International Journal of Research in Orthopaedics

The role of multidisciplinary care in managing sarcoma in low- and middle-income countries: a focus on treatment outcomes

Mon, 25 Aug 2025 00:00:00 +0530

Sarcomas are a heterogeneous group of rare malignancies requiring complex and individualized management strategies. In high-income settings, multidisciplinary care (MDC) has been shown to improve diagnostic accuracy, optimize treatment planning, and enhance patient outcomes. However, the role and implementation of MDC in managing sarcoma within low- and middle-income countries (LMICs) remain underexplored. This paper critically examines the impact of multidisciplinary care models on treatment outcomes for sarcoma patients in LMICs, highlighting current practices, barriers, and opportunities for improvement. Drawing on data from peer-reviewed literature, institutional reports, and global cancer care guidelines, we analyze how team-based approaches involving surgical oncologists, radiation oncologists, medical oncologists, radiologists, pathologists, and supportive care specialists influence early diagnosis, resection margins, recurrence rates, and survival outcomes. Findings indicate that while MDC improves adherence to evidence-based guidelines and fosters coordinated care, its effectiveness in LMICs is limited by workforce shortages, infrastructural deficits, and fragmented health systems. Nevertheless, innovative approaches such as virtual tumor boards, regional centers of excellence, and task-shifting models show promise in bridging gaps. Case studies from selected LMICs demonstrate that even in resource-constrained settings, structured multidisciplinary interventions can lead to earlier diagnosis, improved surgical planning, reduced treatment delays, and better quality of life (QoL). We conclude that scaling up MDC for sarcoma care in LMICs requires sustained investment in health system strengthening, interprofessional training, and policy support. Emphasizing locally adaptable MDC frameworks could significantly enhance sarcoma outcomes and contribute to closing the global cancer care gap.

Graft-specific rehabilitation guidelines for anterior cruciate ligament reconstruction

Abhishek Kumar Sandilya, Ankur Ojha, Pankaj Kumar Singh, Divya Kashyap — Mon, 25 Aug 2025 00:00:00 +0530

Anterior cruciate ligament (ACL) reconstruction is a frequently performed orthopaedic procedure, with rehabilitation playing a pivotal role in patient recovery. The selection of graft type in ACL reconstruction influences biomechanical properties, healing rates and post-surgical complications, necessitating a graft-specific rehabilitation approach. This article presents a comprehensive, phase-based rehabilitation protocol tailored to various ACL grafts, including bone-patellar tendon-bone (BPTB), hamstring tendon, quadriceps tendon, peroneus longus tendon, achilles tendon, allograft and synthetic graft. By integrating evidence-based exercise recommendations, this guideline aims to optimize patient outcomes, minimize complications and facilitate a safe return to functional activities and athletic participation.

Posterolateral corner of the knee “the mysterious corner”: a review of anatomy, biomechanics and current treatment paradigms

Amit K. Srivastava, Rahul Prabhakar, Neha Gupta, Ayushi Maheshwari — Mon, 25 Aug 2025 00:00:00 +0530

The posterolateral corner (PLC) of the knee remains one of the most complex and often underdiagnosed stabilizing units of the knee joint. Injuries to the PLC are frequently overlooked, contributing to chronic instability, early onset osteoarthritis and increased likelihood of total knee arthroplasty. Recent anatomical and biomechanical studies have highlighted the critical role of the PLC in maintaining knee stability, particularly in resisting varus stress, external tibial rotation and posterior translation. This review aims to consolidate current knowledge on the anatomy and biomechanics of the PLC, epidemiological trends and evolving management strategies, including anatomical reconstruction techniques and arthroscopic advancements. It emphasizes the necessity for heightened clinical suspicion, accurate diagnosis and appropriate treatment to prevent long-term disability.

Letter to the editor: integrative approach to knee osteoarthritis management

Abhimanyu — Mon, 25 Aug 2025 00:00:00 +0530

The study provides compelling evidence supporting the synergistic benefit of combining physiotherapy with pharmacologic therapy for managing knee osteoarthritis (OA). The authors have appropriately highlighted that monotherapies-whether pharmacologic or rehabilitative-may offer limited benefit in comparison to a structured dual-modality approach.

Understanding split cord malformation: from pathophysiology to long-term outcomes

Fri, 08 Aug 2025 00:00:00 +0530

Split cord malformation (SCM) is a rare congenital anomaly of the spinal cord, frequently associated with tethered cord syndrome and orthopedic, urological, and neurological sequelae. Surgical management of SCM remains controversial, particularly regarding timing of intervention, selection criteria for asymptomatic cases, and expected outcomes for different SCM types. This systematic review aims to synthesize current evidence regarding surgical indications, techniques, outcomes, and prognostic factors in SCM treatment. We conducted a comprehensive systematic review of the literature, selecting 30 studies comprising over 1,200 patients who underwent surgery for SCM. Outcomes assessed included neurological, urological, and orthopedic status, complication rates, timing of surgery, and comparative outcomes between type I and type II SCM. Study quality was assessed using the Newcastle-Ottawa scale. Early surgical intervention, especially in type I SCM, was consistently associated with superior outcomes. Preoperative neurological status emerged as the strongest predictor of postoperative results, with early surgery preventing progression and facilitating functional improvement. Urological and orthopedic outcomes similarly benefited from timely intervention. Type II SCM demonstrated a more benign course, with selective surgical indications. Overall complication rates were low, with transient neurological worsening being the most common adverse event. Intraoperative neurophysiological monitoring contributed to enhanced surgical safety. Early surgical correction remains the cornerstone of SCM management, particularly in type I cases. Delayed intervention is associated with reduced potential for neurological recovery. Further prospective studies are needed to refine patient selection criteria, optimize long-term outcomes, and guide management of adult and type II SCM presentations.

Improving surgical outcomes through non-technical skills: the case for better training and national evaluation

Mon, 25 Aug 2025 00:00:00 +0530

Effective communication and teamwork are as crucial as technical proficiency for achieving positive surgical outcomes. Non-technical skills (NTS)-including communication, leadership, decision-making, and situational awareness—enhance surgical performance by fostering awareness and capability among both trainees and experienced surgeons. Despite growing recognition of its importance, NTS training is not uniformly implemented in surgical education, leaving a significant gap. This study examines opportunities to expand NTS training within surgical practice. A survey at a local hospital assessed the availability of NTS training and perceived needs among 38 surgical trainees and professionals. The majority acknowledged the value of NTS in improving clinical performance but reported limited focus on human factors in daily practice. Complementing the survey, a literature review was conducted across Medline, EMBASE, and PsycINFO databases, identifying 414 relevant articles, 114 of which focused on clinical or educational contexts. Of these, 61 studies emphasized psychomotor skill assessment via direct observation, patient outcomes, and peer feedback, underscoring the critical role of effective evaluation methods. Findings indicate that while NTS training is appreciated, its effectiveness depends heavily on feedback quality and team dynamics, particularly in addressing challenging behaviors. The study highlights the need for enhanced training design and robust feedback mechanisms. Although current evidence linking NTS training to improved patient outcomes is largely anecdotal, there is strong professional support for broader implementation. The authors advocate for a systematic, nationwide evaluation to determine the true impact of NTS training on surgical performance and outcomes.

Unmasking the curve: is growth hormone therapy a silent contributor to pediatric scoliosis: a systematic review

Mon, 25 Aug 2025 00:00:00 +0530

Growth hormone (GH) therapy is used to promote growth in pediatric short stature conditions, including idiopathic short stature (ISS), growth hormone deficiency (GHD), and Turner syndrome. Concerns have arisen regarding potential associations between GH treatment and the development or progression of scoliosis, particularly when used off-label in ISS. A systematic review following PRISMA guidelines was conducted and registered in PROSPERO (CRD420251069349). Searches were performed across PubMed, Scopus, Embase, and Web of Science through July 2025. Studies evaluating scoliosis onset or progression during GH therapy in children were included. Data extracted encompassed GH dosage, treatment duration, patient demographics, scoliosis incidence, Cobb angle progression, and orthopedic outcomes. Quality assessments were performed using the Newcastle‑Ottawa Scale, Cochrane Risk of Bias, and AMSTAR‑2 tools. Studies involving over 3,000 children were analyzed. Scoliosis incidence ranged from 3% to 22%, with higher risk among boys, those experiencing rapid growth velocity, and syndromic conditions like Turner and Prader–Willi. Ziv‑Baran et al reported a hazard ratio of 2.12 (95% CI: 1.75–2.57; p<0.001) for scoliosis in GH-treated versus controls. Evidence from clinical and animal studies suggests that GH stimulates asymmetric vertebral growth via the GH/IGF‑1 axis. Although most scoliotic curves were mild and non-surgical, regular orthopedic surveillance was recommended. GH therapy in children, particularly for off-label ISS use, may increase risk for scoliosis onset or progression in at-risk subgroups. While overall orthopedic risk is low, early identification of predisposed patients and periodic radiographic monitoring-especially during rapid growth phases-is essential to ensure safe and individualized GH treatment.

Deep infection rate in primary total knee arthroplasty: a case series from Oman

Mon, 25 Aug 2025 00:00:00 +0530

The aim of this report is to assess deep infection rate in total knee arthroplasty (TKA), in a clean theatre, but without using laminar flow. This report is a retrospective case series of TKA conducted in the same hospital and same single operating room, by a single surgeon, to assess the percentage of post operative deep infection, that needed surgical intervention between June 2016 and December 2023. Infection rate was compared to the rate reported in the literature. A total of 430 knee replacements were reviewed, with data obtained from the electronic medical record system. All of these cases were performed under strict vigilance to prevent infection, all were given pre operative prophylactic antibiotics, and all had a surgical drain that was removed at the first post operative day. Prosthetic joint infections (PJI) was defined as a TKA that needed further surgical intervention for a clinical picture and investigations suggestive of deep infection. In this report, four patients out of a total of 430 patients (0.93%), who underwent primary TKA had developed PJIs as defined. Patient’s age ranged from 57 to 71 years (mean 66 years), with three females and one male patient. Two patients underwent staged revision TKA after confirmation of PJI, while other two patients underwent debridement, change of insert, and implant retention. This report has concluded a rate of deep infection that is comparable to the reported rate in the literature, despite that no laminar flow was used in this case series. Using a surgical drain did not seem to increase the infection rate. Two of the infected cases were from bacteria that cannot be surgically acquired, making the surgically acquired rate of infection even lower (0.47%).

