functional outcomes following volar locking plate fixation of AO/OTA 23-B3 volar Barton fractures: a prospective cohort study

Padala Sriram Reddy, A. Srinivasa Rao, P. Varun Kumar — Wed, 28 Oct 2026 00:00:00 +0530

Background: Volar Barton fractures are unstable intra-articular fractures of the distal radius characterized by disruption of the volar rim and radiocarpal instability. Anatomical reduction and stable fixation are important to restore joint congruity, permit rehabilitation, and reduce the risk of persistent instability and post-traumatic dysfunction. Volar locking plate fixation provides angular stability and subchondral support and is widely used for unstable distal radius fracture patterns.

Methods: A prospective cohort study was conducted at a tertiary care teaching hospital between April 2024 and October 2025. Thirty adult patients with closed AO/OTA 23-B3 volar Barton fractures underwent open reduction and internal fixation using a volar locking plate through the modified Henry approach. Patients were followed for 12 months. Functional outcome was assessed using the Modified Mayo Wrist Score (MMWS), which evaluates pain, functional status, range of motion, and grip strength. Clinical and radiological union, postoperative complications, and serial functional recovery were recorded at predefined follow-up intervals.

Results: Thirty patients completed the study. The mean age was 41.6±13.4 years and 23 patients (76.7%) were male. Radiological union was achieved in all patients without loss of reduction or implant failure. At 12 months, 20 patients (66.7%) had excellent MMWS outcomes, 7 (23.3%) had good outcomes, and 3 (10.0%) had fair outcomes; therefore, 90.0% achieved good-to-excellent functional results. Three patients (10.0%) developed superficial wound infection, all of which resolved with antibiotic therapy and local wound care.

Conclusions: Volar locking plate fixation was associated with reliable fracture union and progressive improvement in pain, wrist motion, grip strength, and patient satisfaction during the first postoperative year. The findings support volar locking plate fixation as an effective treatment option for unstable AO/OTA 23-B3 volar Barton fractures, while the absence of a comparison group limits conclusions regarding superiority over alternative treatments.

Functional outcomes following open reduction and internal fixation of closed bimalleolar ankle fractures: a prospective cohort study from a tertiary care centre in South India

Meesala Nagendra Sai, A. Srinivasa Rao, V. Bhanu Prakash — Wed, 28 Oct 2026 00:00:00 +0530

Background: Bimalleolar ankle fractures are unstable injuries that can cause persistent pain, restricted motion, gait disturbance, instability, and post-traumatic osteoarthritis if anatomical alignment is not restored. Open reduction and internal fixation (ORIF) is widely used for unstable ankle fractures, but prospective outcome data from Indian tertiary care centres remain limited. Objective was to evaluate functional outcomes after ORIF of closed bimalleolar ankle fractures using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score over 12 months.

Methods: A prospective observational cohort study was conducted between April 2024 and March 2026 at Siddhartha Medical College and Government General Hospital, Vijayawada, India. Thirty adult patients with closed bimalleolar ankle fractures underwent ORIF according to standard AO fixation principles. Functional outcomes were assessed at 6 weeks, 12 weeks, 6 months, 9 months, and 12 months using the AOFAS ankle-hindfoot score. Demographic characteristics, pain, walking ability, gait, ankle motion, stability, alignment, radiographic findings, and postoperative complications were assessed.

Results: All 30 patients completed the 12-month follow-up. The mean age was 45.4±8.98 years, 60% were male, and road traffic accidents accounted for 66.7% of injuries. Pain, walking ability, gait, ankle motion, and functional scores improved progressively. At one year, 24 patients (80%) had excellent AOFAS outcomes, four (13.3%) had good outcomes, and two (6.7%) had fair outcomes; no patient had a poor outcome. Overall, 93.3% achieved good-to-excellent functional results.

Conclusions: ORIF was associated with progressive functional recovery over 12 months in this cohort of closed bimalleolar ankle fractures. Anatomical reduction, stable fixation, and structured rehabilitation were associated with favourable restoration of pain, mobility, gait, stability, and overall ankle function.

Radiographic evaluation of Baumann angle in North Indian paediatric population: a cross-sectional study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Baumann angle is an essential radiographic parameter used for assessing coronal alignment of the distal humerus in pediatric elbow injuries. It plays a critical role in evaluating fracture reduction, particularly in supracondylar fractures. However, normative values vary across populations and require regional validation. To determine the normative values of Baumann angle in North Indian pediatric population and analyze its variation with age, sex and side.

Methods: A cross-sectional observational study was conducted in the Department of Orthopaedics at GSVM Medical College. A total of 289 children aged 3–13 years with normal elbow radiographs were included. Baumann angle was measured on standardized anteroposterior radiographs. Statistical analysis was performed using descriptive statistics and unpaired t-test.

Results: The mean Baumann angle was 70.42°±5.28°. Males had significantly higher values (72.26°±5.25°) compared to females (68.05°±4.29°) (p < 0.05). Age-wise analysis showed minimal variation, indicating stability across growth. Side-to-side differences were not clinically significant.

Conclusions: Baumann angle is a reliable and consistent parameter in pediatric elbow assessment with significant sex-based variation but minimal age dependency. Establishing population-specific reference values enhances diagnostic accuracy in pediatric elbow trauma.

Comparative effectiveness of advanced multimodal therapy versus conventional physiotherapy in early-stage knee osteoarthritis: a randomised controlled trial

Krina P. Ved, Anup A. Brahmbhatt, Shubham B. Menaria, Divya S. Narania — Wed, 28 Oct 2026 00:00:00 +0530

Background: Knee osteoarthritis (KOA) is one of leading causes of pain, disability, and reduced functional independence among middle-aged and older adults worldwide. Early-stage KOA presents an important opportunity for conservative intervention to alleviate symptoms, improve physical function, and potentially delay disease progression. To compare effectiveness of an advanced multimodal physiotherapy (APT) program with conventional physiotherapy (CPT) in reducing pain and improving functional outcomes in patients with early-stage KOA.

