International Journal of Research in Orthopaedics

Vitamin D deficiency and risk of postoperative complications in joint arthroplasty: a meta-analysis

Rohit Tyagi, Ashish Dubey, Aayushi Khurana, Gaurav Verma, Divyanshu Goyal — Tue, 24 Jun 2025 00:00:00 +0530

Vitamin D deficiency is prevalent among patients undergoing joint arthroplasty and may influence surgical outcomes. This meta-analysis aimed to evaluate the association between preoperative vitamin D deficiency and postoperative complications following joint arthroplasty. A systematic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science and Scopus from inception to January 2025. Random-effects models were used to calculate pooled odds ratios (ORs) and standardized mean differences (SMDs). Subgroup analyses were performed based on study design, joint type, vitamin D threshold and follow-up duration. Twenty-three studies (8,762 patients) were included. Vitamin D deficiency was significantly associated with increased risk of overall postoperative complications (OR 2.18, 95% CI 1.76-2.69), periprosthetic joint infection (OR 2.83, 95% CI 2.05-3.91), superficial surgical site infection (OR 1.89, 95% CI 1.45-2.47), aseptic loosening (OR 1.76, 95% CI 1.38-2.25), prosthetic dislocation (OR 1.82, 95% CI 1.31-2.53) and revision surgery (OR 2.25, 95% CI 1.72-2.94). Functional outcomes were significantly worse in vitamin D-deficient patients at 6 months and 12 months postoperatively. The association between vitamin D deficiency and complications was strongest with the <10 ng/mL threshold. Preoperative vitamin D deficiency is significantly associated with increased risk of multiple complications and poorer functional outcomes following joint arthroplasty. The risk appears to increase with the severity of deficiency suggesting that vitamin D status represent a modifiable risk factor. Future research should investigate whether preoperative vitamin D supplementation can reduce complication risk and improve outcomes.

Extensor hallucis longus tendon rupture and reconstruction using allograft tendon: a case report and literature review

Gur Aziz Singh Sidhu, Isabel Bodgener, Jagmeet Singh Bhamra — Tue, 24 Jun 2025 00:00:00 +0530

This case report examined tendon reconstruction using allograft as a treatment approach for chronic extensor hallucis longus (EHL) tendon ruptures, an area with limited existing research. Two cases were discussed to evaluate this method’s effectiveness. The first case involved a 27-years-old male (Patient A) with an EHL tendon tear with retraction up to 2.2 cm and an additional 1.6 cm gap in the extensor hallucis brevis (EHB) tendon confirmed on imaging. The second case was a 28-years-old female (Patient B) with a spontaneous rupture of the left EHL tendon tear with retraction to the tarsometatarsal joint and proximal attenuation extending to the ankle joint. Both patients received reconstruction with an allograft, performed using Kessler’s technique, reinforced with epitenon sutures. Postoperatively, they remained non-weight bearing for four weeks with early range of motion. At the 3-months follow-up, both patients demonstrated active hallux extension and full range of motion, reporting no discomfort during daily activities. Improvements were noted on the American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale and Foot and Ankle ability Measure (FAAM) scores, including the Activities of Daily Living and Sports subscales.

Surgical intervention for peripheral plexiform schwannoma of the sciatic nerve: a pediatric case study

Pawan P. Nath, Adnan Shariq, Majid H. Alhammadi — Tue, 24 Jun 2025 00:00:00 +0530

Plexiform Schwannoma, or neurilemmomas, is a rare and benign manifestation of peripheral nerve sheath tumors. The tumor mostly arises from the gradual growth of Schwann cells. These nerve tumors occur in several sites, with the most prevalent being the head, or neck, or even upper extremities. This tumor predominantly manifests in individuals aged 30 to 40 years and is seen equally in both sexes, with these tumors generally measuring less than 2 cm in size. A 14-year-old boy was referred to Oriana Specialty Hospital, Sharjah, UAE, with a one-year history of vague pain in the middle third posterior aspect of the right thigh accompanied by mild tenderness but no peripheral neurological deficit. Magnetic resonance imaging (MRI) of the right thigh revealed a lesion, and a true-cut biopsy confirmed the diagnosis of a peripheral plexiform Schwannoma arising from the sciatic nerve. On 29 December 2024, a surgical excision of the right thigh sciatic nerve Schwannoma was carried out. A posterior midline thigh incision was made, and the procedure was done with advanced techniques, including the use of a microscope and intraoperative nerve stimulator, to ensure precise tumor dissection from the sciatic nerve. The entire Schwannoma, measuring 24×5.5 cm, was successfully excised. There were excellent recoveries post operatively with no neurological deficits or complications of surgery. He was mobilized with full weight-bearing three hours after the surgery and discharged the next day on oral medications. This particular case testifies to the complete excision of a tumor through proper surgery techniques, preserving the neurological function, with promising outcomes for similar cases.

Simultaneous anterior shoulder dislocation and Salter Harris type 2 fracture in Senegalese wrestling match

Ibrahima S. Camara, Hawa L. Diallo, Mamady S. Conde, Mohamed Hachim — Tue, 24 Jun 2025 00:00:00 +0530

Anterior shoulder dislocation with proximal humerus fracture in children is rare. We report the case of a 16 years old boy with anterior shoulder dislocation and proximal humerus fracture separation Salter Harris type 2. A 16 years old boy, right-handed, was involved in a wrestling accident. He was received for delayed left shoulder traumatism associated with a filling of the deltopectoral groove, an emptiness of the glenoid cavity without axillary nerve impairment. Anterior shoulder dislocation with Proximal humerus fracture-separation type 2 Salter Harris was made. The dislocation was reduced through external manoeuver. A Kirschner wire fixation was done for both the fracture and the glenohumeral joint. At the last follow up, the shoulder was painless, stable, with satisfactory motion. The consolidation was obtained. Anterior shoulder dislocation with proximal humerus fracture separation Salter Harris type 2 is rare. Good management restores shoulder motion and function.