Analysis of misdiagnosis and malpractice in orthopaedic traumatology: retrospective observational study of 13 cases in a teaching university hospital

Joseph D. Diouf, Souleymane Diao, Pape M. Fall, Amadou N. Kasse, Jean C. Sane — Mon, 25 Aug 2025 00:00:00 +0530

Orthopedics surgery has been a topic in medical malpractice for more than 130 years. The main type errors are diagnostic, treatment, communication, evaluation, environmental or system-related problems. These medical errors arouse more and more interest among our populations and degrade the doctor-patient relationship to the point of seeing more and more legal overtones. This case series presents thirteen patients with major clinical consequence resulting from a misdiagnosis or malpractice. The average age of the patients was 43.5 years. 92% of medical errors were linked to an initial admission to the emergency department. Traumatic injuries were most frequent (84,61%), including 10 cases of fractures and 1 case of dislocation. Cases of misdiagnosis were less frequent than malpractice but had serious consequences, with 1 death and 3 major amputations. Unrecognized vascular injuries remained the most common cause. The causes of malpractice are numerous. The most common main mistakes had occurred outside of operating rooms (89%) and were due to orthopaedic treatment in 67% of cases. We noted 3 cases of death related with general complications (thrombo-embolism, traumatic choc). This case series demonstrates that medical errors can be dramatic for the patients and family. Graduate medical education reform should focus on strengthening these aspects of training which can be an important factor for decreasing this phenomenon.

Short term outcomes following biplane double supported screw fixation of femoral neck fractures in adults: a prospective observational study

Fri, 08 Aug 2025 00:00:00 +0530

Femoral neck fractures are common among the elderly population. Non-union is a common complication of these fractures, despite various fixation options. Nonunion results in considerable morbidity and impaired function. Biplane double-supported screw fixation (BDSF) is a newer technique for femoral neck fractures, demonstrating superior fixation strength in biomechanical studies. We conducted this prospective observational study to evaluate the fixation strength of BDSF in adult femoral neck fractures, focusing on fracture union, loss of reduction over one year, and functional outcomes at the end of one year. Loss of fracture reduction was assessed using radiological parameters, while functional outcomes were measured with the modified Harris hip score (MHHS) and Parker mobility score (PMS). We recruited 19 patients aged 18-65 years who were treated using the BDSF technique and followed them for a year. The radiological and functional parameters were measured at regular intervals. Only 17 patients reported for final follow-up at one year. The mean neck shaft angle reduced by 6.35 degrees and the mean neck length decreased by 1.02 cm over 12 months. Two patients had expired during the follow up period and 17 patients were available for the final follow up at 1 year. Fracture union was achieved in 16 patients. No patient had fixation failure. Both the MHHS and PMS showed significant improvement at 1 year and 6 months respectively. BDSF provides strong fixation and good union rates. Although there was a reduction in neck-shaft angle and neck length, our study showed excellent functional outcomes.

A study of factors which influence the outcome in fracture dislocations of proximal humerus treated by open reduction and internal fixation with philos plate

Purushotham Lal R., Ihjas Ismail — Mon, 25 Aug 2025 00:00:00 +0530

Management of proximal humerus fracture dislocation is challenging owing to the possibility of multiple complications including avascular necrosis. Literature remains controversial regarding the mode of management Osteosynthesis vs arthroplasty and the pros and cons of one over the other, particularly in elderly age groups. This is a case series include 20 patients admitted with proximal humerus fracture dislocation and were treated with open reduction internal fixation with proximal humerus internal locking osteosynthesis systems (PHILOS) plate. Post operatively, serial X-rays were taken at post-operative day 1, 1 month, 6 months and at 1 year to assess the union. Clinically patients were assessed with constant Murley score at the end of 1 year. The mean constant-Murley score at the end of 1 year was found to be 70.8 with 86 being the highest and 42 being the least and it has a strong negative correlation with increasing age. 5% of the patients developed avascular necrosis and remaining 95% united well. The result also shows that the chances of occurrence of AVN humeral head is proportional to the duration of surgery since injury. We conclude that osteosynthesis for proximal humerus fracture dislocation gives good outcome including the elderly patients. Early fixation, anatomic reduction, meticulous placement of implant and minimal soft tissue stripping and adherence to appropriate and regular rehabilitation program can give better functional outcome irrespective of the age of the patient. The learning curve with the implant chosen and surgeon’s skill play a major role in the final outcome.

Clinical reflections on single event multilevel surgery in children with cerebral palsy: a case series of 10 patients

E Venkateshulu, Sundaresh Krishnagiri, Kantesh L. Yallapur, B. N. Pavan Kumar — Mon, 25 Aug 2025 00:00:00 +0530

Single event multilevel surgery (SEMLS) is a comprehensive orthopedic surgical approach designed to correct multiple musculoskeletal deformities in a single operative session in patients with cerebral palsy (CP). This journal reflects on the principles, benefits, limitations, and a clinical case outcome of SEMLS, with emphasis on functional improvement and rehabilitation challenges. SEMLS remains a gold standard surgical approach in moderate to severe spastic CP cases with multilevel involvement. Long-term success hinges on meticulous planning, postoperative care, and patient compliance with rehabilitation protocols.

Functional outcome of varus derotation osteotomy in late presenting Perthes disease: a case series

K. G. Nama, Aakash Bansal, Nihit Mantri, R. P. Meena, Sachin Joshi — Mon, 25 Aug 2025 00:00:00 +0530

Late-onset Perthes disease, particularly in children older than nine years, is known to have a more aggressive course and a less favorable prognosis, often progressing to osteoarthritis by the fourth decade of life if left untreated. While younger children are usually managed conservatively, and those aged 6-9 years may benefit from surgical intervention, the optimal treatment strategy for children aged 8 years and above remains controversial. This case series evaluates the clinical and radiological outcomes of varus derotation osteotomy (VDRO) in 12 children (10 males, 2 females) with a mean age of 9.4 years, treated at the Department of Orthopaedics, Government Medical College, Kota, between 2020 and 2025. All patients were classified as stage IB, IIA, or IIB based on the modified Elizabethtown classification and presented with restricted hip abduction and internal rotation. Hip pain was reported in 58.33% of cases, and 75% had a limp. VDRO was performed approximately three weeks after diagnosis. Five patients (41.67%) were older than 10 years at presentation. Outcomes were assessed at an average follow-up of 3.4 years. Radiological evaluation included the caput index (CI), epiphyseal quotient (EQ), and articulotrochanteric distance, while clinical assessment used range of motion and the Harris Hip Score. Significant improvements were observed in CI (p=0.000) and EQ (mean postoperative value 0.606; p=0.0000). Favorable results were seen in all patients with stage IB and IIA disease, and in 50% of those with stage IIB. VDRO appears to be an effective option for late-presenting Perthes disease in this age group.

A second chance: analyzing trends and outcomes for reapplicants in orthopaedic surgery

Edward L. Major, Vivek P. Shah, James R. Goetz, Sameer Badarudeen — Mon, 25 Aug 2025 00:00:00 +0530

Background: The increasing number of applicants for orthopaedic surgery residency programs, paired with a static number of available positions, has resulted in many candidates being unmatched. This study explored trends and factors associated with successful reapplication outcomes for unmatched orthopaedic surgery applicants.

Methods: This mixed-methods study was conducted between June 2024 and January 2025. Inclusion criteria for qualitative data were unmatched orthopaedic surgery applicants who subsequently matched and participated in interviews. Exclusion criteria included those who did not reapply or did not complete the interview process. Data were obtained from the Orthopaedic Residency Information Network (ORIN) and included demographics of current residents, attending faculty, and residency program characteristics. Gender of program leaders was verified through LinkedIn and program websites. Spearman correlation and ANOVA were used for analysis, with significant variables further examined through multiple regression. Qualitative insights were collected through interviews with previously unmatched applicants who matched on subsequent attempts.

Results: Analysis revealed no statistically significant associations between traditional metrics (e.g., USMLE scores, demographics) and matching outcomes (p>0.05). Qualitative data highlighted that engagement in research and clinical experiences, as well as meaningful mentorship, significantly impacted reapplication success.

Conclusions: Despite the lack of significant predictors from traditional metrics, proactive measures taken during the year off were crucial for unmatched applicants. Candidates should focus on strategic activities to enhance their competitiveness in future applications.

The reduction in the incidence of iatrogenic meralgia paresthetica after hip arthroscopy by preoperative mapping of the nerve

Ahmed Fouad Abotaleb — Sat, 02 Aug 2025 00:00:00 +0530

Background: The gold standard for treating femoroacetabular impingement (FAI) is hip arthroscopy. The proximity of neurovascular structures makes them susceptible to injury. Among these, damage to the thigh's lateral cutaneous nerve is frequently sustained during the anterior portal hip arthroscopy procedure. The study's main goal was to determine whether ultrasound mapping of the thigh's lateral cutaneous nerve reduced the risk of injury during anterior portal hip arthroscopy. The secondary goal was to determine how traction time and subsequent traction-related complications-of which pudendal nerve injury is the most concerning-were affected by medially positioning the anterior portal to allow direct access to the anterior part of the labrum.

Methods: The study included 51 patients who underwent hip arthroscopy for femoral osteoplasty and/or acetabuloplasty, as well as anterior labral repair, between August 2022 to November 2024.

Results: The average traction time was 57.1 minutes, with a range of 40 to 85 minutes and an SD of 10.4 minutes. Three patients (5.9%) experienced partial palsy of the lateral cutaneous nerve of the thigh. Following surgery, one patient (2%) experienced complete pudendal nerve palsy, and 8 patients (15.7%) experienced partial palsy.

Conclusions: The present study discusses the safety and potential advantages of mapping the lateral cutaneous nerve of the thigh using ultrasound. It also suggests that this method may help to shorten the duration of traction and minimize complications associated with it.

Evaluating functional recovery following proximal femoral nail fixation in proximal femoral fractures: a study from a developing nation

Raj Kumar, Gur-Aziz S. Sindhu, Manavdeep Singh, Saphalya Pattnaik — Mon, 25 Aug 2025 00:00:00 +0530

Background: Intramedullary fixation systems have become increasingly favoured over conventional dynamic hip screws in the treatment of proximal femoral fractures. This shift is attributed to several key benefits, including reduced soft tissue trauma, shorter operative times, and enhanced biomechanical properties.

Methods: A prospective randomised study was carried out at Dayanand Medical College and Hospital Ludhiana, India between January 2016 and January 2017, with proximal femoral fractures. Exclusion criteria included paediatric cases, pathological or neglected fractures, periprosthetic fractures, and femoral neck fractures. The primary aim was to evaluate fracture union and functional recovery, while secondary outcomes focused on identifying any postoperative complications.

Results: Among the 35 participants (19 males and 16 females), the average age was 59.8 years. Subtrochanteric fractures were more prevalent in older individuals, with a higher incidence on the left side. Domestic falls accounted for 52% of the injuries, while 48% resulted from road traffic accidents. The surgical procedure involved an average blood loss of 197 ml and lasted approximately 142 minutes. Fracture union was achieved in 95.23% of the cases, while implant failure was observed in 9.52%. Functional assessments showed that 68% of patients had excellent to good recovery outcomes, with minimal complications reported postoperatively.

Conclusions: Proximal femoral nail (PFN) provides secure fixation with high union rate and positive functional outcomes reinforcing its preference over traditional extramedullary fixation methods. Further comparative analyses are required with larger sample sizes to refine the choice of fixation for different fracture types.

Surgical versus conservative management in lumbar disc herniation with neurological deficit

Mon, 25 Aug 2025 00:00:00 +0530

Background: Lumbar disc herniation (LDH) with neurological deficit is a universal problem. Decision making between conservative or surgical treatment for LDH with neurological deficit remains still controversial. The objective of this study was to assess neurological outcomes for LDH with neurological deficit treated with surgical or conservative treatment.