Methods: This study was conducted among 97 diagnosed with KL Grade I or II KOA. Participants were randomly allocated to APT (n=63) and CPT group (n=34). APT integrates Laser Therapy, PEMF, SIS, Magneto therapy, whereas in CPT comprising of NMES, US, and TENS, along with standard exercises as clinically indicated. NPRS and WOMAC for assessing pain intensity and functional disability before and after treatment.

Results: Data normality was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests, Wilcoxon Signed Rank tests were used for within-group comparisons, and Mann-Whitney U tests were performed for between-group analysis, with statistical significance established at p <0.001.

Conclusion: Both physiotherapy approaches effectively reduced pain and improved functional status in individuals with early-stage KOA. However, AMT shows significantly greater improvements in pain intensity, functional disability and overall clinical outcomes compared with CPT. These superior outcomes are likely attributable to positive integration effects of neuromuscular rehabilitation, progressive strengthening, proprioceptive training, functional movement retraining, and advanced electrophysical modalities that collectively address biomechanical, neuromuscular, and inflammatory components of KOA.

Functional outcomes of posteromedial plating in proximal tibial plateau fractures: a prospective clinical study

Wed, 28 Oct 2026 00:00:00 +0530

Background: Proximal tibial plateau fractures involving the posteromedial fragment represent a complex injury pattern associated with instability, late collapse, and poor functional outcomes if inadequately addressed. Conventional fixation strategies focusing only on the anterolateral column may fail to counteract posterior shear forces acting on the medial tibial plateau.

Methods: This prospective clinical study included 30 patients with proximal tibial plateau fractures involving the posteromedial fragment treated with posteromedial buttress plating, with or without additional lateral fixation, at a tertiary care center. Fractures were classified using the Schatzker system. Functional outcomes were assessed using the Rasmussen functional scoring system at final follow-up. Radiological outcomes and post-operative complications were also evaluated.

Results: The mean age of the 30 patients was 42.0±8.92 years, and 25 (83.33%) were male. Motor vehicle accidents were the most common mechanism of injury (13 (43.33%)). Schatzker type IV, V, and VI fractures were observed in 18 (60.00%), 9 (30.00%), and 3 (10.00%) patients, respectively. Single posteromedial plating was performed in 21 (70.00%) patients and double plating in 9 (30.00%). Rasmussen functional outcomes were excellent in 21 (70.00%), good in 6 (20.00%), and fair in 3 (10.00%) patients, with no poor outcomes. Knee stiffness occurred in 2 (6.67%) patients and wound dehiscence in 1 (3.33%); no hardware failure was reported.

Conclusion: Posteromedial plating provides biomechanically stable fixation for proximal tibial plateau fractures involving the posteromedial fragment, resulting in favourable functional outcomes and a low complication rate. Direct fixation of the posteromedial fragment should be considered an integral component in the management of complex proximal tibial plateau fractures.

A prospective comparative study of Henry versus Thompson approach in radius shaft fracture fixation: functional and surgical outcomes

Jayanth Bisaleri, Raghukumar Jogadh, Manoj Kumar Veerappa, L. Karthik — Wed, 28 Oct 2026 00:00:00 +0530

Background: Surgical fixation of radius shaft fractures typically employs either the Henry (volar) or Thompson (dorsal) approach. This study compares their functional outcomes, intraoperative parameters, and complications.

Methods: A prospective study of 60 patients undergoing open reduction and internal fixation (ORIF) for isolated radius shaft fractures from January 2025 to June 2026. Patients were divided into Henry (n=30) and Thompson (n=30) groups. Outcomes assessed included DASH scores, range of motion (ROM), grip strength, time to union, operative time, blood loss, and complications.

Results: The Henry group showed better early wrist flexion, forearm supination (p<0.05), and final DASH scores, indicating superior functional recovery. The Thompson group had longer operative times and higher rates of extensor tendon irritation. Union rates were similar across both groups.

Conclusions: The Henry approach offers improved functional outcomes and fewer complications, making it the preferred option for most radius shaft fractures.

Clinical and radiological outcomes of proximal humerus fracture fixation with PHILOS plate

Vidisha S. Kulkarni, Utkarsh K. Vishwakarma, Sunil G. Kulkarni — Wed, 28 Oct 2026 00:00:00 +0530

Background: Proximal humerus fractures account for approximately 5–6% of all adult fractures. Surgical management of displaced fractures remains challenging because of fracture complexity, poor bone quality, and the need for stable fixation. The proximal humerus internal locking system (PHILOS) plate provides angular stability and has become a widely accepted fixation method. This study evaluated the clinical and radiological outcomes of displaced proximal humerus fractures treated with PHILOS plate.

Methods: A retrospective study was conducted on 182 patients with displaced proximal humerus fractures fixed with PHILOS plate from January 2014 to December 2024. According to Neer's classification, 33 fractures were two-part, 84 were three-part, and 65 were four-part injuries. Functional outcomes were assessed using the Constant-Murley Score while radiological evaluation included fracture union, implant position, maintenance of reduction, and postoperative complications.

Results: Mean age of patients was 47.70±13.96 years with mean follow-up of 21.24±19.85 months. Radiological union was achieved in all patients, with a mean union time of 18.13±4.62 weeks. Mean Constant-Murley Score was 74.89±13.54 points. Functional outcomes were excellent in 48 patients, good in 89, fair in 25, and poor in 20 patients. Overall complication rate was 14.29%, with varus collapse being the most common complication, followed by infection, humeral head resorption, avascular necrosis, and post-traumatic arthritis.

Conclusion: PHILOS plating provided reliable fixation, fracture union, and satisfactory functional outcomes in displaced proximal humerus fractures. Restoration of medial support, accurate reduction, inferomedial calcar fixation, and structured rehabilitation are essential for optimizing outcomes and minimizing complications.

Does the severity of patellofemoral arthritis affect the functional outcomes after total knee arthroplasty without patellar resurfacing: a prospective study

Jude Martin, Mohamed Shakeeb K. U., Aswinlal K. S., Ashraf Ebrahim — Wed, 28 Oct 2026 00:00:00 +0530

Background: The role of patellofemoral (PF) arthritis severity in influencing functional outcomes after total knee arthroplasty (TKA) without patellar resurfacing remains controversial. This study aimed to evaluate the effect of PF arthritis severity on postoperative functional outcomes following primary TKA without patellar resurfacing.