Symptomatic hamulus-pisiform coalition in a 53-year-old woman with a flexor carpi ulnaris pain

Hamza Habbachich, Alexandre Ladjimi, Marta Malinowska, Wissam Elkazzi — Tue, 24 Jun 2025 00:00:00 +0530

Hamulus-pisiform coalition is a rare form of carpal bone fusion that is usually asymptomatic but can occasionally cause chronic wrist pain and ulnar neuropathy. We present the case of a 53-year-old woman with persistent ulnar-sided wrist pain lasting over a year despite multiple corticosteroid injections and physiotherapy. Imaging confirmed a complete osseous fusion between the pisiform and hamulus of the hamate bone, accompanied by moderate chronic enthesopathy of the flexor carpi ulnaris tendon. Due to ongoing symptoms and failure of conservative management, surgical excision of the coalition was performed. Three weeks postoperatively, the patient experienced complete pain relief and full recovery of wrist range of motion. This case emphasizes the importance of considering hamulus-pisiform coalition as a possible diagnosis in patients presenting unexplained ulnar-sided wrist pain nonresponding to conservative treatment.

Dual plate fixation for combined mid-clavicle fracture and acromioclavicular joint injury: a case report

Islam M. Alsayed, Marya W. Alhammadi, Biju P. Aliyarukunju, Ahsan Butt — Tue, 24 Jun 2025 00:00:00 +0530

This case report presents a rare injury involving a combined mid-clavicle fracture and acromioclavicular (AC) joint injury. While conservative management is typically recommended for Rockwood's grade I and II AC joint injuries, surgical intervention is commonly advised for grade IV, V, and VI injuries. However, there is limited literature addressing the management of mid-clavicle fractures in conjunction with ipsilateral AC joint injuries.

Irreducible ankle fracture dislocation: a case report of posterior tibial tendon entrapment

Tue, 24 Jun 2025 00:00:00 +0530

Ankle fracture-dislocations are complex injuries that often involve displaced bones and significant soft tissue damage. In rare instances, the posterior tibial tendon can become incarcerated in the tibiofibular space, complicating standard reduction techniques. We present the case of a 61-year-old man who, eight weeks after a traffic accident, exhibited a Gustillo-Anderson IIIA open fracture-dislocation of the right ankle. Initial treatment involved wound debridement, external fixation, and fibular osteosynthesis. However, postoperative radiographs revealed persistent anterolateral displacement of the talus and widening of the medial clear space, necessitating further investigation. During definitive tibial fixation, the posterior tibial tendon, which had initially been missed, was found to be trapped between the tibia and fibula. Using an anteromedial approach, the tendon was successfully repositioned behind the medial malleolus. The patient experienced an uneventful recovery, achieving full ankle function and strength by 12 weeks, with stable fracture healing confirmed on radiographs. This case underscores the critical importance of early recognition of posterior tibial tendon entrapment in ankle fracture-dislocations, as delayed diagnosis can result in severe long-term complications.

Fat embolism syndrome before surgical treatment of open tibial and fibular shaft fracture: a case report

Kareem S. Khalil, Samah A. Ibrahim, Nada A. Yakout — Tue, 24 Jun 2025 00:00:00 +0530

A 26-year-old male with no significant medical history sustained open fractures of the left tibia and fibula following a workplace accident. Initially alert and stable, he developed sudden neurological deterioration (GCS 9/15) 10 hours post-injury, without respiratory compromise or cutaneous signs. CT was unremarkable; diffusion-weighted MRI revealed widespread acute cerebral infarcts. No intracardiac shunt was found on echocardiography. Supportive care led to gradual neurological improvement, and successful surgical fixation followed. Isolated cerebral fat embolism can precede orthopedic intervention and present without classic signs. Early neuroimaging and high clinical vigilance are crucial for prompt diagnosis and management.

Flap-sparing approach to pediatric hand wound management with acellular dermal matrix, skin grafting and vacuum-assisted closure: a case report

Ankur B. Shinde, Ashok Ghodke — Thu, 08 May 2025 00:00:00 +0530

Severe pediatric hand injuries with exposed tendons and vessels have traditionally been managed using flap coverage. Flap surgeries in young children can be technically demanding, associated with donor site morbidity. Emerging evidence supports alternative reconstructive strategies using dermal substitutes and advanced wound therapies. We report a case of a 3-years-old male with a 3×2 cm anterolateral hand laceration exposing thenar muscles, tendons and vessels following road traffic trauma. Initial primary closure failed. The wound was managed with debridement, application of vacuum-assisted closure (VAC) therapy, placement of an acellular dermal matrix (ADM), split-thickness skin grafting (STSG) and VAC reapplication. Functional and aesthetic outcomes were documented. The wound healed with complete graft take and without the need for flap coverage. The patient regained full hand function with satisfactory cosmetic appearance. No complications such as infection, graft loss or contracture were noted at 1 month follow-up. The ADM facilitated neodermis formation over exposed tendons, allowing successful skin grafting. ADM combined with STSG and VAC therapy provided an effective alternative to flap surgery for pediatric hand wounds with exposed structures. This method can simplify management, reduce morbidity and preserve excellent functional outcomes in young patients.

Surgical encounter with radial nerve dysmorphogenesis in the arm: a case-based analysis and its operative implications

Fri, 16 May 2025 00:00:00 +0530

Radial nerve palsy is a well-recognized complication of mid-shaft humeral fractures, with an incidence of 7% to 17%. Although most cases resolve spontaneously, anatomical variations in the radial nerve may complicate surgical management and increase the risk of iatrogenic injury. We report the case of a 42-year-old male who sustained a closed mid-shaft fracture of the left humerus following a road traffic accident, presenting with partial wrist and finger drop and diminished sensation over the first webspace in the dorsum of the hand. Surgical fixation was performed via posterior approach. Intraoperatively, multiple aberrant radial nerve branches with an unusual intramuscular course were identified in the posterior aspect of arm. Careful dissection with decompression and preservation of these aberrant branches were done without tension. The patient showed progressive neurological improvement over the ensuing weeks. By two months postoperatively, there was complete recovery of motor and sensory function in the radial nerve distribution with the patient resuming normal activities. This case highlights the significance of preoperative preparedness and intraoperative vigilance in the presence of radial nerve palsy associated with humeral shaft fractures. Awareness of potential anatomical variations in the radial nerve branching pattern is critical for preventing iatrogenic injury and ensuring favorable neurological outcomes.