Methods: Total 40 patients, 20 (50%) treated surgically and 20 (50%) conservatively, 18 to 55 years with neurological deficit due to LDH, irrespective of sex, established clinical symptoms, signs and radiologically evidenced (X-ray L/S spine and magnetic resonance imaging (MRI) of lumbar spine) were included and prospectively studied in Bangladesh medical University from August 2024 to June 2025. Outcomes were measured by visual analog scale (VAS) for back and leg pain and disability by Oswestry disability index (ODI) and satisfaction by modified Macnab criteria.

Results: 21 (52.5%) male and 19 (47.5%) female, 65% patients had right sided neurological deficit. At final follow up, VAS score for back and leg pain were significantly decline in both operative and conservative management and were 0.85±0.66, 1.00±0.63 and 1.85±.55, 1.65±0.67 respectively. Initially the ODI score for operative and conservatively treated patients were 62±4.92 and 61.6±2.86 and 6 months after these were 14.5±6.30 and 20±4.80 (p=0.0036). At final follow up, 90% of patients were satisfied with surgical treatment versus 55% treated conservatively (p=0.035).

Conclusions: Management of LDH with neurological deficit shows better outcome by surgically than conservatively treated patients at final follow up.

Resident involvement in upper extremity fracture fixation impacts surgical time and hospital stay

Paul J. Pottanat, Colin Zieminski, J. Ryan Allen, Charles Daly — Mon, 25 Aug 2025 00:00:00 +0530

Background: The purpose of this study was to evaluate the impact of resident post graduate year (PGY) on surgical outcomes and operative time for upper extremity fracture fixation ad associated complications.

Methods: Using the American college of surgeons’ national surgical quality improvement program (NSQIP) database, we conducted a query for all upper extremity fracture cases using current procedural terminology (CPT) codes outlined by the ACGME requirements for orthopaedic resident education. A total of 2,853 patients met inclusion criteria based on our initial query. Surgical complications and operative times were analyzed based on resident participation and PGY level. Linear regression models were used to assess the impact of resident training level on case duration and patient time in the OR.

Results: Average total operative duration was significantly longer in cases with residents compared to cases without (average operative duration was 86.57 without a resident compared to 116.21 with resident(s), p<0.001). As PGY year increased, operative case duration also increased. Calculations of change in operative duration per PGY year. Proximal humerus fractures 9.975-minute increase per year (p=0.042); Humeral Shaft Fractures 9.933-minute increase per year (p=0.023); elbow 7.558-minute increase (p=0.011); distal radius 2.969-minute increase per year (p=0.038). Resident involvement was also associated with an increased risk for intraoperative transfusions (p=0.019) but not with any other surgical complications.

Conclusions: For upper extremity fractures, there was a predictable increase in total operative time as PGY year increased. Resident involvement led to increased operative duration and patient time in the operating room.

Prevalence and treatment outcomes of incidental dural tears in lumbar spine surgery

M. Mofizur Rahman, Mohammad Abdul Hannan, M. Sarwar Jahan, Moniruzzaman Monir — Mon, 25 Aug 2025 00:00:00 +0530

Background: Incidental dural tears (IDT) are common in lumbar spine surgery, varying in prevalence due to patient factors, pathology, and surgical techniques. They may cause cerebrospinal fluid leakage, headaches, and delayed recovery. Proper identification and management are essential for favorable outcomes. This study aimed to evaluate the prevalence and treatment outcomes of incidental dural tears.

Methods: This study was conducted at the Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) and Sylhet M.A.G. Osmani Medical College, Sylhet, Bangladesh from January 2023 to December 2024, using purposive sampling. A total of 86 patients undergoing lumbar spine surgery were included, excluding those with infections or malignancies. Incidental dural tears and treatment outcomes were analyzed using SPSS Version 23, with significance set at p<0.05.

Results: The prevalence of IDT in lumbar spine surgery was 15.1%. The IDT group consisted of 84.6% males, 23.1% patients aged ≤30 years, and 53.8% with previous spinal surgery. The IDT group had longer operation times (197.4±37.7 minutes), longer hospital stays (10.5±2.1 days), and higher drainage volumes (266.7±28.9 ml). Post-operative complications, including wound infections (23.1%) and headaches (30.8%), were more common in the IDT group.

Conclusions: IDT occur in 15.1% of lumbar spine surgeries. Risk factors include male gender, younger age, and previous spinal surgery. IDT is linked to longer operation times, extended hospital stays, higher drainage volumes, and increased post-operative complications.

Outcome of minimally invasive transforaminal lumbar interbody fusion for the treatment of low grade (grade I and II) spondylolisthesis in obese patients

Mon, 25 Aug 2025 00:00:00 +0530

Background: Spondylolisthesis in obese patient is one of the causes of back pain, severe morbidity, and impairment. This study examines low-grade spondylolisthesis patients' pain relief, functional improvement, fusion rates, and complications after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Methods: This study was conducted in the Department of Orthopedic Surgery at BSMMU, Dhaka, from July 2023 to June 2024. 30 low-grade spondylolisthesis patients were included according to selection criteria. Functional outcomes were assessed by Visual Analogue Scale score, Oswestry disability index, Modified Macnab’s Criteria. Interbody fusion was evaluated by Bridwell interbody fusion grading system and also perioperative events were noted. Mean, standard deviation, Frequency and percentage were used to test qualitative data with chi-square. SPSS 26 data analyses will consider p-values <0.05 significant.

Results: 23.33% patients were day laborer and housewives. Most commonly involved level was L5/S1 (60%), followed by L4/L5_,(40 peri-operative complications were seen in 4 (13.33%) patients where in 2 (6.67%) patients had seroma, 1(3.33%) patient had discitis and 1(3.33%) patient had foot drop. One patient had discitis and 1 patient had foot drop. VAS score and Oswestry Disability Index Score had showed significant improvement in post-operative follow up (at 6 months) compared to pre-operative status (p<0.05). Overall, excellent improvement was seen in 40% of cases according to modified Macnab’s criteria on 6 months of post-operative follow up.

Conclusions: MIS TLIF is a safe, efficient, and cost-effective technique when performed accurately. The reduced surgical invasiveness, shortened hospital stay, and rapid return to employment represent substantial advantages of MIS TLIF.

Results of fixation of medial malleolus fractures with closed versus open reduction

Mohammad Khaled Ali, Mohamed Maher Al Araj — Mon, 25 Aug 2025 00:00:00 +0530

Background: Medial malleolus fractures are common ankle injuries with varied treatment approaches, most notably closed and open reduction techniques. Each method presents distinct outcomes and complication profiles. The study aimed to investigate and compare the clinical and radiological outcomes of both techniques in a local context and in comparison, with international literature.

Methods: A prospective-retrospective study was conducted at Aleppo University Hospital, orthopedic surgery Branch, between January 2020 and January 2025. A total of 67 patients with medial malleolar fractures were included. Patients underwent closed or open reduction based on clinical judgment. Data were collected via clinical examination, medical history, radiological, and laboratory investigations. Outcomes and complications were statistically analyzed.

Results: The non-union rate was higher in the open reduction group (7.7%) than in the closed group (2.4%), but this was not statistically significant. However, the mean union time was significantly longer in the closed reduction group (14.6 weeks vs. 11.5 weeks, p=0.041). Complications such as infection, nerve injury, malunion, and joint stiffness were more frequent in the open reduction group. Secondary displacement and Sudeck’s atrophy were more frequent in the closed group, although none of these differences were statistically significant.

Conclusions: While both open and closed reduction techniques are effective in managing medial malleolus fractures, open reduction is associated with a higher rate of complications despite shorter union time. Closed reduction may be preferable in selected patients due to its favorable complication profile. These findings align with international data, although variations exist depending on study settings and sample characteristics.

Outcome of closed tibial diaphyseal fracture managed by intramedullary interlocking nail through suprapatellar approach

Mon, 25 Aug 2025 00:00:00 +0530

Background: Tibial fractures are among the most common long-bone injuries, and their subcutaneous location makes management challenging. Intramedullary fixation is the preferred treatment for diaphyseal tibial fractures, though the optimal approach remains debated. The suprapatellar approach is increasingly favored by surgeons.

Methods: A prospective observational study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, from September 2021 to March. Thirty-three patients with closed diaphyseal tibial fractures meeting the selection criteria were treated with intramedullary interlocking nails using a suprapatellar approach and followed up for 12 months.

Results: The mean age was 38.3±11.6 years, with 70% male patients. The mean duration from injury to surgery was 13.4±3.3 days. Anterior knee pain occurred in only 5 patients (15.2%). The mean VAS score was 0.5±1.1 (range 0–4). Union time averaged 17.9±3.5 weeks; delayed union occurred in 2 cases (6.1%) and nonunion in 1 case (3%). The mean arc of knee motion was 130.3±8.6 degrees. Functional outcome assessed via Lysholm knee score averaged 93.8±8.9. Outcomes were excellent in 72.7%, good in 18.2%, and fair in 9.1% of patients.

Conclusions: Intramedullary nailing using the suprapatellar approach for tibial diaphyseal fractures demonstrates favorable outcomes, including high Lysholm scores, low complication rates, reliable union, improved knee motion, and reduced anterior knee pain.

Patient-generated health communication: a novel readability analysis of online reviews in orthopaedic surgery

Mon, 25 Aug 2025 00:00:00 +0530

Background: Health literacy plays a critical role in patient outcomes, treatment adherence, and care satisfaction. Leading national health organizations and institutions recommend that health communication materials be written at or below the sixth-grade reading level to maximize accessibility. However, the appropriateness of this standard for digitally engaged patient populations remains unclear. This study examined the readability of patient-written online reviews of orthopaedic surgeons to explore whether higher readability levels may still support effective patient communication.

Methods: Orthopaedic surgeons were randomly selected from the American Association of Hip and Knee Surgeons (AAHKS) directory. The most recent online patient review (minimum 50 words) for each surgeon was retrieved from Healthgrades.com, along with the surgeon’s star rating and reviewer’s ZIP code. Readability was assessed using validated tools, including the Flesch-Kincaid grade level (FKGL). Statistical analyses were performed to explore the relationships between readability scores and surgeon rating, geographic region, and household income.

Results: A total of 114 reviews and ratings were analyzed. The mean FKGL was 7.46 (SD 2.49; median: 7.24), significantly above the sixth-grade recommendation (t (114) =6.251, p<0.001). No significant associations were found between the readability level and star rating (p=0.976), region (p=0.697), or median income (p=0.720).

Conclusions: These results suggest that patients actively participating in online health communication exhibit higher literacy levels than the current guidelines assume. This suggests that health communication materials can be crafted at a higher readability level, potentially enhancing message clarity, engagement, and educational value without reducing patient comprehension.

A novel technique to treat osteoporotic proximal humeral fractures with diaphyseal extension

Ahmed Fouad Abotaleb — Wed, 30 Jul 2025 00:00:00 +0530

Background: Recent reports of failure of proximal humeral locked plate (PHILOS) in treating comminnuted proximal humeral fractures (PHF) with diaphyseal extension (DE) prompted attempts to either augment or add more fixation which is challenged with the proximity to important neurovascular structures.