Methods: A prospective observational study was conducted on 37 patients undergoing primary TKA without patellar resurfacing. Patients were stratified based on the severity of PF arthritis using the Iwano classification. Functional outcomes were assessed using the knee society score (KSS) and WOMAC score at 3, 6, and 12 months postoperatively. Statistical analysis was performed to compare outcomes across severity groups.

Results: There was a statistically significant improvement in mean KSS from 55.9 preoperatively to 87.6 at final follow-up (p<0.001). The mean WOMAC score improved from 88 preoperatively to 41 postoperatively (p<0.001). Improvement in range of motion was also significant. No statistically significant difference in functional outcomes was observed between different grades of PF arthritis.

Conclusion: Primary TKA without patellar resurfacing results in significant functional improvement irrespective of the severity of PF arthritis. The severity of PF arthritis does not significantly influence postoperative outcomes.

Functional and radiological outcomes of plate osteosynthesis for comminuted olecranon fractures: a prospective observational study of 30 patients

Jay Rathod, Prabhav Tijoriwala, Soham Gohil, Pratik Makwana — Wed, 28 Oct 2026 00:00:00 +0530

Background: Comminuted olecranon fractures disrupt the greater sigmoid notch and are subjected to the deforming pull of the triceps brachii. Tension band wiring does not reliably maintain length or articular alignment when the dorsal cortex is fragmented. This study was performed to determine the functional recovery and radiological union achieved when such fractures are stabilised with plate osteosynthesis, and to define the tempo at which that recovery occurs.

Methods: Thirty skeletally mature patients with comminuted olecranon fractures treated by open reduction and internal fixation with dorsal plating at a tertiary care teaching hospital were enrolled in a prospective observational study over 18 months. Gustilo-Anderson type 3C injuries were excluded. All underwent a standardised posterior approach with pre-contoured or reconstruction plating. Function was assessed with the mayo elbow performance score (MEPS) at 6 weeks, 3 months and 6 months; union was assessed on serial radiographs.

Results: Mean age was 40.93 (SD 13.06) years and 21 patients (70.0%) were male. Mayo type IIB was the commonest pattern (18, 60.0%). Union was achieved in 30 of 30 patients (100%) at a mean of 10.00 (SD 0.98) weeks. Mean MEPS rose from 54.00 (SD 5.2) at 6 weeks to 77.70 (SD 6.1) at 3 months and 96.20 (SD 8.9) at 6 months, when 24 patients (80.0%) scored a maximum 100.

Conclusions: Plate osteosynthesis produced universal union at approximately 10 weeks and excellent 6-month elbow function, with the steepest functional gain occurring between 6 weeks and 3 months.

Hospital-acquired COVID-19 and deep vein thrombosis in orthopaedic inpatients: a retrospective cohort study in a resource-constrained setting

Wed, 28 Oct 2026 00:00:00 +0530

Background: Hospital-acquired COVID-19 presents a distinct challenge in orthopaedic care within low- and middle-income country (LMIC) settings, where prolonged isolation, delayed mobilization and system constraints increase immobilization-related morbidity. Unlike high-income settings that emphasize respiratory outcomes, LMIC orthopaedic inpatients appear to face a disproportionate burden of thromboembolic complications, particularly deep vein thrombosis (DVT).

Methods: A retrospective cohort study was conducted at a South Indian teaching hospital between January 2020 and December 2025. Orthopaedic inpatients with RT-PCR–confirmed COVID-19 were categorized as having nosocomial or community-acquired infection based on timing of diagnosis. Demographic data, injury and treatment characteristics, immobilization duration, comorbidity burden, thromboprophylaxis use and vitamin D status were analysed. DVT was diagnosed using duplex ultrasonography and multivariable logistic regression identified independent predictors.

Results: Of 217 patients (median age 48 years; 68.2% male), 68 developed nosocomial COVID-19. Hospital-acquired infection was associated with significantly longer hospital stay and immobilization. Overall DVT incidence was 11.1%, with a higher prevalence in nosocomial compared with community-acquired cases (19.1% vs. 7.4%). Nosocomial infection, immobilization exceeding seven days and vitamin D deficiency independently predicted DVT. In-hospital mortality did not differ between groups.

Conclusion: Hospital-acquired COVID-19 significantly increases DVT risk among orthopaedic inpatients in LMIC settings, driven primarily by prolonged immobilization. Preventive strategies should prioritize early mobilization, optimized isolation workflows and correction of modifiable risk factors to reduce avoidable thromboembolic morbidity.

A prospective observational comparative study about foot pressure pattern of patients with knee osteoarthritis undergoing total knee arthroplasty

Archana Gadhia, Jignesh Kumar Gadhia, Samkit Jain, Tanmay Bhagwatkar — Wed, 28 Oct 2026 00:00:00 +0530

Background: Knee osteoarthritis (OA) alters lower limb alignment and gait biomechanics. This study used a pedobarographic mapping system to evaluate early changes in dynamic single-leg stance plantar pressure distribution in OA patients undergoing total knee arthroplasty (TKA) compared to healthy controls.

Methods: In this prospective study, 33 patients undergoing primary TKA and 33 healthy controls were evaluated. Clinical status (Knee Society score (KSS) and Visual Analogue Scale (VAS) score) were measured pre-operatively. Single-leg plantar pressure distribution across nine anatomical zones (M1–M9) were measured preoperatively (T0), immediate post operatively (T1) and postoperatively at 6 weeks (T2) and 3 months (T3).

Results: TKA significantly improved clinical outcomes; mean VAS decreased from 8.91 to 0.84 and mean KSS improved from 38.03 to 88.39 at 3 months. Preoperatively, OA patients exhibited abnormal loading concentrated over the great toe (M1) and lateral deficits, differing significantly from controls (p<0.05). Postoperatively, significant progressive pressure redistribution occurred at 6 weeks (M2, M4, M8) and 3 months (M2, M7, M8, M9). By 3 months, pressure patterns approached control baselines, with residual differences limited only to the M4 and M5 regions (p<0.05).