A case report of rare incidence of benign vascular lesion of hand masquerading magnetic resonance imaging findings

Pallav S. Mehta, Aastha R. Gohil — Tue, 24 Jun 2025 00:00:00 +0530

Vascular anomalies of hand can present as soft tissue swelling and can be one of differential along with the common ones’ ganglion cyst, giant cell tumor (GCT), and epidermoid cyst. It can be hemangioma or vascular malformation, they differ based on histological, clinical and biological characteristics. A 65-year-old male presented with swelling in right little finger dorsal part since one month. It was insidious in onset and not associated with pain or trauma. Vascular lesions of hand should be kept in mind as one of differential while examining swellings of hand. Initial investigation like ultrasonography (USG), X ray, magnetic resonance imaging (MRI) and fine needle aspiration cytology (FNAC) should always be followed by excisional histopathology for confirmation and labelling the diagnosis.

An uncommon presentation of aneurysmal bone cyst in spine of scapula: a rare case report

Ashraf Jamal, Arun Prashanth, Probin Joseph, Pragash, Muhammed Raffath — Tue, 24 Jun 2025 00:00:00 +0530

Aneurysmal bone cyst is locally aggressive benign osteolytic lesion of the bone. It is more common in second decade of life with slight inclination to female gender. Metaphysis of long are most commonly affected. Incidence in flat-bones is <2% especially in scapula. We present a rare case of aneurysmal bone cyst of scapula with atypical radiological finding that was confirmed with pathological correlation. A 45 years old female, right hand dominant, presented with 3 months old swelling over left shoulder. There was painful restriction of terminal shoulder range of movements. On examination the swelling was 8×7 cm cystic, non-trans illuminant, fixed to scapula, no neurovascular deficit. X-ray shown eccentric lytic lesion over the supraspinous fossa with relatively more prominent soft tissue shadow. MRI image shown well defined cystic swelling with fluid filled level, lacking septations. Excision and extended curettage of lesion revealed hematogenous fluid as content. Histopathology confirmed aneurysmal bone cyst. Our case presented with all atypical features of ABC with regards to age, location and imaging. High degree of clinical suspicion and ruling out other closest possibilities like telanectatic osteosarcoma is necessary when cystic swelling around the scapula is encountered. Excision and extended curettage of the lesion is satisfactory. Periodic follow up with MRI and long-term clinical assessment for recurrence is needed.

Arthroscopic synovectomy with loose bodies removal in a case of synovial chondromatosis of knee joint

Karthik B., Palanivelrajan, B. P. Sharma, Vineeth Jain, Hitesh Lal, Vishnu S. — Tue, 24 Jun 2025 00:00:00 +0530

Synovial chondromatosis is a rare condition which affects the synovial joints, tendon sheath, bursa. Mostly commonly seen in 3rd to 5th decade with male predominance. The exact etiology is unknown. usually manifest clinically as synovitis. Clinical evaluation with appropriate radiological evaluation is necessary for the diagnosis. Surgical intervention is appropriate either open or arthroscopic. It involves arthrosopic loose body removal with extensive synovectomy. Histopathological evaluation is required for confirmation of diagnosis. Long term follow up is needed

Subtrochanteric femur fracture with pre-existing ipsilateral hip arthritis treated with long stem total hip arthroplasty: a case report

M. Faisal, Padmanabh N. Kukde, Akshay J. Atilkar, Vivek O. Maurya — Tue, 24 Jun 2025 00:00:00 +0530

High velocity trauma involving fractures of lower limbs is one of the most common causes of morbidities in young and working population in developing countries. Amongst these injuries, subtrochanteric femur fractures are the one that cause significant impact on the lifestyle. The strong deforming forces across the fracture makes it difficult to achieve the reduction. The entire outcome depends on the adequate reduction and the stable fixation of the fracture. The longer duration required for the recovery causes significant morbidity and imparts financial burden on the families. Additionally, the presence of hip arthritis worsens the situation and limits the use of implants like intra-medullary nails. Arthroplasty has been defined in the literature for such situations. Arthroplasty remains one of the good options in such patients that address both fracture as well as arthritis providing a stable, mobile and painless hip. Here, we report a case of hip arthritis with subtrochanteric femur fracture treated with total hip arthroplasty.

Bilateral neck of femur fracture induced by osteomalacia secondary to phosphaturic mesenchymal tumor of paranasal sinus: a case report

Shamseer K. V., Radhesh Nambiar — Tue, 24 Jun 2025 00:00:00 +0530

Phosphaturic mesenchymal tumors (PMTs) are rare, often occult neoplasms that cause tumor-induced osteomalacia (TIO) due to excessive fibroblast growth factor 23 (FGF23) secretion, leading to phosphate wasting, hypophosphatemia, and impaired bone mineralization. This results in progressive skeletal fragility and increased fracture risk. We present a 53-year-old male with bilateral femoral neck fractures following a trivial fall, accompanied by generalized myalgia. MRI of the hip and pelvis revealed bilateral femoral neck fractures with sclerotic changes in the superior and inferior pubic rami, sacral ala, and bilateral iliac wings. Laboratory investigations confirmed severe hypophosphatemia and osteomalacia. Further imaging and biopsy identified a phosphaturic mesenchymal tumor in the right anterior ethmoidal sinus as the underlying cause. The patient underwent bilateral femoral neck fracture fixation with cannulated cancellous (CC) screws, along with vitamin D and phosphate supplementation. The PMT was surgically resected to correct the metabolic disorder. Postoperatively, the patient demonstrated significant clinical and biochemical improvement. This case highlights the critical need to consider PMT in patients presenting with unexplained fractures and persistent hypophosphatemia. Early detection, surgical resection of the tumor, and appropriate metabolic correction are essential for optimal recovery and fracture healing.