Methods: Between February 2020 and May 2024, 29 patients with comminuted fractures of PHF-DE were treated at El-Hadra University Hospital with the addition of either a small locked dynamic compression plate (sLDCP) or a small locked reconstruction plate (sLRP) to the standard PHILOS plate, using the trans-deltoid approach.

Results: The average follow-up (FU) period was about 19.5 months. The average age of the patients was approximately 62.6 years. Most of the patients (72.4%) were females. All patients healed their bones without needing additional procedures like bone grafts. The average healing time was just over six months. The mean visual analogue scoring system (VAS) was 8.2. At the end of the FU, there was no significant change in the neck shaft angle (p=0.7). At the end of the FU, the average Constant-Murley shoulder score was noted as 86.6, the mean Simple Shoulder Score was 79.3%, and the average score for the shoulder rating at the University of California Los Angeles (UCLA) was 31.1. No iatrogenic neurovascular fractures occurred during the study.

Conclusions: Performing double plating on PHF-DE is safe. It does not increase the risk of shoulder impingement, harm to the blood supply of the humeral head, or nerve injuries caused by treatment.

Early spinal decompression after documentation in the initial CES-S and CES-R stages of Cauda Equina syndrome: saving both the patient and the clinician

Wed, 23 Jul 2025 00:00:00 +0530

Background: Cauda equina syndrome (CES), described by Mixter Barr in 1934, is a rare and acute surgical emergency, and in our observation, the slower stages of bowel, bladder or limb dysfunction are more common than that claimed in the literature. This paper is to remind clinicians to document all the clinical changes of an evolving CES because patients could already be slipping into a progressive CES but will not reveal them unless inquired.

Methods: The IRT Programme for Medicos and Doctors (IRTP) of KRUSHI Orthopaedic Welfare Society, an NGO based in India, emphasises "preventive orthopedics", conducted this compilation study which is a mixed or ambispective study design of 650 patient data of which 450 patient data was from direct study in our KOWS research purview and 150 patients from various data bases like the Scopus, Web of Science, PubMed, JSTOR, and ScienceDirect.

Results: Incidence of early stages of CES may be missed if only bladder dysfunction is given importance while taking in the patient information by the clinician as only of 33% of the patients complain of bladder dysfunction whereas genital numbness is 47%, sexual dysfunction is of 53% of incidence when carefully enquired into.

Conclusions: The slower forms of cauda equina syndrome are usually missed by the clinicians if they trivialise the red flags of the autonomic dysfunction which are more frequent than that noticed and also the radiologist is equally responsible for not reporting enough about the redundant nerves (RND), the spinal canal diameters as smaller canals promote CES even with a smaller compression. If the clinician asks the right questions, the patients in these slower CES (S), CES(R) will never be missed. This article highlights the sigmoid curve pathophysiology and highlights the time frame and emphasis the early stages of CES(S) and CES (R) to be the best stages where the surgery is beneficial.

Clinical efficacy of single intra-articular platelet-rich plasma injections in mild to moderate knee osteoarthritis: a prospective study

Kushal Parikh, Nishant Solapurwala, Vidit Pathak, Yogenkumar Adodariya — Tue, 05 Aug 2025 00:00:00 +0530

Background: Knee osteoarthritis (OA) is a degenerative joint disease that significantly impacts mobility and quality of life, particularly in older adults. Conventional treatments often provide limited relief, leading to interest in regenerative therapies like platelet-rich plasma (PRP) injections. This study aims to evaluate the clinical effects of a single intra-articular PRP injection in patients with mild to moderate knee OA.

Methods: A prospective, randomized study was conducted with 56 patients aged 40 to 70 years diagnosed with primary knee OA (Kellgren-Lawrence grades 1 and 2). Participants were treated with a single intra-articular PRP injection, prepared using the double-spin technique. Pain intensity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, and follow-up assessments were performed at 1 week, 4 weeks, 8 weeks, 12 weeks, and 6 months post-injection.

Results: Significant improvements in both pain and function were observed. The mean VAS score decreased from 7 at baseline to 4 at 12 weeks, and to 3 at 6 months. The mean WOMAC score improved from 53 at baseline to 30 at 12 weeks, and 24 at 6 months. These changes were statistically significant (p <0.05). No major adverse events were reported during the study period.

Conclusion: A single intra-articular PRP injection significantly reduces pain and improves function in patients with mild to moderate knee OA. PRP therapy is a promising treatment option for managing knee OA, offering an alternative to more invasive procedures. Further studies are needed to explore the long-term effects and optimal treatment protocols.

A comparative study of magnetic resonance imaging and arthroscopic findings in the diagnosis and management of meniscal lesions

Rakesh Singh, Rajat Saran, Nisha Singh — Thu, 14 Aug 2025 00:00:00 +0530

Background: Meniscal injuries are the most common types of knee injuries, particularly in athletes and individuals with physically demanding activities. Meniscal lesions can be assessed by either magnetic resonance imaging (MRI) or arthroscopy. There is a pressing need to compare the findings of MRI and arthroscopy to optimize the diagnostic process, which is critical in determining the most appropriate treatment, whether conservative or surgical.

Methods: The aims of this study was to evaluate the MRI and arthroscopy findings in patients with meniscal injuries of knee joint and to compare and assess the clinical significance of MRI and arthroscopic findings in the management of Meniscal Injuries. Hospital based observational study conducted on 50 patients with knee injury ranging from 18 to 60 years after obtaining written informed consent. Participants recruited by non- probability convenience sampling. Those with local infections or neoplasms, those having contraindications to MRI and unfit for anaesthesia were excluded from the study. Data collected using semi- structured questionnaire after pilot testing. Data entered into Microsoft excel and analyzed using Stata 17.0. Diagnostic accuracy analysis viz., sensitivity and specificity assessments for MRI and arthroscopy were conducted.

Results: Mean age of study participants was 34.6 years and 70% were males. Grade III meniscal tears were the most common (42%). The sensitivity and specificity of MRI was 89.6% and 100% respectively indicating that it correctly identified a high proportion of true meniscal tears and ruled out meniscal injury in all patients without tear.

Conclusions: MRI is a highly accurate, non-invasive diagnostic tool for detecting meniscal injuries.

Comparison of platelet-rich plasma versus corticosteroid injection for adhesive capsulitis: a randomised controlled trial

Anshuman Karak, Ashish Naik — Mon, 25 Aug 2025 00:00:00 +0530

Background: Adhesive capsulitis is characterized by pain and progressive restriction of shoulder range of motion. Corticosteroid injections are routinely used for short‑term pain relief, whereas platelet‑rich plasma (PRP) contains bioactive growth factors that may promote longer‑lasting recovery. Evidence comparing these treatments is conflicting and optimal therapy is still unclear. Objectives of the study were to compare the efficacy and safety of a single ultrasound‑guided intra‑articular PRP injection versus a corticosteroid injection for pain relief, functional recovery and range of motion (ROM) in adults with primary adhesive capsulitis.

Methods: In this prospective randomised trial, 40 adults (mean age ~54 years) with idiopathic adhesive capsulitis were randomly allocated to receive either a 4 ml autologous PRP injection or 40 mg of triamcinolone acetonide under ultrasound guidance. A computer‑generated random sequence and sealed opaque envelopes ensured allocation concealment; patients and outcome assessors were blinded. Baseline evaluations included visual analogue scale (VAS) pain scores, Constant–Murley score (CMS), shoulder pain and disability index (SPADI), and passive ROM in forward flexion, abduction, external and internal rotation measured by goniometer. Follow‑ups were performed at 6 weeks, 3 months and 6 months. The primary outcome was change in VAS at 6 months; secondary outcomes included CMS, SPADI, ROM, patient satisfaction (Likert scale) and adverse events. Data were analysed with independent t‑tests and χ² tests using statistical package for the social sciences (SPSS) v26 with p<0.05 considered statistically significant.

Results: Baseline characteristics were comparable between groups. At 6 months, patients in the PRP group demonstrated greater reductions in VAS scores (1.7±0.7 versus 3.1±0.9; p<0.001), higher CMS (80±5 versus 65±6; p<0.001) and lower SPADI scores (20±6 versus 35±7; p<0.001) compared with the corticosteroid group. Gains in forward flexion (150±10° versus 130±12°; p<0.001), abduction (140±9° versus 120±10°; p<0.001), external rotation (60±5° versus 50±6°; p<0.001) and internal rotation (70±6° versus 55±7°; p<0.001) were also significantly larger with PRP. Clinically meaningful pain reduction was observed in 88% of PRP recipients compared with 48% of those receiving corticosteroid injections. Functional improvement and ROM gains occurred in 82% and 80% of PRP patients but in only 48% and 2% of corticosteroid recipients, respectively. High satisfaction (Likert ≥4) was reported by 70% of PRP‑treated patients versus 40 % in the steroid group. No serious adverse events occurred.

Conclusions: A single intra‑articular PRP injection provided superior and sustained improvements in pain, shoulder function and ROM compared with corticosteroid injection at 6 months, with a higher proportion of satisfied patients and no significant safety concerns. PRP may therefore be considered an effective longer‑term option for managing adhesive capsulitis - whereas corticosteroids provide only short‑term relief.

Assessment of depression, anxiety and quality of life in chronic low back pain patients in rural population

Vivek Narendra Pawar, Rohit Balasaheb Rahane — Mon, 25 Aug 2025 00:00:00 +0530

Background: Chronic low back pain (CLBP) being one of the most common musculoskeletal disorders, has a clear impact on the psychological status of the patient; also studies have shown that Quality of Life (QOL) is hampered in CLBP cases. Several studies have been conducted recently on CLBP and its association with depression, anxiety and QOL, however, this study has been majorly surveyed on the urban population; a need was felt to perform a similar survey on the rural population. This stud aimed to assess the depression, anxiety and quality of life in patients with chronic low back pain in rural population.

Methods: Total 60 participants were selected based on inclusion and exclusion criteria from the orthopedic department of Dr. APJ Abdul Kalam College of Physiotherapy. PHQ 9, GAD-7 and WHOQOL-BREF Questionnaires were used in their local language (Marathi). Data was collected on sheet of paper, and a consent form was given to participants.

Results: Results of PHQ-9, and GAD-7 obtained in the study revealed that 54 participants were severely depressed and 6 participants were moderately severe depressed. 50 participants of CLBP have severe anxiety issues, 8 participants have moderate anxiety and only 2 have mild anxiety. QOL was more affected in CLBP patient.

Conclusions: This study concludes that there is high incidence of depression and anxiety in CLBP patients and have reduced QOL. Therefore, psychological counseling should be integral part of conventional CLBP treatment.