Conclusions: Coronal realignment through TKA drives rapid postoperative redistribution of plantar pressures toward normal physiological patterns, aligning with marked clinical recovery. However, persistent lateral forefoot deficits at 3 months suggest that complete biomechanical adaptation requires a longer recovery period.

A prospective randomized comparative study of interlocking intramedullary nailing and plate fixation in the surgical management of distal third tibial fractures

Abhishek Ojha, Devarsh Goyal, Vicky Kumar — Wed, 28 Oct 2026 00:00:00 +0530

Background: Extra-articular distal third tibial fractures remain challenging due to the region's anatomical characteristics and limited blood supply, with persistent controversy regarding the optimal fixation method between intramedullary nailing (IMN) and plate fixation.

Methods: This prospective randomized comparative study enrolled 60 patients (30 per group) with extra-articular distal third tibial fractures at SMS Medical College, Jaipur, from January to December 2024. Group A underwent plate fixation (ORIF/MIPO), while Group B received intramedullary interlocking nailing. Outcomes were assessed using the AOFAS ankle-hindfoot score, visual analogue scale (VAS) for pain, and radiological union at 6 weeks, 3 months, 6 months, and 9 months.

Results: Both groups were comparable in demographics and fracture characteristics. Mean operative time was significantly shorter in the nailing group (72.6±4.57 vs 93.2±4.94 minutes, p<0.001). Partial and full weight bearing were achieved significantly earlier in the nailing group (p=0.008 and p=0.003, respectively). AOFAS scores at 9 months were comparable between groups (93.1±2.12 vs 92.2±2.13, p=0.120). Complete radiological union was achieved in all patients by 9 months, and complications were minor and comparable between groups.

Conclusions: Both intramedullary nailing and plate fixation are effective for extra-articular distal third tibial fractures, with comparable functional outcomes. Intramedullary nailing, however, offers shorter operative time, earlier weight bearing, and fewer wound complications, making it preferable when early mobilization is desired.

Comparative efficacy of vancomycin and gentamicin soaked hamstring autografts in reducing infection rates following ACL reconstruction

Sachin C. Thagadur, Prathap U. S., Vijay Girish — Wed, 28 Oct 2026 00:00:00 +0530

Background: Deep knee infection after anterior cruciate ligament reconstruction (ACLR) is uncommon but carries a disproportionate clinical burden, often ending in graft loss and staged revision surgery. Because systemic antibiotics penetrate avascular tendon poorly, presoaking the harvested graft in a topical antibiotic solution has emerged as a practical adjunct to standard intravenous prophylaxis. Vancomycin has the largest published experience for this purpose, while gentamicin has been proposed as a comparably effective and more practical alternative. Objective was to directly compare vancomycin-soaked and gentamicin-soaked hamstring autografts for their effect on postoperative infection rate and functional recovery following arthroscopic ACLR.

Methods: Eighty patients undergoing primary ACLR over a six-month period were divided into two groups of 40: group 1 received autografts presoaked in vancomycin (500 mg/vial), and group 2 received autografts presoaked in gentamicin (40 mg/2 ml). Both groups received identical intravenous antibiotic prophylaxis, surgical technique, and rehabilitation. Functional recovery was assessed with the IKDC subjective knee score preoperatively and at three and six months.

Results: The cohort comprised 52 men and 28 women, with injuries distributed almost evenly between the right (36) and left (44) knee. Non-contact mechanisms accounted for the largest share of injuries (45), followed by road traffic accidents (20) and sport (15). One deep knee infection occurred in the entire cohort, in a patient from the gentamicin group (group 2), giving group-wise infection rates of 0% (group 1) and 2.5% (group 2). The combined IKDC score rose from a mean of 34±3.1 preoperatively to 54±2.6 at three months and 93.5±1.5 at six months.

Conclusions: Both vancomycin and gentamicin graft-presoaking were associated with a low overall infection rate and comparable functional recovery, supporting either agent as a reasonable, low-cost adjunct to intravenous prophylaxis during ACLR. Larger comparative trials are needed to establish whether either antibiotic carries a true advantage over the other.

Prevalence, pattern, and determinants of musculoskeletal pain among maintenance hemodialysis patients: a cross-sectional analytical study

Maulik Patel, Gaurang Patel — Wed, 28 Oct 2026 00:00:00 +0530

Background: Musculoskeletal pain is common but frequently under-recognized among patients receiving maintenance hemodialysis (MHD). It may impair mobility, sleep, daily activities, functional independence, and participation in dialysis treatment. This study evaluated the prevalence, clinical pattern, functional impact, and determinants of musculoskeletal pain among adults receiving MHD.

Methods: This cross-sectional analytical study included 1,000 consecutive adults receiving MHD who attended the nephrology outpatient department of a tertiary care center between May 2021 and April 2026. Musculoskeletal pain was assessed during a single outpatient visit using an 11-point numerical rating scale and was characterized according to anatomical site, severity, duration, laterality, and functional impact. Demographic, clinical, dialysis-related, nutritional, and chronic kidney disease-mineral and bone disorder variables were compared between participants with and without pain. Independent factors associated with musculoskeletal pain were identified using multivariable logistic regression.

Results: Musculoskeletal pain was reported by 620 participants, corresponding to a prevalence of 62.0%. Moderate pain was most common (54.5%), followed by severe pain (26.5%) and mild pain (19.0%). The knee (54.2%), lower back (46.5%), and shoulder (32.9%) were the most frequently affected sites. Functional limitation and pain-related sleep disturbance were reported by 53.9% and 46.1% of affected participants, respectively. In multivariable analysis, older age (p<0.001), female sex (p=0.041), diabetes mellitus (p=0.002), longer dialysis vintage (p<0.001), higher serum phosphate (p<0.001), higher alkaline phosphatase (p=0.001), higher intact parathyroid hormone (p<0.001), and vitamin D deficiency (p=0.001) were independently associated with greater odds of musculoskeletal pain. Higher hemoglobin (p=0.007) and serum albumin (p=0.003) were independently associated with lower odds of pain.