Primary ligament repair in unstable elbow dislocations: a case report

Manan Shroff, Sanjay Soni, Saptak Mankad, Dhruv Sharma, Shivam Sharma — Tue, 24 Jun 2025 00:00:00 +0530

The second most commonly affected joint, when it comes to joint dislocations, is the elbow joint. These injuries can usually be treated non surgically, but the complexity of the injury can increase chronic pain and instability requiring surgical intervention. There isn’t enough evidence-based recommendation on the ideal treatment approach in acute elbow dislocations, hence, we bring forth a case report on the same. A 54-year-old male presented with a left elbow dislocation from a road traffic accident experiencing a fall on an outstretched hand and elbow. The patient complained of pain and restricted movements of the left elbow, scoring a 7 out of 10 on the Visual Analogue Scale. Examination confirmed restricted movement and tenderness along with paraesthesia in the region of the left ulnar nerve supply. Vascular integrity was maintained distal to the injury. Imaging showed closed postero-lateral elbow dislocation. Closed reduction under anesthesia was performed which revealed joint instability, leading to the soft tissue surgical repair along with complete elbow reduction. A medial approach for repair of medial ligament and lateral approach for repair of lateral ligament complex and anterior capsule repair was undertaken. Four-week follow-up revealed to have restored range of motion at the elbow joint with significant improvements in joint stability. An ideal treatment approach to elbow dislocations has yet to be decided upon based on the literature. However, common consensus dictates that simple elbow dislocations with joint instabilities warrant surgical intervention to prevent chronic joint instabilities and recurrent dislocations.

En bloc resection of aneurysmal bone cyst at proximal fibula in skeletally immature individual presented with neuropraxia: a case report

Aakash Bansal, R. P. Meena, Umesh K. Meena, Prince Singh — Tue, 24 Jun 2025 00:00:00 +0530

Aneurysmal bone cysts (ABCs) are usually benign but locally destructive, blood-filled reactive lesion of the bone. Although a wider age group may be affected, usually they are seen in patients less than 20 years of age, with a more female preponderance. Most common sites include metaphysis of femur, proximal leg bone and then humerus. Aneurysmal bone cyst of proximal end of fibula is a rare and uncommon. Here, we report a case of 17-year-old female with classic histologic, clinical, and radiographic findings that was treated by en bloc resection.

Outcome of talonavicular arthritis treated with platelet rich plasma injection: a case report

Tanari Bhargavi, Venugopala R. Pondugula — Tue, 24 Jun 2025 00:00:00 +0530

Osteoarthritis of the talonavicular (TN) joint, which can result from inflammatory, degenerative, or post-traumatic arthritis, is frequently reported. TN arthritis causes pain, swelling, and stiffness in the joint. Early diagnosis is crucial, typically using X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRIs) to detect joint damage. Treatment often involves pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs). If these methods don't provide relief, isolated fusion (arthrodesis) of the TN joint is often recommended as a treatment option. There are no published reports describing the use of platelet rich plasma (PRP) for treating TN arthritis. A 45-year-old female presented with persistent right foot pain for one year following a twisting injury. Radiographs showed joint space narrowing, osteopenia, and peripheral osteophytes at the TN joint. PRP was prepared using a two-step centrifugation process and injected under C-arm guidance into the TN joint. The patient was followed for two years and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, which improved from 68 to 90. No adverse events were reported. This case highlights the potential of PRP as a minimally invasive treatment option in early-stage TN arthritis. It adds to the growing evidence supporting intra-articular PRP injections for small joint osteoarthritis, as also supported by recent studies on ankle and talar cartilage degeneration. PRP may serve as a safe and effective alternative to surgery in selected patients with TN arthritis. Further research is warranted to establish standardized treatment protocols.

Parallel tunnel ligamentopexy-a novel technique for medial collateral ligament deficiency in primary total knee arthroplasty: a case study

Natesh Kolusu, Sudheer Kumar Pothu, Vannala Raju — Tue, 24 Jun 2025 00:00:00 +0530

Managing medial collateral ligament (MCL) deficiency in primary total knee arthroplasty (TKA) remains a challenge, often necessitating constrained implants or revision prostheses. We present an innovative technique, Parallel Tunnel Ligamentopexy, which stabilizes the MCL without requiring revision implants, thus preserving native structures and reducing bone loss. A 68-year-old male with severe varus deformity and grade 4 osteoarthritis of the left knee presented with progressive difficulty in ambulation and performing daily activities. Radiographic evaluation confirmed knee subluxation. The patient underwent left-sided TKA. Intraoperatively, a femoral attachment deficiency of the MCL was observed. Parallel tunnel ligamentopexy was performed by whip-stitching the residual MCL, creating two parallel 2-mm tunnels in the lateral distal femur, and securing the MCL using these tunnels. This approach was preferred over semitendinosus augmentation, given its reduced risk of supracondylar femoral fractures and improved suitability for osteoporotic bones. The patient was mobilized on postoperative day 1. The varus deformity was corrected, and knee stability was maintained. At six months follow-up, clinical and radiological evaluations demonstrated no signs of MCL laxity. The patient resumed daily activities independently, highlighting the efficacy of Parallel Tunnel Ligamentopexy in preserving knee stability without requiring a constrained implant. Parallel Tunnel Ligamentopexy is a cost-effective, biologically favorable solution for MCL deficiency in primary TKA. This technique avoids constrained implants, minimizes bone loss, and optimizes functional outcomes, particularly in osteoporotic patients.

Endoscopic calcaneoplasty with flexor hallucis longus transfer for the management of Haglund syndrome

B. Valya, P. Savithri Devi, N. Bhavya, S. Dharma Teja — Sat, 17 May 2025 00:00:00 +0530

Haglund syndrome consists of a triad of posterosuperior calcaneal exostosis (Haglund deformity), retrocalcaneal bursitis, and insertional Achilles tendinopathy. Endoscopic resection of this prominence along with flexor hallucis longus (FHL) transfer is a novel technique for the treatment of Haglund syndrome. The purpose of this study is to evaluate the outcome of 10 patients presenting with Haglund disease treated by an endoscopic Haglund resection and FHL transfer. In this study, from April 2023 to August 2024, we have taken up 10 patients presenting with heel pain, diagnosed as insertional Achilles tendinopathy (IAT) with Haglund’s based on clinical findings of tenderness along Achilles tendon 2 cm proximal to the point of insertion and radiographs, with failed conservative treatment. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. A mean of 71.2 preoperative AOFAS-hind foot score which showed a significant improvement postoperatively to 3 (VAS), 82 (AOFAS) at the end of 1.5 months, 2 (VAS), 96 (AOFAS) at the end of 4 months and 1 (VAS), 97 (AOFAS) at 6 months respectively. Endoscopic calcaneoplasty with FHL transfer is a minimally invasive technique which has led to a significant improvement in preoperative and postoperative AOFAS scores and has resulted in faster recovery times with less complications.