The hidden cost of delay: meniscal and osteochondral damage in neglected ACL tears

Syeda S. Khaleel, Nagam K. Chandra, Goka R. Reddy, Soud S. Uddin — Mon, 25 Aug 2025 00:00:00 +0530

Background: Neglected anterior cruciate ligament (ACL) tears cause repeated incidences of giving-way and rotational-translational instability. The effects of untreated ACL tears and its impact on the meniscus and cartilage was evaluated in this study over a two year time period, especially those with high Tegner activity levels, results in more severe and complicated meniscal and osteochondral lesions with potential affect on the outcome. The study emphasized the importance of early treatment of ACL injury to prevent damage to the meniscal and cartilaginous tissue and secondary osteoarthritis.

Methods: This study examined 385 patients who underwent arthroscopic ACL reconstruction between 2022 and 2024. Researchers analyzed arthroscopic findings, MRI scans, and patient records from the time of surgery. The focus was on identifying severe meniscal and osteochondral lesions that could adversely impact patient outcomes. These lesions were classified as meniscal lesions affecting outcome (MLAO) and osteochondral lesions affecting outcome (OLAO). The study also investigated statistical correlations between MLAO, OLAO, time since injury, and Tegner activity levels.

Results: The occurrence of MLAO and OLAO increased significantly as the duration between injury and surgery lengthened (p=0.001, p<0.05). However, no statistically significant correlation was found between the Tegner activity score and the risk of MLAO or OLAO (p=0.317, p=0.184, p>0.05).

Conclusions: A delay in ACL reconstruction can result in a higher occurrence of meniscal and osteochondral lesions, negatively influencing surgical results.

The study of functional outcome of k-wire fixation with link joints in proximal humerus fractures

Shreyas B. L., Dinesh Kumar Meena, Ali Asgar Burhani, Athul M., Aakash Bansal — Mon, 25 Aug 2025 00:00:00 +0530

Background: Proximal humeral fractures are the common type of osteoporotic fractures seen in elderly patients. The objective was to evaluate the functional outcome of a novel modification of percutaneous k-wire fixation technique using Neer’s classification. In this technique, the transfixing K wires were linked together with a link joint which functions as an external fixator, easily available and cheap compared to MIROS (Minimally invasive reduction and osteosyntesis system) and also has additional advantage of trans fixation.

Methods: The prospective study was conducted in MBS and new medical college, Kota, India over a 24 months period, we treated 25 patients of minimally displaced two-, three- and four-part fractures, 14 patients (56%) were males and 11 patients (44%) were females. Mean age of the patients were 50.52±14.46 years, the mean surgical time was 30.4 min. mean fluoroscopy time was 42.64 seconds, all k wire and link joints removed at 9.5 weeks. mean clinical union was 7.94 weeks.

Results: Final constant score at 18 months was 80.28±4.09. Mean abduction was 129.6±30.6 degrees, the mean anterior forward flexion was 125.5±25degrees. 2 patients developed pin tract infection, 1 patient developed stiffness .4 patients (16%) had fair results, 18 patients (72%) had good results and 3 patients (12%) had excellent results.

Conclusions: The modified novel method that takes advantage of the minimal invasive approach for treating proximal humeral fractures by Kirschner wire mutual linking technique with link joints, providing a great deal of flexibility in the fixation construct's composition which is cost effective and provide even more stability.

Study of effect of zoledronic acid on back pain in patients with osteoporosis

Kushal N. Parikh, Dhruv M. Patel, Yogenkumar A. Adodariya — Mon, 25 Aug 2025 00:00:00 +0530

Background: The objective of the study was to assess functional result in back pain treated with a Zoledronic acid.

Methods: A prospective observational study was conducted over period of 18 months. SMIMER-Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India. Thirty-eight patients with various stages of back pain treated with zoledronic acid fulfilling selection criteria admitted in department of orthopaedics in tertiary health care hospital in Surat. Follow up was done after 2nd and 6th month and recording of pain relief in term of VAS and MODQ score.

Results: We expected that Patients after receiving Zoledronic acid shows an appreciable and statistically significant improvement in back pain & related complains as well as improvement in monthly follow-up period compared to previous status based on VAS score & MODQ.

Conclusions: Our findings have shown that there is a statistically significant improvement in complain of back pain over period of 6 months as compared to previous status of patient.

Functional outcome study for operatively managed cases of rotator cuff tear: managed by mini open repair

Kushal N. Parikh, Yogenkumar A. Adodariya, Dhruv M. Patel — Mon, 25 Aug 2025 00:00:00 +0530

Background: Rotator cuff tears (RCTs) are common musculoskeletal injuries impacting quality of life due to pain and functional limitation. The mini-open repair technique offers an alternative to arthroscopic repair with high success and accessibility. Objective of this study was to evaluate anatomical and functional outcomes of mini-open repair for rotator cuff tears.

Methods: A prospective observational study was conducted on 30 patients operated by mini-open rotator cuff repair at a tertiary care hospital between 2022–2024. Preoperative and postoperative evaluations included ROM, UCLA score, and VAS at six months follow-up.

Results: Mean age was 54.1 years, with male predominance. Dominant limb was involved in 67%. Significant improvements were observed in abduction (mean 76.7° to 147.1°), forward flexion (82.2° to 157.2°), external rotation (28.7° to 56.3°), and internal rotation. Mean UCLA score improved from 13.4 to 31.2 (p<0.001).

Conclusions: Mini-open rotator cuff repair offers excellent pain relief, improved range of motion, and patient satisfaction in the short term. It remains a viable and effective option, especially in resource-limited settings.

Diagnostic accuracy of digital imaging and computed tomography in calcaneal fracture evaluation

Kartik Samria, Sunil Kumar Rawat, Krati Bhardwaj, Parakh Dhingra, Ravi Khurana — Mon, 25 Aug 2025 00:00:00 +0530

Background: Initially, suspected calcaneal fractures are typically evaluated using conventional radiography. However, contemporary classification systems for calcaneal fractures rely heavily on computed tomography (CT) due to its ability to provide three-dimensional imaging, which offers a more comprehensive assessment than traditional two-dimensional plain radiography. This study aimed to investigate and compare the diagnostic efficacy of digital X-ray imaging versus computed tomography in evaluating calcaneal fractures.

Methods: This study was conducted S.M.S Medical College Jaipur on 40 patients with isolated calcaneal trauma and was diagnosed radiologically by plain X-ray and CT to have calcaneal fractures. lateral view images was obtained to measure the Böhler’s angle, the angle of Gissane, the inclination angle and the facet height. Each angle was measured by two different interpreters (a senior radiologist and a resident) in order to verify accuracy.

Results: A statistically significant difference was observed between Digital X-ray and CT image findings in both intra-articular fractures and total fractures. Specifically, significant differences were noted in the measurements of Bohler's angle, the angle of Gissane and facet height, whereas no significant difference was found in the inclination angle. These findings highlight the superior diagnostic accuracy of CT imaging in assessing calcaneal fractures.

Conclusions: Computed Tomography (CT) scanning has emerged as a indispensable, non-invasive diagnostic tool, widely adopted for its exceptional utility in accurately identifying, classifying and informing treatment strategies for both extra-articular and intra-articular calcaneal fractures, thereby revolutionizing the management of these complex injuries.

Functional outcome of distal femoral fractures treated with distal femoral locking compression plate: a cross-sectional study

Sandeep Kumar Kumar Deep, Varun Phogat, Sankar Debroy — Mon, 25 Aug 2025 00:00:00 +0530

Background: Despite advances in fixation techniques, distal femoral fractures still pose significant challenges for orthopedic surgeons. Effective treatment hinges on a detailed understanding of local anatomy, accurate clinical and imaging assessments, recognition of the fracture morphology, and the judicious choice of a fixation device suited to the particular case. Locking compression plates (LCPs), with their numerous advantages such as enhanced stability, fixed-angle screw locking, and minimal disruption to periosteal blood supply have proven to be highly effective in addressing these challenges and are especially valuable in osteoporotic bone.

Methods: This cross-sectional study was conducted at a tertiary care institution in Tripura between October 2016 and September 2019, comprising 60 patients with distal femoral fractures who underwent open reduction and internal fixation utilizing a distal femoral locking compression plate (DF-LCP). The functional outcome was assessed using Neer’s criteria.

Results: The study included 60 patients, of whom 42 were male and 18 were female. The majority of fractures (70%) were attributed to road traffic accidents. The mean duration for radiological evidence of fracture union was 17.2 weeks. According to Neer’s criteria, the final functional outcome of the knee was rated as excellent in 34 patients (56.7%), good in 20 patients (33.3%), fair in 5 patients (8.33%), and poor in 1 patient (1.67%).

Conclusions: Surgical fixation of distal femoral fractures with distal femoral LCP provides good functional outcome and is one of the best modalities of treatment available for these kinds of fractures especially in severely comminated and in osteoporotic cases.

Functional and radiological outcome of distal femur fracture with intra-articular extension fixed with variable angle-locking compression plate: a prospective study

Ayush Agrawal, Arun Heddur Shanthappa, Akshay Panduranga — Mon, 25 Aug 2025 00:00:00 +0530

Background: Distal femur fractures, often resulting from high-velocity injuries, pose significant challenges due to their complexity. This study aims to evaluate the efficacy of variable angle-locking compression plate (VA-LCP) in treating these fractures, focusing on both functional and radiological outcomes.

Methods: This prospective observational study included 40 patients aged 20-70 years with distal femur fractures treated at R. L. Jalappa Hospital and Research Centre. Data on demographics, comorbidities, fracture type and outcomes were collected. Patients underwent open reduction and internal fixation with VA-LCP and were followed up at 1 month, 3 months and 6 months postoperatively.

Results: The study revealed significant improvements in functional outcomes as measured by NEER's score, with most patients showing substantial increases by 6 months post-op. The majority of fractures were successfully united within an average of 20 weeks. Complications were minimal and included superficial infections and knee stiffness in a few cases.

Conclusions: VA-LCP provides effective stabilization for distal femur fractures, enabling early mobilization and resulting in positive functional and radiological outcomes. This technique is particularly beneficial for complex intra-articular fractures.

Functional outcome of the sinus tarsi approach in the treatment of intraarticular calcaneal fractures

Raj N. Gadhavi, Soham B. Gohil — Mon, 25 Aug 2025 00:00:00 +0530

Background: Intraarticular calcaneal fracture is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in thirty patients, all of which were managed by sinus tarsi approach an average follow-up period of 18 months. Though open reduction is prevailing, this technique also gives favorable outcome.

Methods: Thirty patients with intraarticular calcaneal fracture were managed by dorsal tarsi approach using between March 2023 to November 2025 were included in this series. All cases were treated with closed reduction. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted.

Results: Of the Thirty patients in the study, twenty-two were males and eight were females. The mean age was 40.4 years (range 18 to 65 years). Eighteen out of thirty patients (60%) had the dominant side fractured). The mean fracture union (radiological) time was 8 weeks (range: 6-12 weeks) and clinical union time was 8.5 weeks week. However, ankle function was excellent in 30 cases (100%).

Conclusions: This study confirmed a high overall rate of union and excellent functional outcomes sinus tarsi approach for a intraarticular calcaneal fractures give good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time-consuming method intraarticular calcaneal fracture. When the surgeon is experienced in the technique.