Conclusions: Musculoskeletal pain affected nearly two-thirds of this MHD population and was frequently accompanied by functional limitation and sleep disturbance. Its independent associations with nutritional status, anemia, dialysis duration, and mineral-bone abnormalities suggest that structured pain assessment and targeted evaluation of potentially modifiable contributors should be incorporated into routine outpatient care of patients receiving maintenance hemodialysis.

Comparative evaluation of radiological and functional outcomes in extra-articular distal radius fractures managed by closed reduction with cast versus percutaneous K-wire fixation

Mihir Anantbhai Tejura, Aas Rajendrakumar Kaneriya, Divyesh Jetpariya — Wed, 28 Oct 2026 00:00:00 +0530

Background: Distal radius fractures are among the most common fractures encountered in orthopaedic practice, accounting for approximately one-sixth of all skeletal fractures. Although closed reduction with casting remains the standard treatment for stable extra-articular fractures, maintenance of reduction remains a challenge in unstable fracture patterns. Percutaneous Kirschner wire (K-wire) fixation has been advocated as a minimally invasive technique to improve fracture stability and prevent secondary displacement. The present study was undertaken to compare the radiological and functional outcomes of closed reduction with cast immobilization and closed reduction with percutaneous K-wire fixation followed by cast immobilization in patients with extra-articular distal radius fractures.

Methods: A prospective randomized controlled study was conducted in the Department of Orthopaedics, GMERS Medical College and Civil Hospital, Morbi, from July 2025 to July 2026. One hundred adult patients with AO type 23-A2 and 23-A3 extra-articular distal radius fractures were randomly allocated into two equal groups. Group A underwent closed reduction and below-elbow cast application, whereas Group B underwent closed reduction with percutaneous K-wire fixation followed by below-elbow casting. Radiological parameters including radial height, radial inclination, volar tilt and ulnar variance, along with functional outcomes using the Gartland and Werley demerit scoring system, were assessed. Statistical analysis was performed using SPSS version 29, with p <0.05 considered statistically significant.

Results: Patients treated with percutaneous K-wire fixation demonstrated significantly better maintenance of radial height, radial inclination, volar tilt and ulnar variance than patients treated with casting alone (p<0.05). Functional outcomes at final follow-up were comparable between the two groups despite superior radiological restoration in the K-wire fixation group.

Conclusions: Closed reduction with percutaneous K-wire fixation provides superior maintenance of anatomical alignment compared with closed reduction and cast immobilization alone while achieving comparable short-term functional outcomes. The technique is simple, minimally invasive, economical and particularly useful in unstable extra-articular distal radius fractures.

Role of additional lateral wall buttressing in the management of unstable trochanteric fractures treated by internal fixation: a prospective observational study

Aniket Sett, Sandipan Goswami, Pritam Rahaman — Wed, 28 Oct 2026 00:00:00 +0530

Background: Unstable trochanteric fractures have a high risk of biomechanical failure, particularly when the lateral femoral wall is compromised. This study evaluated the clinical and radiological outcomes of cephalomedullary fixation augmented with an additional lateral buttress plate.

Methods: This prospective, single-centre observational study included 50 patients aged 25–80 years with unstable trochanteric fractures (AO/OTA 31A2.2, 31A2.3 and 31A3) treated between March 2022 and July 2024. Fractures were stabilised with a cephalomedullary nail supplemented by a lateral buttress plate selected according to availability. Patients were evaluated at 6 weeks, 3 months and 6 months. Functional outcomes were assessed using the Harris Hip Score (HHS), while radiological evaluation included union, alignment and implant-related complications.

Results: Mean age was 59.36±11.61 years, and falls accounted for 76% of injuries. Mean operative time was 107.7±14.4 minutes and blood loss was 228.6±14.3 ml. Mean HHS improved from 46.38±4.17 at 6 weeks to 82.58±6.81 at 6 months. At final follow-up, 90% achieved good-to-excellent outcomes. All fractures united, with a mean union time of 13.3 weeks. Superficial infection occurred in 4% and implant impingement in 6%. No varus malunion, Z-effect, screw cut-out, implant breakage or non-union occurred.

Conclusion: Lateral buttress plate augmentation with cephalomedullary fixation provided favourable functional and radiological outcomes with a low complication rate in unstable trochanteric fractures.

Microbial etiology and antibiogram profile of surgical site infections in orthopaedic open reduction and internal fixation surgeries from a tertiary care hospital

Bineeta Kashyap, Priyanka Gupta, Haarish Jayaraj, Aditya Aggarwal, Vinod Kumar — Wed, 28 Oct 2026 00:00:00 +0530

Background: Surgical site infections (SSIs) are the most common hospital-acquired infections, constituting around 20% of all healthcare-associated infections. In India, surveillance of SSI, particularly after discharge, is limited; therefore, the true burden and microbiological patterns of these infections may be underestimated. The objective was to describe the microbiological profile and antimicrobial susceptibility patterns in patients who developed SSI after open reduction and internal fixation (ORIF) for closed fractures.

Methods: A retrospective study was conducted, and data were collected from patients diagnosed with SSI following ORIF for closed fractures over a period of one year from January 2025 to December 2025. SSI surveillance forms were completed for all diagnosed SSI cases according to CDC/NHSN SSI criteria. Pus aspirate and tissue biopsy were collected for microbiological analysis, and antimicrobial susceptibility testing was performed.

Results: Of 1,290 patients reviewed, 21 developed SSI, yielding an SSI rate of 1.62%. The mean age was 39.6 years with marked male predominance. Comorbidities included diabetes mellitus and immunocompromised status (19% each), with 96% being emergency surgeries. The mean time to SSI detection was 18.2 days. Of 21 samples, 15 (71.4%) yielded bacterial isolates. Enterobacter species were most frequent (46.6%), followed by Klebsiella pneumoniae (20%) and MRSA (20%). Enterobacteriaceae showed high resistance to ciprofloxacin (100%), piperacillin-tazobactam (80%), and amikacin (77.8%). MRSA was resistant to erythromycin (100%) and clindamycin (66.7%). Most cases were managed with debridement, antibiotic and implant retention; implant removal was required in 9.5% of cases.