Functional outcome of cauda equina syndrome treated by decompression and transforaminal lumbar interbody fusion in 11 cases: a case series

Vikaas Ethanur Thuppale, Ranjith Unnikrishnan — Tue, 24 Jun 2025 00:00:00 +0530

The unspecific description and definition of Cauda Equina syndrome (CES) in literature gives rise to a quantum of doubts regarding its decision making and management in clinical practice. Prospective analysis of 11 cases of CES, between Jan 2015 and Sep 2017, who had been treated with Decompression and Transforaminal Lumbar Interbody Fusion, was done. The varied presentations were studied and the following parameters were assessed in the evaluation of the functional outcome of each patient: Pain (assessed by the VAS-Visual Analogue Scale), Motor status (assessed by the MRC grading), Bladder recovery (graded as per Gleave and Macfarlane) and the Oswestry Disability Index. Our analysis of the results supported the following points: Increased duration of symptoms had a negative effect on the ODI at 3 months and 1 year, the denser the neurological deficit, the worse was the ODI score at 3 months and 1 year; age>60 years had a negative effect on the ODI score at 3 months and 1 year, time to surgery since presentation had no significant effect on the overall functional outcome and ODI at 1 year, the mean VAS (Visual Analogue Scale) was drastically low at the end of 1 year with most of the patients almost free of back pain at the end of 1 year, bladder recovery was also related to the duration of symptoms and the age of the patient, as increasing age and longer duration of the deficits had a negative impact on the bladder recovery ultimately.

Functional outcome of subtalar arthrodesis using compression screws in cases of subtalar arthritis

Tue, 24 Jun 2025 00:00:00 +0530

Subtalar arthritis, which frequently results from fractures that are inadequately reduced surrounding the talus or calcaneus, induces chronic pain, rigidity and functional impairment. Subtalar arthrodesis is a conventional therapy for subtalar arthritis. Subtalar arthrodesis employs compression screws to facilitate the joint fusion, which may serve as an alternative. We conducted a retrospective analysis of 20 patients having subtalar arthritis who underwent subtalar arthrodesis with compression screws between September 2022 and January 2024. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were the primary outcomes that were assessed before and after surgery. Seventeen out of twenty patients that performed subtalar arthrodesis were able to achieve an effective fixation at the arthrodesis location. The success rate was 85%, with 17 of the 20 patients achieving successful fusion. The AOFAS scores improved about a mean of 65 prior to surgery to 88 and 93 at six and 10 months postoperatively, correspondingly, with a mean time to fusion of 16 weeks. High fusion rates and substantial AOFAS score improvements are indicative of the efficacy of subtalar arthrodesis with compression screws in enhancing functional outcomes and alleviating pain in patients having subtalar arthritis.

Functional recovery and quality of life after surgical fixation of segmental femoral shaft fractures: a case series from India

Haemanath Pandian, Silambarasi Nagasamy, Chockalingham Kasi, Prashanth Pandian — Tue, 24 Jun 2025 00:00:00 +0530

Segmental femoral shaft fractures, which are often a result of high-energy trauma, pose significant challenges in management and rehabilitation. This case series presents twelve male patients (mean age 40 years, range 28-52) with segmental femoral shaft fractures treated between October 2022 and March 2023 at tertiary care centers in Tamil Nadu, India. Surgical fixation methods included intramedullary interlocking nails (58.3%), locking plates (25%), and other constructs (16.7%), with all patients undergoing open reduction. Functional recovery and quality of life were assessed using WOMAC, EQ-5D-3L, and SMFA scores at 1, 3, and 6 months postoperatively. Significant improvements were observed across all measures, with mean WOMAC scores decreasing from 55.6 (±6.5) to 18.2 (±5.9), EQ-5D-3L scores improving from 0.62 (±0.10) to 0.91 (±0.06), and SMFA dysfunction index decreasing from 41.4 (±5.3) to 12.6 (±3.9) over six months. Radiological union was achieved in 33.3% of cases at 3 months and in all remaining eleven patients (one lost to mortality from associated injuries) by 6 months, with a mean union time of 23.7 weeks. This case series demonstrates that appropriate surgical fixation of segmental femoral shaft fractures can yield favorable functional outcomes and quality of life improvements, with complete radiological union achievable within six months in this challenging fracture pattern.

Assessment of the role of manipulation under anaesthesia in knee stiffness following total knee arthroplasty

Rakesh Rajput, Kunal Kanti Pal, Debangshu Kumar — Tue, 24 Jun 2025 00:00:00 +0530

About 3-4% of all total knee arthroplasty (TKA) patients develop unfortunately develop stiff knee. There is inadequate understanding of risk factors and a lack of consensus regarding its management protocol. This study aims to assess the risk factors and outcome of manipulation under anaesthesia to treat stiff knee following TKA. 18 knees with stiffness following primary TKA were enrolled in this study who underwent manipulation under anesthesia (MUA) between January 2023 and April 2024. Patient demographics, type of surgery (conventional or robotic), contributing factors and knee motion before and after manipulation were assessed from hospital records. Final FFD and arc of motion was recorded in a follow-up clinic. Female patients were significantly more affected than male. Delayed physiotherapy due to comorbidities was associated with stiffness. 72.22% stiff knee patients had conventional surgery while rest had robotic assisted surgery. Manipulation under anaesthesia led to mean 31.11degree improvement in arc of motion immediate post manipulation and 26.39 degree in final follow-up. There was no complication during MUA. MUA is safe, effective and noninvasive and can be considered as a first line treatment for stiff knee following TKA.

Optimization of surgical fixation in cervical spine fractures using advanced imaging techniques: a systematic review of functional and neurological outcomes

Sat, 31 May 2025 00:00:00 +0530

Cervical spine fractures are high-stakes injuries with substantial risks of permanent neurological damage and disability. Traditional imaging methods, including plain radiographs and fluoroscopy, are limited by low sensitivity and spatial resolution. This systematic review assesses the impact of advanced imaging specifically preoperative MRI, CT and intraoperative navigation systems on surgical fixation accuracy and patient outcomes. In methodology, we followed PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Scopus and Web of Science from 2010 to 2024. Eligible studies included adult patients with cervical spine trauma undergoing surgical fixation with reported outcomes in screw accuracy, neurological recovery (ASIA scores) or functional status (JOA, NDI, SF-36). Data were synthesized and quality assessed using the Newcastle-Ottawa Scale. In results, eleven studies (n=1,220 patients) met inclusion criteria. Intraoperative CT-based navigation consistently improved screw accuracy (up to 98.1%), reduced malposition and operative times and minimized radiation to staff. MRI influenced surgical decision-making in elderly and neurologically impaired patients, particularly by identifying occult cord compression and reducing surgical delay. Select studies reported functional gains, including ODI improvements from 67.1% to 25.6% and VAS pain reduction from 8.2 to 2.2. Advanced imaging modalities significantly enhance surgical precision and contribute to improved patient safety and recovery in cervical spine trauma. Their integration into surgical planning supports evidence-based, patient-centered care, especially in high-risk or anatomically complex cases.