Comparison of arthroscopic capsule release and manipulation under anaesthesia for frozen shoulder: a prospective randomized single blinded interventional study

Arvind, Gurchetan Singh, Pavan Sudarshan — Mon, 25 Aug 2025 00:00:00 +0530

Background: Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain, affecting approximately 2% of the population. Despite its prevalence, the exact aetiology remains unclear, leading to varied treatment protocols. Among the available interventions, manipulation under anaesthesia (MUA) and arthroscopic capsular release (ACR) are widely used for refractory cases, though comparative data on their outcomes are limited. Aim: To compare early clinical outcomes, complications and pain relief between MUA and ACR in patients with refractory adhesive capsulitis.

Methods: A prospective, randomized, single-blinded study was conducted from November 2020 to April 2022 at a tertiary care hospital. Forty-four patients with refractory adhesive capsulitis were randomized into two groups: MUA (n=22) and ACR(n=22). Preoperative evaluations included clinical and ultra-sonographic examinations. Postoperative outcomes were assessed at 2, 4 and 12 weeks using the Visual Analogue Scale (VAS), Oxford Shoulder Score (OSS) and range of motion (ROM) measurements.

Results: Both groups demonstrated significant improvements in pain and ROM. However, ACR yielded superior results, with a greater reduction in VAS scores (8 to 1in ACR vs. 8 to 3 in MUA) and better ROM at 12 weeks. Forward flexion improved from80º to 180º in the ACR group, compared to 70º to 170º in the MUA group. External and internal rotation improvements were also significantly greater in the ACR group.

Conclusions: Arthroscopic capsular release, combined with an exercise regimen, provides significantly better pain relief and functional recovery compared to MUA in refractory adhesive capsulitis.

Functional and radiological outcomes of Essex-Lopresti procedure in intra-articular calcaneal fractures: a prospective study

Varshant Pareek, Ananya Mishra, Mohit Yadav, Kartik Yadav, Deepak Khandelwal — Mon, 25 Aug 2025 00:00:00 +0530

Background: Calcaneal fractures are among the most common tarsal bone injuries, often leading to significant morbidity. The Essex-Lopresti procedure is a minimally invasive surgical technique used to treat intra-articular fractures of the calcaneum. Objective of the study was to evaluate the functional and radiological outcomes of the Essex-Lopresti procedure in patients with intra-articular calcaneal fractures and assess post-operative pain relief and complication rates.

Methods: A hospital-based prospective study was conducted at tertiary care centre, Jaipur, on 85 patients. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, while radiological outcomes were evaluated using Bohler’s angle.

Results: The mean preoperative Bohler’s angle (15.19°) improved to 29.55° postoperatively and stabilized at 27.38° at the 6-month follow-up. The AOFAS score improved significantly from 47.56 preoperatively to 87.38 at 6 months. The mean Visual Analog Scale (VAS) score decreased from 7.53 preoperatively to 0.54 postoperatively, indicating significant pain relief.

Conclusions: The Essex-Lopresti procedure is an effective treatment for intra-articular calcaneal fractures, achieving favorable functional and radiological outcomes with minimal complications.

Functional outcome of peritrochanteric fractures femur treated with proximal femoral nail

Binay Gowda T., Chunchesh M. D., Vani Ahuja, Sushan K. — Mon, 25 Aug 2025 00:00:00 +0530

Background: Peritrochanteric fractures are common injuries, especially in the elderly, with significant impact on health care. The aim of treatment should be prevention of malunion and early mobilization. Taking all the factors into consideration, surgery by internal fixation of the fracture is an ideal choice.

Methods: This study included 40 adult patients with peritrochanteric fractures of the femur who met the inclusion criteria and were treated with a Proximal Femoral Nail at BGS Global Institute of Medical Sciences, Bangalore, from November 2022 to November 2024.

Results: The study included 40 cases, 31 males and 9 females, aged 22–94. The majority of patients (45%) were admitted for slip-and-fall injuries, mostly right-sided fractures. 25 of 40 cases were trochanteric, 15 subtrochanteric. The trochanteric fracture group had 40% Boyd and Griffin type 2, while the subtrochanteric group had 33.3% Seinsheimer type IIIa and 20% type IIb. The average hospital stay was 20.67 days and weight-bearing took 16.5 weeks. Two patients died before the 6-week follow-up and three were lost to follow-up. The remaining 35 fractures were 22 trochanteric and 13 subtrochanteric. 90.9% of trochanteric fractures and 88.57% of subtrochanteric fractures had good to excellent results.

Conclusions: The study concludes that the PFN is an excellent implant for the treatment of peritrochanteric fractures. The terms of a successful outcome include a thorough understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate reduction of the fracture, instrumentation and a good image intensifier.

Current practices and perceptions among clinicians in osteoarthritis and osteoporosis management in Indian settings

Manjula S., Krishna Kumar M. — Mon, 25 Aug 2025 00:00:00 +0530

Background: Although there were several clinical studies available, there was a dearth of studies among clinicians in actual practice. So, the present study aimed to assess clinician perspectives on the prevalence, risk factors, diagnosis and management practices of osteoarthritis (OA) and osteoporosis (OP) in routine clinical settings, to identify gaps in awareness, treatment approaches and patient compliance.

Methods: The cross-sectional study utilized a 23-item questionnaire to gather expert insights on the management of OA and OP in Indian settings. It explored various aspects, including epidemiology, risk factors, diagnostic practices, treatment preferences and challenges in current management. The collected data were analysed using descriptive statistics.

Results: The study included 119 experts and nearly 75% of them identified knee OA as the most prevalent form of the condition. For the early management of OA, around 88% of respondents preferred a combination of nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, dietary modifications and exercise. Nearly 83% recognized family history, smoking, poor diet, advancing age and post-menopausal status as common risk factors for OP. Regarding screening practices, 55% of participants reported that blood tests, bone turnover markers and bone mineral density (BMD) assessments via ultrasound are the most commonly used methods. Around 77% believed that calcitriol supports fracture management, offers the benefit of weekly dosing for better compliance and is effective in treating OP. A majority (84.87%) of participants agreed that calcium aspartate is a well-tolerated and effective calcium supplement suitable for individuals across all age groups.

Conclusions: This study indicates that knee OA is the most commonly observed form, with early management favouring NSAIDs, physiotherapy, dietary modifications and exercise. In OP, lack of awareness remains a key treatment gap, while calcium aspartate and calcitriol are widely regarded as effective and well-tolerated options.

A comparative study of the outcomes of fixation of fractures of distal femoral nailing versus plating

Thakur G. Singh, Vaishali Chhetri — Mon, 25 Aug 2025 00:00:00 +0530

Background: Distal femur fractures have been historically very difficult to treat as they are often comminuted, unstable, more common in elderly or patients having multiple injuries. Hence, we conducted this study to assess the feasibility and the functional outcome of 30 cases of supracondylar fractures of femur, treated with locking compression plates and retrograde intramedullary supracondylar nails.

Methods: All patients of distal femoral fractures were admitted and history was elicited to reveal the mechanism of the injury and the severity of the trauma, site of the incident, circumstances about which the injury occurred, premorbid medical history and preinjury functional status. Post-operatively patients were discharged with advice to continue physiotherapy as advised and to come for follow up after 3 weeks and later 3 months, 6 months,18 months and 24 months.

Results: Among the 30 cases of supracondylar fracture fixed by supracondylar nail 14 had good scores and one was scored as excellent, whereas those fixed by locking compression plate 14 were scored as good and 1 case was scored as fair. There were no intances of surgical wound infections during the immediate postoperative period.

Conclusions: From the observations and results of our study, it can be concluded that the supracondylar nail is more ideal when compared to the distal femoral locking compression plate as it has less operative time, less blood loss, more range of movement, less soft tissue stripping and faster radiological union when compared to the distal femoral locking compression plate.

A randomized controlled study comparing the efficacy of ultrasound guided intra articular-triamcinolone vs platelet rich plasma in active phase (stage 1) of adhesive capsulitis (frozen shoulder)

Darshan Gadenahalli Thimmegowda, Ihjas Ismail, Sharath Kumar P. V. — Mon, 25 Aug 2025 00:00:00 +0530

Background: Adhesive capsulitis is a common cause of shoulder pain and restricted movement. Various treatment options exist, ranging from analgesics and steroid injections to biologics like platelet-rich plasma (PRP). PRP offers potential healing benefits with minimal immunological risk. Given conflicting evidence for existing therapies and the growing use of PRP, comparing PRP with steroid injections is warranted.

Methods: A randomized, single-blinded controlled trial included 84 patients aged 30–70 years with adhesive capsulitis. Participants were randomized into Group A (triamcinolone 80 mg) and Group B (2 ml autologous PRP). Outcome measures included Visual Analogue Scale (VAS), range of motion (ROM), Shoulder Pain and Disability Index (SPADI), and Constant-Murley Score (CMS), assessed at baseline, 3 months, and 6 months. Statistical analysis employed Chi-square/Fisher’s exact test and Student’s t-tests.

Results: Patients receiving PRP showed significantly greater improvements in VAS, SPADI, CMS, and ROM compared to those receiving steroid injections at both 3- and 6-month follow-ups (p<0.001). Transient side effects such as nausea, vomiting, and hypotension were more frequent in the PRP group but lacked statistical significance. Recurrence and lack of treatment response were higher in the steroid group.

Conclusion: PRP is more effective than triamcinolone in short-term pain relief and functional recovery among adhesive capsulitis patients, with minimal adverse effects. Larger multi-centric studies with longer follow-up are recommended to evaluate its long-term benefits and comparative efficacy with other treatments.

Functional outcomes of medial open wedge high tibial osteotomy in rural Indian patients with medial compartment osteoarthritis and varus deformity: a prospective study

Mukund Sharma, Prafulla Herode, Rajendra Fiske — Mon, 25 Aug 2025 00:00:00 +0530

Background: Osteoarthritis of the knee is a leading cause of disability in rural India, were cultural practices and delayed presentation often complicate treatment. High tibial osteotomy (HTO) represents a joint-preserving alternative to total knee arthroplasty, particularly suitable for younger patients with medial compartment disease. This study aims to evaluate the functional outcomes of medial open wedge high tibial osteotomy in rural Indian patients with medial compartment osteoarthritis and varus deformity.

Methods: This 24-month prospective study at Dr. BVP Rural Medical College, Loni, Maharashtra, evaluated 50 patients with symptomatic medial compartment osteoarthritis undergoing medial open wedge HTO using TomoFix plates. Outcomes were assessed using Visual Analog Scale (VAS), Knee Society Score (KSS) and Knee Society Functional Score (KSFS) over 6-month follow-up.

Results: Significant improvements occurred across all measures. Mean VAS improved from 6.7±1.1 to 1.8±0.9 (p<0.001). KSS improved from 54.7±5.8 to 82.8±6.1 (p<0.001) and KSFS from 55.2±4.9 to 83.8±5.7 (p<0.001). Walking distance increased from 178±65 to 575±90 meters (p<0.001). Mechanical axis was corrected from 7.2°±1.3° varus to 2.1°±1.1° valgus. All patients achieved radiological union by 12 weeks. Minor complications occurred in 22% with no major complications.