Conclusions: SSIs following ORIF for closed fractures occurred at a rate of 1.62%, with Gram-negative pathogens, particularly Enterobacter species, emerging as the predominant organisms. High resistance to ciprofloxacin, amikacin, and piperacillin-tazobactam underscores the need for local microbiological data for empirical therapy for established infections. Strengthening SSI surveillance, infection control practices, and antimicrobial stewardship is essential to reduce SSI burden in orthopaedic trauma patients.

Effectiveness of anterior guided growth in correction of knee flexion deformity in children with cerebral palsy: a prospective study

Joseph Jayan, Anantha Balaram B., Nithin Chandrashekaran, Jimshad Kakkattil — Wed, 28 Oct 2026 00:00:00 +0530

Background: Knee flexion deformity is a common and functionally disabling problem in children with cerebral palsy, leading to impaired gait, increased energy expenditure and progressive loss of mobility. Conventional surgical procedures provide correction but are associated with higher morbidity and risk of recurrence. Anterior guided growth (AGG) has emerged as a minimally invasive alternative that utilizes residual growth potential for gradual deformity correction. To evaluate the effectiveness of anterior guided growth in correcting fixed knee flexion deformity in children with cerebral palsy.

Methods: This prospective study included skeletally immature children with cerebral palsy presenting with fixed knee flexion contracture who underwent anterior distal femoral hemiepiphysiodesis. Clinical assessment included measurement of fixed knee flexion contracture (FKFC) and popliteal angle using a goniometer. Radiological evaluation assessed sagittal plane alignment. Measurements were recorded preoperatively and compared with postoperative values at a minimum follow-up of 12 months. Statistical analysis was performed using repeated measures ANOVA and Friedman test.

Results: There was a statistically significant reduction in fixed knee flexion contracture both clinically and radiologically over the follow-up period. The popliteal angle also showed significant improvement, indicating reduction in hamstring tightness. The correction was gradual and sustained, with an average correction rate consistent with growth modulation principles. Complications were minimal and no major implant-related failures were observed.

Conclusions: Anterior guided growth is an effective, safe and minimally invasive technique for the management of moderate knee flexion deformity in children with cerebral palsy. It allows gradual correction with low morbidity and represents a valuable growth-preserving surgical option in appropriately selected patients.

Economic burden of osteoporosis in India among treated populations (ECON-OP): a prevalence-based cost-of-illness analysis across key risk groups

Lakshmi Nagendra, Yogesh Sharma — Wed, 28 Oct 2026 00:00:00 +0530

Background: Osteoporosis is a major public health concern in India, leading to fractures, disability, and increased healthcare utilization. However, evidence on its economic burden in the Indian setting remains limited. This study estimated the economic burden of osteoporosis among treated patients in India and evaluated differences between primary and secondary prevention populations.

Methods: A prevalence-based cost-of-illness model was developed for postmenopausal women (PMO), men aged ≥50 years, and patients with glucocorticoid-induced osteoporosis (GIOP). The analysis included treated patients only and applied a weighted healthcare cost mix of 70% public and 30% private sector utilization. Costs were estimated from payer and societal perspectives and reported in Indian Rupees (INR).

Results: The total annual societal economic burden among treated patients was estimated at INR 22,773.6 crores, comprising INR 16,226.5 crores for PMO, INR 6,057.3 crores for male osteoporosis, and INR 489.7 crores for GIOP. Direct medical costs were the major contributor across all populations. Per-patient costs were substantially higher among fracture patients than non-fracture patients, reaching INR 2.15 versus 0.30 lakhs in PMO, INR 2.29 versus 0.35 lakhs in men, and INR 2.16 versus 0.34 lakhs in GIOP. Fracture-related costs were approximately seven-fold higher than costs in primary prevention populations. Scenario analyses suggested a markedly greater burden associated with untreated osteoporosis.

Conclusions: Osteoporosis imposes a substantial economic burden in India, driven primarily by fracture-related costs. Early diagnosis, sustained treatment, and effective fracture prevention strategies may substantially reduce healthcare expenditure and societal burden.

Factors affecting quality of life after total knee arthroplasty: a prospective observational study

Kouluru Dheeraj Reddy, Harish K., Pradeep H. — Wed, 28 Oct 2026 00:00:00 +0530

Background: Total knee arthroplasty (TKA) is a widely performed procedure for advanced knee osteoarthritis, and contemporary evaluation increasingly emphasizes patient-reported quality of life (QoL) rather than radiographic or implant-survival outcomes alone. This study aimed to assess the clinical, demographic, and psychological factors affecting QoL after TKA.

Methods: A prospective observational study was conducted in the Department of Orthopaedics, Adichunchanagiri Institute of Medical Sciences, from August 2024 to February 2026. One hundred and twenty patients aged over 60 years with Kellgren-Lawrence grade III/IV knee osteoarthritis undergoing primary TKA were enrolled by convenience sampling. Patients were evaluated at baseline and at 6 weeks, 3, 6, and 12 months postoperatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), Visual Analog Scale (VAS) for pain, and the 10-item Center for Epidemiologic Studies Depression Scale (CES-D10). Predictors of 12-month outcomes were identified using multiple linear regression and binary logistic regression; p<0.05 was considered significant.

Results: Sixty-five percent of patients were 60–70 years old and 55% were female. Mean total WOMAC score improved from 62.3±14.8 preoperatively to 10.1±3.9 at 12 months, mean KSS improved from 40.9±13.3 to 89.3±8.1, and mean VAS pain score fell from 8.7±0.9 to 1.6±0.6. The proportion of patients with depressive symptoms fell to 7% at 12 months. Baseline WOMAC, VAS, and CES-D10 scores independently predicted 12-month WOMAC score (R² = 0.464, p<0.001); age, female sex, baseline KSS, and baseline WOMAC predicted 12-month KSS (R²=0.375, p<0.001). Diabetes mellitus, baseline WOMAC, VAS, and CES-D10 scores significantly reduced the odds of achieving “good improvement” in QoL (model χ²=48.12, p<0.001).