Surgical drains following arthroplasty: a systematic review and summary of evidence based on available systematic reviews

Rupin S. Singapanga, Rayeez Ahmed, Ajay N. Samuel — Tue, 10 Jun 2025 00:00:00 +0530

The use of surgical drains following arthroplasty is an age-old practice, but has declined in popularity in recent times. Various aspects pertaining to their safety and efficacy have been studied in the past, in focused studies and systematic reviews. The present research aimed to review and summarize the high-quality evidence on the subject. A described methodological framework for conducting a “systematic review of systematic reviews” was chosen, and reporting was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Following a search in the PubMed/Medline and PubMed Central indexing databases, a total of 34 systematic reviews with or without meta-analyses were included. Our research unequivocally indicates that routine drain application is not associated with a reduction in the incidence of postoperative hematoma formation or limb swelling, though it unambiguously results in a significant reduction in the incidence of surgical site erythema and ecchymoses, and the need to change wound dressings postoperatively. This benefit, however, comes at the expense of the possibility of increased blood loss, transfusion requirement, and time to functional recovery, as well as the deterrence to a full implementation of the principles of “enhanced recovery after surgery” protocols and day-care surgery. Where drains are deemed inevitable, the practice of intermittent clamping can mitigate the magnitude of blood loss, while autologous re-transfusion drains may reduce blood transfusion requirements.

Randomized and double-blinded controlled trial: percutaneous trigger finger release concomitant steroid injection versus percutaneous trigger finger release alone

Tue, 24 Jun 2025 00:00:00 +0530

Background: Corticosteroid injection is a common nonoperative treatment that provides immediate pain relief but carries a risk of recurrence. Percutaneous A1 pulley release is a minimally invasive alternative to open surgery, offering comparable outcomes. However, postoperative pain remains a concern. This study evaluated the effect of combining corticosteroid injection with percutaneous A1 pulley release on postoperative pain control compared to percutaneous release alone. Objective was to compare early postoperative pain control, quality of life, and complications between percutaneous A1 pulley release alone and with corticosteroid injection.

Methods: This was a randomized, double-blinded controlled trial including 76 patients diagnosed with trigger finger. Participants were randomly assigned to group A (percutaneous A1 pulley release with corticosteroid injection, n=36) or group B (percutaneous A1 pulley release alone, n=40). Primary outcome measures included postoperative pain scores (visual analog scale, VAS), while secondary outcomes assessed quality of life (quick disabilities of the arm, shoulder, and hand score, qDASH), patient satisfaction, and complications.

Results: A total of 76 patients were enrolled, with no significant differences in baseline characteristics between groups. Pain scores (VAS) decreased in both groups from day 1 to day 3 (group A: 5.33 to 4.11; group B: 6.90 to 5.00, p>0.05). However, group A exhibited significantly lower pain scores from postoperative day 4 to 6 (1.78 versus 4.00, p<0.05), a trend that persisted through weeks 1 and 2, as well as at 1 and 2 months postoperatively. Quality of life (qDASH) and patient satisfaction were slightly higher in group A, but differences were not statistically significant (p>0.05). No major complications (e.g., infection, nerve injury, tendon rupture, recurrent triggering, or bowstringing) were reported in either group.

Conclusions: The addition of corticosteroid injection to percutaneous A1 pulley release significantly improves early postoperative pain control without affecting functional recovery or patient satisfaction. These findings support the safety and efficacy of corticosteroid injection in reducing postoperative discomfort. Future studies should explore long-term outcomes, recurrence rates, and return-to-work effects.

Distal tibia physeal fractures and premature growth arrest

Tue, 24 Jun 2025 00:00:00 +0530

Background: Distal tibia children’s physeal fractures can cause growth complications, as premature physeal closure (PPC), which is radiographic growth plate closure compared to unaffected side.

Methods: Retrospective analysis of 243 patients, conducted to assess occurrence of physeal growth arrest. The study aims to identify factors associated with risk of PPC, investigate how common these complications are and to identify factors might predict their occurrence. Data of 243 children with distal tibial physeal fractures were reviewed in multiple military hospitals in Jordan between January 2018 and October 2023.

Results: Average follow-up was 37 weeks. PPC occurred in 29 cases (12.1%). Majority of PPC cases (64%) associated with Salter-Harris II fractures (19 cases), 14% in Salter-Harris III (4), 14% in Salter-Harris IV (4 cases), 8% in triplane fractures (2 cases). No cases of physeal arrest found in Salter-Harris I or Tillaux fractures. Cox multivariate regression analysis revealed statistically significant associations between mechanism of injury and PPC, and between degree of initial displacement and PPC. Each millimeter of initial displacement increased relative risk of PPC by 1.15 (P < 0.01). Although trends suggested possible link between residual displacement after reduction or number of reduction attempts and PPC risk, these correlations were not significant.

Conclusions: Recent studies reported higher PPC following distal tibial physeal fractures compared to this cohort. Significant predictors of PPC included extent of initial fracture displacement and mechanism of injury. While trends noted regarding residual displacement and number of reduction attempts, found not significant in predicting PPC.

Outcome of single event multi-level surgery in the treatment of spastic cerebral palsy involving lower limbs

Tue, 24 Jun 2025 00:00:00 +0530

Background: Spastic cerebral palsy (CP) is a leading cause of childhood physical disability, characterized by muscle stiffness and movement limitations, primarily affecting the lower limbs. Single Event Multi-Level Surgery (SEMLS) is considered a gold-standard surgical intervention for managing musculoskeletal deformities associated with spastic CP. However, limited data exist on the effectiveness of SEMLS in low- and middle-income countries (LMICs) like Bangladesh. This study aimed to evaluate the outcomes of SEMLS in children with spastic cerebral palsy involving the lower limbs, focusing on improvements in gait patterns, gross motor function, range of motion (ROM) and postoperative complications.