Conclusions: Medial open wedge HTO provides significant functional improvement in rural Indian patients with medial compartment osteoarthritis, offering a cost-effective, culturally appropriate alternative to total knee arthroplasty while preserving traditional sitting postures and occupational activities.

Short-term results of synovectomy and total knee arthroplasty in patients with diffuse-type pigmented villonodular synovitis

Mon, 25 Aug 2025 00:00:00 +0530

Background: Diffuse-type pigmented villonodular synovitis (D-PVNS) is a rare, benign proliferative condition that affects the knee joint, often leading to subchondral bone erosion, cyst formation, and ultimately secondary osteoarthritis. This study aimed to assess the short-term clinical outcomes of synovectomy combined with total knee arthroplasty (TKA) in patients diagnosed with D-PVNS.

Methods: This study was conducted in the department of orthopaedics at government medical college, Kota, between 2020 and 2025, 28 patients with histopathologically confirmed D-PVNS of the knee underwent synovectomy followed by TKA. Clinical and operative data were recorded perioperatively and throughout follow-up to evaluate surgical effectiveness.

Results: There were no intraoperative complications. The mean operative time was 73.4 minutes (range: 47-115 minutes), and the average estimated blood loss was 223.9 mL (range: 50-600 mL). Patients were followed up for an average of 58.7 months (range: 36-84 months). Range of motion improved from a mean of 86.1°±11.3° preoperatively (range: 60°-100°) to 107°±11.4° postoperatively (range: 90°-130°). The average knee society clinical score increased from 38.9±9.5 to 84.4±6.1, while the functional score improved from 48.9±13.1 to 84.6±6.1 (p<0.05). Postoperative radiographs revealed no signs of prosthesis loosening, dislocation, or periprosthetic fracture.

Conclusions: Synovectomy combined with total knee replacement offers favorable short-term outcomes in managing D-PVNS of the knee, with significant improvements in joint function and stability and no major complications observed during follow-up.

Comparative study to assess the outcome of surgical management of humerus shaft fracture: anterior bridge plating versus humerus intramedullary nailing

Gagan Arora, Anurag Varshney, Surya V. Singh, Kanwal Bajaj — Mon, 25 Aug 2025 00:00:00 +0530

Background: Aims and objectives of the study were to assess the outcomes of surgical management of humeral shaft fractures using anterior bridge plating (ABP) versus humeral intramedullary nailing (HIN) in terms of functional recovery and complication rates.

Methods: A prospective observational and interventional study was conducted from July 2022 to June 2024 at the tertiary care hospital. Sample size of 40 patients was taken.

Results: The study included 40 patients, with similar demographics between the groups. We divided the cases in two groups (HIN group A and ABP group B). Out of 40 patients, 23 were male and 17 were female. Postoperative follow-up at 24 weeks indicated improved functional outcomes assessed by UCLA score system for the ABP group B, with 65% achieving excellent, 25% good, 10% fair and 0% poor as compared to 55% good, 30% fair, and 15% poor in the HIN group A. In terms of complication, in the group A, one (5%) patient had radial nerve palsy, 3 (15%) nonunion, 1 (5%) delayed union and 1 (5%) superficial infection whereas in group B, no radial nerve palsy and nonunion, but 3 (15%) patients have delayed union and 1 (5%) superficial infection.

Conclusions: Anterior bridge plating demonstrated superior functional recovery compared to intramedullary nailing in patients with humerus shaft fractures, suggesting it may be the preferred surgical option for better patient outcomes but no significant difference in complications like delayed union and infection. Further research is warranted to validate these findings and refine treatment guidelines.

Functional outcomes of acromioclavicular joint dislocation repair using the double Endobutton technique: a retrospective study

Aakash Bansal, R. P. Meena, Prince Singh, Umesh Kumar Meena, Rohit Kharalwa — Mon, 25 Aug 2025 00:00:00 +0530

Background: A range of surgical techniques has been proposed for acromioclavicular (AC) joint dislocations. Traditional methods, including hardware fixation and non-anatomical reconstructions, are often associated with complications and high failure rates. Recent advancements focus on anatomical reconstruction of the coracoclavicular (CC) ligaments to improve outcomes. This study evaluates the clinical and radiological results of the double Endobutton technique, which reconstructs the trapezoid and conoid ligaments separately, in acute complete AC joint dislocations.

Methods: A retrospective study was conducted at government medical college, Kota, from December 2022 to December 2024, involving 40 patients with Rockwood type III to V injuries. Reconstruction was performed using double Endobuttons, Mersilene tape, and 5 Ethibond sutures through a vertical strap incision. The cohort comprised 18 type V, 6 type IV, and 5 type III injuries; 12 right-sided and 28 left-sided.

Results: Outcomes were assessed using the Constant score and disabilities of the arm, shoulder and hand (DASH) questionnaire at 6, 12, and 24 weeks postoperatively, along with radiological evaluations via Zanca and bilateral AP stress views. At final follow-up (mean: 12 months; range: 8-14), 36 patients had excellent outcomes, 2 had good, and 2 had fair results. The mean Constant score was 96 (range: 80-100) and the mean DASH score was 5.3 (range: 1-11).

Conclusions: The double endobutton technique offers favorable clinical and radiological outcomes, with effective anatomical reduction and functional restoration in most patients. It is a safe and reliable option for treating complete AC joint dislocations.

A comparative study between intravenous alone and combined intravenous and intra-articular administration of tranexamic acid in primary total knee replacement patients

Mon, 25 Aug 2025 00:00:00 +0530

Background: With the better understanding of the total knee arthroplasty, the number of patients with extremes of ages and advanced comorbidities undergoing total knee arthroplasty are increasing. The most common post-operative complication remains the blood loss. The intravenous use of tranexamic acid was initially thought to decrease the blood loos. Over the past years, intra-articular administration of Tranexamic acid is also being used to reduce the blood loss. Now there is an increasing trend to combine the intravenous and intra-articular route for tranexamic acid in patients undergoing total knee arthroplasty. There are very few studies that evaluates or compares the intravenous and combination of intravenous and intra-articular route of tranexamic acid in total knee arthroplasty patients.

Methods: Two Hundred and two patients with severe knee osteoarthrosis planned for total knee arthroplasty were selected in accordance to inclusion and exclusion criteria. Patients were divided into Group A and B and was administered with combination of intravenous and intra-articular tranexamic acid for Group A patients and intravenous tranexamic acid for Group B patients .The outcome was measured in terms of blood loss in post-operative day one calculated using classical Nadir Method.

Results: The blood loss were found to be 328.04±178.9 ml in Group A and 362.88±220.408 ml in Group B. The p value was found to be greater than 0.005 and hence the difference in post-operative blood loss in both group was not statistically significant.

Conclusions: There is no difference between the combination of Intra-venous Transexmic and Intra-articular Tranexamic acid when compared with intravenous Tranexamic acid in reducing blood loss in patients undergoing total knee arthroplasty.

Functional and radiological outcomes in revision total knee arthroplasty

Mon, 25 Aug 2025 00:00:00 +0530

Background: Following a primary total knee arthroplasty, patients with rheumatoid arthritis and osteoarthritis are reported to have comparable clinical prognoses and overall failure rates. Information on revision techniques is limited, despite the fact that the causes of failure and survivorship for primary total knee arthroplasty (TKA) have been well investigated. This study, which investigated the radiological and functional outcomes of revision total knee arthroplasty, was conducted as a consequence of these factors.

Methods: This observational study was conducted in the Department of Orthopedics in Sapthagiri institute of medical sciences and research centre among cases who underwent revision TKA during November 2022 to June 2023. A total of forty cases who underwent RTKA during the study period were included in the study. After taking the written informed consent, principal investigator assessed the detailed history of the participants and clinically examined the patients. Pre and post-operative functional and radiological outcomes were measured. The data was entered in excel sheet and analyzed using statistical package for the social sciences (SPSS) - version 19.

Results: Pre op and post-operative HSS score, KS score including the sub-scales like objective knee score, patient satisfaction score, patient expectations core and functional activity score and radiological outcome scores were found to be statistically improved post-operatively. Also, pain was markedly reduced postoperatively based on VAS scale. However, only one case died who underwent two stages TKA, which was not statistically significant.

Conclusions: We infer that further improvement in prevention and management of infection following TKA can helps to prevent the proportion of cases requiring RTKA and thus much attention is warranted on this dreaded complication.

Can height and weight of the patient predict the tibial footprint dimensions of anterior cruciate ligament on MRI: an observational study

Mon, 25 Aug 2025 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) reconstruction techniques are increasingly individualized based on patient-specific anatomy. Preoperative knowledge of ACL dimensions guides surgical planning, particularly regarding single versus double-bundle reconstruction. This study aimed to evaluate ACL tibial footprint dimensions in a South Indian population and investigate their correlation with patient anthropometric measures.

Methods: This retrospective observational study analyzed MRI scans of 78 patients (41 males, 37 females) with intact ACL who presented with knee pain at a tertiary care teaching hospital in South India between January 2023 and April 2025. ACL tibial footprint length and width were measured on MRI. Correlation and regression analyses were performed to investigate relationships between ACL dimensions and patient height, weight, age and gender.

Results: The mean ACL tibial footprint length and width were 13.7±1.8 mm and 11.5±1.4 mm, respectively. Height demonstrated a strong positive correlation with ACL length (r=0.68, p<0.001) and a moderate correlation with ACL width (r=0.52, p<0.001). In multivariable analysis, height remained the strongest independent predictor of ACL length (standardized β=0.53, p<0.001), while weight (β=0.04, p=0.687) and age (β=0.03, p=0.749) showed no significant independent association. For every 1 cm increase in height, ACL length increased by 0.182 mm (95% CI: 0.140-0.224). Gender differences in ACL dimensions were significant but partially attributable to height differences. Overall, 60.3% of participants had ACL length <14 mm, with a significantly higher proportion among females (83.8%) compared to males (39.0%).

Conclusions: Height is a strong predictor of ACL tibial footprint dimensions in South Indian patients, explaining 46% of the variability in ACL footprint length. Patient height could serve as a simple clinical predictor of ACL footprint dimensions when advanced imaging is not readily available, potentially guiding surgical decision-making regarding reconstruction technique.

Periprosthetic fractures after total knee arthroplasty: an extensive review of its patterns, risk factors, treatment options, outcomes and correlation of its severity with the bone mineral density

Mon, 25 Aug 2025 00:00:00 +0530

Background: Periprosthetic fracture (PPF) around knee is a rare but debilitating complication after total knee arthroplasties.

Methods: Retrospective analysis of 12,133 knee replacements done at a single centre from 2011-2024 was done to analyse incidence, risk factors, pattern, treatment and outcomes of PPF and correlation of its severity with the Bone mineral Density.