Conclusions: TKA produces substantial and sustained improvement in pain, function, and psychological well-being over 12 months, with most gains occurring within the first 3–6 months. Greater baseline symptom burden and comorbid diabetes mellitus predict poorer QoL gains, supporting comprehensive preoperative assessment and optimization of modifiable risk factors before surgery.

Morphometric analysis of posterior cruciate ligament: an Indian cadaveric study

Yashavantha Kumar Chalavadi, Syed Abdul Mubdi, Vishal Patil, Rahul Panduranga — Wed, 28 Oct 2026 00:00:00 +0530

Background: Functionally, the posterior cruciate ligament (PCL) is divided into an anterolateral (AL) and a posteromedial (PM) bundle. Bundle-level morphometric data are needed to guide anatomically accurate PCL reconstruction.

Methods: The AL and PM bundles of the PCL were dissected and measured in 30 adult Indian cadaveric knees. Measurements of bundle length, midpoint width, and femoral and tibial attachment areas were recorded at knee flexion angles of 30°, 60°, and 90°.

Results: The AL bundle length increased from 34.5 mm at 30° flexion to 38.5 mm at 90° flexion, while its midpoint width decreased from 6.23 mm to 5.92 mm. In contrast, the PM bundle length decreased from 32.82 mm to 30.79 mm, whereas its midpoint width increased from 4.14 mm to 4.32 mm across the same range of flexion. Both bundles demonstrated larger femoral attachment areas compared to their corresponding tibial attachment areas. These findings indicate significant flexion-dependent changes in PCL bundle morphology.

Conclusions: Knee flexion produced significant, reciprocal changes in the dimensions of the two PCL bundles. These values provide population-specific anatomical reference data that may assist the planning of anatomical PCL reconstruction in Indian patients; their clinical relevance requires confirmation.

Prevalence of hyponatraemia in geriatric hip fracture patients in rural India: a one-year retrospective observational cohort study

Yogesh Dilip Narkhede, Sarika Nair, Jaiwardhan Bhosale — Wed, 28 Oct 2026 00:00:00 +0530

Background: Hip fractures are a major cause of morbidity, functional decline and healthcare burden in older adults. Hyponatraemia is common in hospitalized older patients and has been associated with falls, fractures and adverse perioperative outcomes. Evidence from rural Indian hip-fracture cohorts is limited. Differences in access to care, timing of presentation, comorbidity burden and continuity of follow-up may influence the burden of hyponatraemia and early outcomes in such settings. The aim is to determine the prevalence of admission hyponatraemia among patients aged ≥60 years with radiologically confirmed hip fractures treated at a rural tertiary care teaching hospital in Maharashtra, India, and to assess its association with postoperative complications, length of hospital stay and 30-day readmission.

Methods: This retrospective observational cohort study included 150 eligible patients aged 60 years or older with radiologically confirmed hip fractures and an admission serum sodium result during January-December 2024. Admission sodium was classified as normal (≥135 mmol/l) or hyponatraemic (<135 mmol/l); severity was described as mild (130-134 mmol/l), moderate (125-129 mmol/l) or severe (<125 mmol/l). Categorical variables were compared using Pearson chi-square or Fisher exact tests, and length of stay was compared using the Mann-Whitney U test. Effect estimates are unadjusted; 95% confidence intervals are reported where applicable.

Results: Admission hyponatraemia was present in 44/150 patients (29.3%; 95% CI 22.6%-37.1%) using the biochemical threshold of serum sodium <135 mmol/l. Among these 44 patients, 28 (63.6%) had mild, 12 (27.3%) moderate and 4 (9.1%) severe hyponatraemia. Postoperative complications were recorded in 16/44 (36.4%) patients with hyponatraemia and 20/106 (18.9%) with normal sodium (unadjusted RR 1.93, 95% CI 1.11-3.36; p=0.022). Median hospital stay was 9.0 versus 8.0 days (Mann-Whitney U=1522.5; p<0.001). Thirty-day readmission was recorded in 6/44 (13.6%) versus 11/106 (10.4%) (unadjusted RR 1.31, 95% CI 0.52-3.33; Fisher exact p=0.579). Diabetes mellitus was more frequent in the hyponatraemic group. Three records with sodium exactly 135 mmol/l were coded as mild in the source severity field; they were classified as normonatraemic for this analysis, consistent with the prespecified threshold <135 mmol/l.

Conclusions: Admission hyponatraemia was present in 29.3% of this single-centre rural/peri-urban Indian geriatric hip-fracture cohort when defined as serum sodium <135 mmol/l. In unadjusted analyses, it was associated with more recorded postoperative complications and longer hospital stay; 30-day readmission did not differ significantly. Because the study was retrospective and no multivariable adjustment was performed, these findings do not establish independent effects or causality. The results should be interpreted within the cohort eligibility criteria and data limitations.

Outcomes of supracondylar humerus fractures treated with Dorgan’s pinning and extension casting at 150°: a retrospective cohort study of 112 children with 5-year follow-up

Abhishek N. K. Saha, Anindya Dutt, Aindrila Biswas, Ravi Chauhan — Mon, 05 Oct 2026 00:00:00 +0530

Background: Objectives were to evaluate the long-term clinical and functional outcomes of the Dhavani Technique-a minimally invasive approach combining closed reduction, Dorgan’s lateral cross pinning, and 150° extension casting-in the management of paediatric supracondylar humerus fractures.

Methods: A 10-year multicenter retrospective cohort study conducted across three tertiary care centres. Between 2015 and 2024, 112 children with closed supracondylar humerus fractures (75 Gartland type II and 37 type III) were treated using closed reduction followed by Dorgan’s lateral cross-pinning without incision and post-operative immobilisation with casting at 150° elbow extension. All procedures were performed within four days of injury. Patients were followed for a mean duration of five years. Outcome measures included operative time, neurovascular complications, pin site infections, plaster-related issues, residual deformity, physiotherapy requirement, and final functional range of motion.