Methods: A quasi-experimental study was conducted at the National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. A total of 36 children aged 7–16 years with spastic hemiplegic or diplegic CP underwent SEMLS. Outcomes were assessed using gait analysis, GMFCS levels, ROM measurements and complication rates.

Results: Postoperative outcomes demonstrated significant improvements in gait, with 72.22% achieving near-normal gait and 27.78% attaining normal gait. A substantial shift was observed in GMFCS levels, with 63.89% of participants improving to level I. Statistically significant improvements were also recorded in hip, knee and ankle ROM (p<0.001), with minimal postoperative complications observed.

Conclusions: SEMLS is an effective surgical intervention for improving mobility, joint function and overall quality of life in children with spastic cerebral palsy, particularly in resource-constrained settings.

Efficacy of the anterograde calcaneo-stop method in the management of flexible flatfoot in children

Tue, 24 Jun 2025 00:00:00 +0530

Background: Flexible flatfoot is one of frequent foot deformity among pediatric population. The calcaneo-stop procedure has been reported to be effective in short-term studies when conservative treatment is not successful. The aim of this study to evaluate the efficacy after removal of screws following the anterograde calcaneo-stop procedure in the treatment of flexible flatfoot in children.

Methods: This retrospective study consists of 260 calcaneo-stop procedures performed from the period of January 2016 to December 2024 in 65 patients (130 anterograde calcaneo-stop surgeries and 130 removals of calcaneo-stop implant surgeries), which were evaluated clinically, and instrumental diagnostic techniques such as radiography, photoplantography and pedobarography were implemented. The inclusion criteria of this study consist of patients with symptomatic flexible flatfoot, patients with ages from 6 to 14 years, patients with informed consent, patients with negative Wynne-Davies joint hypermobility test and the exclusion criteria of this study includes the following; patients with ages below 6 years and above 14 years, the time elapsed of 3 years after screw implantation, patients with other skeletal deformities, patients without informed consent.

Results: Out of the 130 surgical interventions performed on bilateral flexible flatfoot, which were evaluated in 65 patients after removal the screws following the anterograde calcaneo-stop procedure, revealed no signs of loss correction; which were further evaluated by radiography, photoplantography and pedobarography.

Conclusions: The calcaneo-stop procedure is the least invasive and simplest surgical treatment for symptomatic flexible flatfoot in children. The collected data indicated a sufficiently high efficiency of anterograde calcaneo-stop method in the treatment of flexible flatfoot in children.

Failure rate after primary anterior cruciate ligament reconstructions

Ibrahim M. Alabri, Ali A. Allawati — Tue, 24 Jun 2025 00:00:00 +0530

Background: One of the most common sport injuries is anterior cruciate ligament injury, making anterior cruciate ligament reconstruction (ACL) a very common orthopaedics procedure. Arthroscopic anterior cruciate ligament reconstruction can be performed using auto-graft from different sources like, bone patellar tendon graft, hamstring tendons (semitendinosus with or without gracilis) or peroneus longus tendon.

Methods: A retrospective study of total 230 patients operated from June 2017 until December 2020. All of then underwent primary arthroscopic anterior cruciate ligament (ACL) reconstructions using hamstring tendons auto-graft. The others underwent revision ACL; their primary surgery was done in other hospital.

Results: Statistically, total rate of complications after primary ACL reconstructions, which was defined as the need for revision surgery, was five patients (2.17%) for home revision was done using contra lateral hamstring graft.

Conclusions: A failure rate of 2.17 percent over the reported period of three years falls within reported rates in literature.

Effective outcomes of home-based unsupervised rehabilitation protocol after rotator cuff repair: a prospective study

Jugaratna Khatua, Somnath Baskey, Manmatha Nayak, Gopabandhu Patra — Sat, 17 May 2025 00:00:00 +0530

Background: Rotator cuff tears, common in both elderly and athletic populations, require effective rehabilitation following surgical repair for optimal recovery. The study evaluates the outcomes of a patient-led home-based rehabilitation program after rotator cuff repair.

Methods: This prospective study was conducted at SCB Medical College and Hospital, Cuttack, with 46 patients who underwent rotator cuff repair via mini-open incision. A structured home-based rehabilitation program was followed, with outcomes assessed at one year using visual analogue scale (VAS), disabilities of the arm, shoulder, and hand (DASH) score, range of motion, and cuff strength.

Results: Postoperative VAS score improved from 7.3 to 1.5, and the DASH score decreased from 35.0 to 5.2. Range of motion significantly improved in active abduction, forward flexion, and external rotation. Ninety-one percent of patients returned to work within three months, though five failures were noted, including one with stiffness and four with retear.

Conclusions: The home-based rehabilitation program resulted in significant pain relief and functional recovery, with a high return-to-work rate. The study suggests that home-based rehabilitation is a viable alternative to supervised physiotherapy.

Functional outcome of intracapsular neck of femur fracture treated in elderly with bipolar hemiarthroplasty at tertiary health care center

Sat, 31 May 2025 00:00:00 +0530

Background: Fractures of the neck of the femur are common in the elderly and are expected to rise significantly due to increased life expectancy. While conservative management has limited indications, surgical intervention remains the standard of care. Among surgical options, open reduction and internal fixation have shown high failure rates due to nonunion and avascular necrosis, leading to revision surgeries and increased morbidity. Aim of study was to evaluate the functional outcomes of intracapsular neck of femur fractures in elderly patients treated with cemented bipolar hemiarthroplasty.

Methods: This prospective observational study was conducted at a tertiary care hospital and included 60 patients aged 60 years and above with intracapsular femoral neck fractures. All patients underwent cemented bipolar hemiarthroplasty. Functional and clinical outcomes were assessed using the Harris hip score (HHS) during follow-up visits. Patient consent and comprehensive clinical evaluations were obtained on admission.

Results: The mean patient age was 69.88 years, with 55% females. According to Garden’s classification, 11.7% had grade I/II, 53.3% grade III, and 35% grade IV fractures. At 3 months post-surgery, 45% had poor, 43.3% fair, and 11.7% good functional outcomes.