Results: The incidence of PPF was 0.42% (femur=0.34%, tibia=0.07% and patella=0.01%). 51.6% were female patients. Mean age, BMI, CCI and follow up was 63.32 (22-89 years; SD=13.51), 30.6 (20.2-43.8; SD=3.9), 2.2 (1-4; SD=0.77) and 5.1 years (1-14 years; SD=4.29). Mean BMD was -1.78 (1 to -3; SD=0.69). Primary osteoarthritis was the diagnosis in 93.91% and PFC Sigma (Depuy, Johnson and Johnson) posterior stabilised prosthesis was used in 88% of the patients. The mean grade of anterior cortex notching (Tayside classification) was 0.39 (0-3, SD=0.12). Only female gender was a significant risk factor for PPF (OR=3.1; 2.31-3.97 at 95%CI; p value=0.01). There was no significant correlation between the BMD and the grade of fracture as per Lewis and Rorabeck, Su and Felix classifications (p values=0.77, 0.80 and 0.74 respectively). 33 PPFs (64.7%) were fixed with locking plates and 5 (9.8%) were revised to hinged prosthesis. 98% fractures united at mean 17.8 weeks and Mean KSS at 1 year was 144.77+/-2.08. 1 year mortality rate post PPF was 2%.

Conclusions: While female gender is a significant risk factor for PPF, BMD does not correlate with its severity. Appropriate treatment option selected based on the general health of the patient, fracture pattern and implant stability results in good outcomes and less mortality.

Paralytic sciatica revealing a thigh hematoma: a case report

Mon, 25 Aug 2025 00:00:00 +0530

Authors report the case of a 27-year-old man, on fondaparinux for prophylaxis, who presented to the emergency department with acute, paralyzing, painful sciatica of the left lower limb, following minor trauma. Clinical examination, combined with angio-computed tomography (angio-CT), revealed a voluminous compressive hematoma in the posterior compartment of the thigh, probably of muscular origin. The patient underwent emergency surgical evacuation, during which approximately one liter of hematoma was removed. The postoperative course was favorable, and appropriate rehabilitation led to full neurological recovery within 12 months. This case highlights the importance of considering a compressive hematoma in the differential diagnosis of sciatic paralysis following trauma, however minimal, particularly in patients on anticoagulants. It also highlights the crucial role of early diagnosis and multidisciplinary management.

Subungual glomus tumor: a clinical case and a review of the literature

Diogo Gameiro, Fábio Fernandes, Leonardo Miraldo, Daniel Peixoto, Susana Ângelo — Mon, 25 Aug 2025 00:00:00 +0530

Glomus tumors are rare vascular lesions, located in the dermis, very difficult to diagnose. A 55 years old female patient with pain at first finger of her right hand, which eradiated to the forearm, with several years of evolution. The pain was worst with local compression and cold exposure. The magnetic resonance imaging was compatible with a subungual glomus tumor. Surgical resection of the lesion by a lateral approach was done. The histopathological analysis confirmed the diagnosis and the patient complaints disappeared after the procedure. The surgical treatment is usually curative and the lateral approach, although not the most commonly used, could be a good alternative.

Comprehensive management of high-grade knee injuries: a case report and surgical technique on patellar tendon rupture with multi ligament injury following self reduced posterior dislocation of knee

Mon, 25 Aug 2025 00:00:00 +0530

Knee dislocations and patellar tendon ruptures are rare but complex injuries. Incidence of patellar tendon rupture is approximately 0.5% of the general population each year. These injuries are often present with a wide range of symptoms, depending on the structures involved. Significant soft tissue damage is almost always present, frequently accompanied by multi-ligamentous injuries and bony involvement. The potential for neurovascular compromise, particularly injury to the popliteal artery, adds to the urgency of prompt diagnosis and management and are considered as surgical emergencies. Delayed diagnosis or inadequate treatment can lead to devastating complications. A 42-year-old male presented with a high-grade knee injury diagnosed with a complete patellar tendon rupture, complete anterior cruciate ligament (ACL) disruption, and partial posterior cruciate ligament (PCL) tear, along with complex tears in both the medial, lateral menisci and osteochondral fractures, posing challenges for surgical planning. Single stage surgical intervention was planned. ACL reconstruction with peroneus longus tendon graft, medial meniscal balancing, lateral meniscal root repair and semitendinosus graft was harvested with an open stripper with insertion kept intact for patellar tendon repair with augmentation. PCL and collateral ligaments were managed conservatively since they found stable. A tailored rehabilitation protocol focused on early mobilization and progressive strengthening was implemented postoperatively. This case highlights the complexity of high-grade knee injuries involving multiple structures and the importance of thorough evaluation and surgical intervention. The tailored rehabilitation protocol facilitated recovery, leading to significant improvements in range of motion (ROM) and functionality. Individualized management strategies are crucial for addressing these complexities, ultimately enhancing patient outcomes and minimizing complications.

A case report of giant cell tumor of the extensor tendon sheath in index finger

Ranjith Kumar, Narender Saini, Sushma R. — Mon, 25 Aug 2025 00:00:00 +0530

Giant cell tumor of the tendon sheath (GCTTS) is an uncommon benign soft tissue lesion of uncertain etiology. Although it predominantly involves the hand, occurrences in the ankle and foot have also been reported but remain rare. Patients typically present with a painless, palpable mass that has often been present for an extended duration. While imaging studies and fine-needle aspiration cytology (FNAC) may suggest the diagnosis, definitive confirmation relies on histopathological examination following surgical excision. This report describes a rare case of GCTTS involving the extensor tendon sheath of the right index finger. A 38-year-old male presented with a 4-year history of a gradually enlarging, painless swelling on the dorsal aspect of the right index finger. Clinical examination revealed a well- defined, firm, 4 cm × 1.5 cm mass located over the proximal phalanx. The swelling had a smooth surface, uniform consistency, and was easily mobile in the lateral plane. Radiographic imaging of the hand showed a localized soft tissue shadow without any evidence of bony involvement. Ultrasonography revealed a soft tissue mass, and FNAC was suggestive of GCTTS. The lesion was subsequently excised, and histopathological analysis confirmed the diagnosis by demonstrating characteristic features of GCTTS. Given its indolent course and subtle presentation, GCTTS should be considered in the differential diagnosis of soft tissue swellings in the hand, particularly in adults. FNAC, followed by surgical excision and histopathological evaluation, remains both diagnostic and therapeutic. Ongoing follow-up is recommended due to the potential for local recurrence.

A case report-management of concomitant acromion fracture with acromioclavicular joint dislocation

Justin Thomas, Niranjan T. J. — Mon, 25 Aug 2025 00:00:00 +0530

Shoulder injuries which comprises of simultaneous acromion fracture and acromioclavicular dislocations are rare injuries which were usually managed conservatively or sub optimally in previous times. These managements provided functional results with variable satisfaction. But in this era of grand armamentarium of fixation options we are trying a management option for these type of injuries. Here we present the case of 52 year old gentleman who met with a road traffic injury presented with right dominant side injury with pain and inability to move the shoulder. X-ray and CT evaluation done which yielded concomitant acromion fracture and acromioclavicular joint ligamentous dislocation. He was managed by fixation of acromion fracture by 4 holed 3.5 locking reconstruction plate and tightrope endo-button fixation of the acromioclavicular joint. As the said injury is a rare injury, literature references aided in decision making. Systematic approach to the injury along with a planned rehabilitation protocol yielded patient near normal pre injury level status of dominant side shoulder function. More literature must be published with variants of these fractures and varying fixation methods to attain a meta-analysis level for conclusive evidence.

An unstable knee with gross varus deformity treated with unconstrained total knee replacement with long tibial stem: a case report

Nikunj Agrawal, Charan Kumar Voonna, Sunil Sharma, Abhishek Sharma — Mon, 25 Aug 2025 00:00:00 +0530

Severe varus deformity of the knee poses a technical challenge in balancing the flexion and extension gaps. Bone defects are a challenging problem encountered with severe varus deformity of knee during primary total knee arthroplasty (TKA). In this case report we have achieved good stability and alignment with unconstrained posterior stabilised TKA in unstable knee with severe varus deformity and with significant bone loss without preferring constrained options as these have concerns for longevity and difficult revision surgery. 72 years male had complaints of severe pain, swelling, deformity in both knees since 1 year and bed ridden from 6 months. History of similar complaints from past 10 years. Physical examination revealed severe varus deformity, diffuse swelling, tenderness, restricted range of movements, crepitus in bilateral knee joints. Pre anaesthetic check-up revealed patient was known coronary artery disease, on pacemaker since 7 years so anaesthetist advised to go for staged total knee replacement. Total knee replacement using unconstrained posterior stabilised implants with a long tibial stem was done, extreme varus deformity was corrected, osteophytes loose bodies removed, posteromedial tibial bone defect was repaired with cement and screw construct. It is concluded that in extreme varus deformity of the knee, if proper step-wise release is done, we can balance the knee without using constraint implants. Bone defects can be reconstructed using cement or augment. In this case, we used cement and screw construct, and the results were satisfactory. The increasing amount of evidence that supports the use of long-stem total knee replacement for complex knee osteoarthritis (OA) presentations is strengthened by this case report. While an extended period of observation is required to assess the longevity of implants.

Distal humerus fractures caused during amateur arm wrestling-a case report and literature review

Ali A. Burhani, Shreyas B. L., Akash Bansal — Mon, 25 Aug 2025 00:00:00 +0530

Arm wrestling is a popular game played worldwide due to its basic nature and though many sports injuries can be associated with arm wrestling, humeral shaft fractures are the most common in adults. These injuries are more common in amateur arm wrestlers due to improper technique and lack of experience. This generates an axial torque on the humerus with shoulder stabilized and elbow fixed in flexion, which can lead to humeral fractures. We present such a case of 21-year-old young man presenting to our department of orthopaedics, GMC Kota with complaints of pain, swelling and deformity in right arm following an arm-wrestling match. We planned for operative intervention by open reduction and internal fixation with locking compression plate (LCP) based on the patient's choice and preference after explaining consent and all treatment modalities. Good union and post op recovery was achieved.

Beyond the terrible triad: a rare case of complex elbow injury and its surgical approach

Devinder Kumar, Kunal Goel, Lokesh Thakur, Virender Singh, Neelam Kumari — Mon, 25 Aug 2025 00:00:00 +0530

This case report presents a rare and complex elbow injury that expands the conventional scope of the "terrible triad" pattern. A 21-year-old male sustained high-energy trauma resulting in posterior elbow dislocation, radial head and coronoid process fractures, intra-articular distal humerus fractures involving the trochlea and capitellum, and a midshaft ulna fracture. Surgical management was performed using the posterior trans olecranon approach. The ulnar shaft fracture was stabilized by using a locking reconstruction plate and interfragmentary screw fixation. Intra-articular fractures were reduced and fixed using Herbert screws followed by dual-column plating of the distal humerus. The lateral collateral ligament was repaired, and olecranon osteotomy was fixed with tension-band wiring. A structured rehabilitation protocol was implemented postoperatively. At nine months, the patient returned to light activity with fair range of motion and no complications. This case highlights the importance of individualized surgical planning and early rehabilitation in managing complex elbow injuries that transcend the traditional definition of the terrible triad. The use of a trans-olecranon approach, stable fracture fixation, and anatomical articular reconstruction are the key elements for achieving satisfactory functional outcomes.