Results: No post-fixation neurovascular complications were observed. Operative time was notably shorter compared with traditional crossed pinning techniques. Superficial K-wire site infections occurred in seven cases (6.25%) and were managed conservatively. Plaster slippage occurred in nine cases; all successfully converted to full casting at two weeks without further issues. Cubitus varus developed in two patients (1.8%). Twenty-one children (18.75%) required physiotherapy for complete motion recovery. At final follow-up, all patients achieved full functional range of motion with no lasting functional limitations.

Conclusions: The Dhavani Technique is a safe, reliable, and minimally invasive option that reduces operative time, avoids incisions, and provides excellent long-term functional and cosmetic outcomes.

Factors associated with contralateral limb knee pain in unilateral lower limb amputees: a cross-sectional analysis of 531 patients

Shashi B. Sahu, K. Gouri Prasad, Rajiv Kaul, Vishwavijet Mopagar — Wed, 28 Oct 2026 00:00:00 +0530

Background: Lower limb amputation results in substantial biomechanical alterations during gait, frequently leading to asymmetrical loading of the contralateral limb. Chronic overloading of the sound extremity has been implicated in the development of secondary musculoskeletal complications, including knee pain and osteoarthritis. However, the factors associated with contralateral joint pain among amputees remain incompletely understood. The objective of the study was to estimate the prevalence of patient-reported contralateral knee pain among unilateral lower limb amputees and identify demographic and clinical factors associated with its presence.

Methods: A cross-sectional observational study was conducted using a clinical database of 531 adult unilateral lower limb amputees undergoing prosthetic rehabilitation from 2016 to 2021. Contralateral knee pain was recorded as a patient-reported binary outcome (yes/no) during clinical assessment. Demographic variables, amputation characteristics, time since amputation, time to first prosthetic fitting, body weight, and walking distance were analysed. Continuous variables were compared between pain and no-pain groups using independent-samples t-tests, and categorical variables using chi-square tests where applicable.

Results: Contralateral knee pain was reported by 64 of 531 participants, giving an overall prevalence of 12.1% (95% CI 9.6-15.1%). Participants with knee pain were older than those without pain (54.9 versus 48.9 years; p=0.009) and had a longer duration since amputation (20.1 versus 13.5 years; p=0.018). Body weight (p=0.48), daily walking distance (p=0.26), and time to prosthetic fitting (p=0.25) were not significantly different between groups.

Conclusions: Contralateral knee pain was present in approximately one in eight unilateral lower limb amputees in this cohort. Increasing age and longer duration since amputation were associated with the presence of contralateral knee pain. Because this cross-sectional study used a patient-reported binary pain outcome and did not include a validated knee functional score, the findings should be interpreted as associations rather than causal or independent predictive effects.

A DEXA scan at 20 years of age in select subjects may show a z-score "shift to the left" giving time after ethnic corrections to regain optimal peak BMD at 30 years

Wed, 28 Oct 2026 00:00:00 +0530

Background: Osteoporosis is a silent pandemic, and it's vital to detect osteopenia early. This study shows the importance of a DEXA baseline scan at 20 years of age as a part of a PREVENTIVE MEASURE to gain time to reach the optimum Peak BMD at around 30 years.

Methods: Among 5,000 patients tested in a mixed or ambispective study determining BMD between 2000-2026, by the IRT programme by NGO KRUSHI OWS.

The exclusion criteria were patients with known causes of bone weakness due to congenital diabetes, Thyroid deficiencies, renal dysfunction, familial history of bone weakness.

Results: Osteopenia was prevalent in 60% (n=3,000), Osteoporosis was found in 15% (n=750), and Normal Bone Density was found in 25% (n=1,250). The analysis showed that 75% of study patients had low bone density, highlighting the consequences of low bone mass for individuals, families, and insurance companies.

Conclusions: If the osteopenia stage, a precursor to osteoporosis, is missed or neglected, the opportunity to reach optimal peak BMD is lost forever, making this study an important call for attention from osteoporosis foundations worldwide.

Functional outcome of displaced (gartland type III) supracondylar humerus fractures in children treated by closed reduction and percutaneous kirschner wire fixation: a prospective observational study

Sai Vamshi B., Bhushan Chickle, Kiran Kumar A. S. — Wed, 28 Oct 2026 00:00:00 +0530

Background: Displaced (Gartland type III) supracondylar humerus fractures in children risk malunion and neurovascular complications. Closed reduction and percutaneous K-wire fixation is widely regarded as standard treatment, however Indian tertiary-centre data are limited. We evaluated the functional and cosmetic outcomes and complications of this procedure.

Methods: This prospective observational study was conducted at a tertiary care centre, BMCRC Ballari, India; from June 2023 to December 2024, 50 children aged 3–13 years with closed, completely displaced supracondylar fractures underwent closed reduction and percutaneous K-wire fixation under C-arm guidance (crossed pins, n=40; two lateral pins, n=10), then an above-elbow slab application for three weeks. Outcome was graded by Flynn’s criteria.

Results: Mean age was 8.0±2.5 years; 68% were boys and 64% had left-sided injuries. Median time to surgery was 1 day and mean hospital stay 2.6 days. Outcome was excellent in 36 (72%), good in 9 (18%) and fair in 5 (10%); none was poor (satisfactory 100%, 95% CI 92.9–100). Mean loss of motion was 5.4° and of carrying angle 1.9°. Five patients (10%) had complications such as ulnar nerve palsy in 2 (both after crossed pinning; full recovery by two months), K-wire migration in 2 and superficial pin-tract infection in 1. No cubitus varus was recorded.

Conclusions: Closed reduction and percutaneous K-wire fixation gave satisfactory outcomes in all 50 children with few, mostly minor complications. Ulnar nerve injury occurred only after crossed pinning, supporting lateral-entry pinning when adequate stability can be achieved without a medial pin.