Conclusions: Cemented bipolar hemiarthroplasty for intracapsular femoral neck fractures in the elderly offers favorable functional outcomes, reduces complications associated with prolonged immobilization, and facilitates early rehabilitation and return to activity.

The clinical outcome of fixation of posterior malleolus fragment in trimalleolar ankle fracture

Tue, 24 Jun 2025 00:00:00 +0530

Background: Trimalleolar ankle fractures are complex injuries that often require surgery. Posterior malleolus fixation is important to restore ankle stability and function. The aim of this study was to evaluate the clinical outcomes associated with posterior malleolus fixation in patients with ankle fractures in the malleolus ankle fracture.

Methods: From 2018 to 2024, clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, range of motion measurements, and radiographic evaluations. Complications and functional recovery were carefully recorded to analyze the effectiveness of posterior malleolus fixation in trimalleolus ankle fractures.

Results: All 100 patients were included in the study. The mean AOFAS score at final follow-up was 85, indicating a significant improvement compared with the preoperative score. Radiographic analysis showed satisfactory alignment and integration of the posterior malleolus fragments in 92% of cases. Complications included minor infections and delayed wound healing in a few cases; however, overall, most patients achieved good results, demonstrating improved ankle stability and functional recovery.

Conclusions: Posterior malleolus fixation in trimalleolar ankle fractures is associated with satisfactory clinical outcomes, increased stability and recovery from work. These findings support the importance of managing the malleolus during surgery for trimalleolus fractures. Further prospective studies are needed to validate these results and improve surgical techniques.

Comparing the outcome of fixation of supracondylar femur fractures using retrograde intramedullary nailing and distal femur locking compression plate

Debanga S. Barua, Tirupati S. Shirdinayak, Mahmoodul Karim, Imran H. Kabir — Tue, 24 Jun 2025 00:00:00 +0530

Background: Supracondylar femur fractures typically occur as a result high energy trauma in young and in elderly after low energy trauma. Retrograde intramedullary nailing (RIMN) and distal femur locking compression plate (DFLCP) are widely used for fixation distal femur fractures. This study was done to compare the clinicoradiological outcome of fixation of supracondylar femur fractures using RIMN and DFLCP.

Methods: In our study with 26 patients fulfilling the criteria were enrolled and one group treated with RIMN while the other group treated with DFLCP and corresponding Functional and radiological assessment done on basis of Neer’s score.

Results: Fractures occurred primarily as a result of RTA in young and self-fall in elderly. Fracture type AO33-A1 was seen more commonly in both groups. The mean duration of surgery, blood loss and bone union time in the RIMN group minutes was less than that the DFLCP group. All fractures in the RIMN group united while three cases of non-union in DFLCP group, with one case of delayed union, one case of periprosthetic implant fracture, and one case of knee joint arthrosis. Local soft tissue complications were more common among DFLCP group. Functional and radiological assessment on basis of Neer’s score was found to be better in RIMN group than the DFLCP group.

Conclusions: RIMN is a better option in the operative treatment of supracondylar femur fractures found to be correct in terms of less soft tissue complications, shorter duration of surgery, less intraoperative blood loss, shorter duration of hospital stays, and fracture union.

Safety and efficacy of the Prakash method in closed reduction of anterior shoulder dislocation

Sanjay Singh Rawat, Rohit Barwar, Sachin Joshi, Anand Kumar — Tue, 24 Jun 2025 00:00:00 +0530

Introduction: Shoulder dislocation is a frequently encountered injury in daily medical practice. Among various types of shoulder dislocations, anterior shoulder dislocation is the most prevalent. Numerous techniques have been proposed for reducing a dislocated shoulder. The objective of this study was to evaluate the efficacy and safety of the Prakash technique in treating patients with anterior shoulder dislocation who sought treatment at our hospital's emergency department.

Methods: This was a prospective study conducted from March 2023 to July 2023 in the Department of Orthopedics in Government Medical College & Associated group of Hospitals, Kota. 50 shoulders fulfilling the inclusion criteria were included in this study, and observations were noted.

Results: After conducting a statistical analysis, it was observed that the new reduction method proved highly effective, successfully reducing 98% of the shoulders without the need for anesthesia. The study included a total of 50 patients, among whom 8 (16%) had left-sided shoulder dislocation, and 42 (84%) had right-sided shoulder dislocation. Notably, the reduction could be accomplished on the first attempt in 45 patients (90%), while a second attempt was required in 4 patients (8%). Fortunately, no complications were observed during the course of the study.

Conclusion: The Prakash method for reducing anterior shoulder dislocation has proven to be a straightforward and effective technique based on our study findings. Due to its success rate and the fact that it doesn't necessitate anesthesia, we strongly recommend that both orthopedic surgeons and emergency care providers familiarize themselves with this method. It can be a valuable addition to their skill set and provide a safe and efficient option for treating patients with anteriorly dislocated shoulders.

Comparison of the patients undergoing total knee arthroplasty with and without drain in terms of functional outcome, hemoglobin drop and infection rate

Shamseer K. V., Pradeep Kumar T., Shameem G. M., Prince Shanavas Khan — Tue, 24 Jun 2025 00:00:00 +0530

Background: There is still no consensus about use of post-op drain in TKA. We compared postoperative outcomes of TKA with drain and without drain in terms of hemoglobin drop, functional outcome and infection.

Methods: An observational cohort study was conducted at a tertiary hospital between March 2023, and March 2024. Men and women with primary OA knee and age more than 40 years were included. Patients on antiplatelets, with acute and active infection, revision TKA, malignancy were excluded.

Results: 90 patients were included age range 50-80 years. Males to female ratio was 74.4:25.6. Of 90 patients, 45 (50%) received a drain. The drain group had greater hemoglobin drops. There was no statistically significant difference in functional outcome by KOOS score and WOMAC score in both groups. There was no significant difference in occurrence of infection in both groups.

Conclusions: This comparative study aimed to assess the outcomes of total knee arthroplasty (TKA) with and without drain insertion, focusing on hemoglobin drop, functional outcomes measured by (KOOS) and (WOMAC) scores, and infection rates. In conclusion, my study supports reconsidering routine drain use in TKA procedures, as omitting drains was associated with a notable reduction in hemoglobin drop without compromising functional outcomes or increasing infection risks. Surgeons should carefully weigh the potential benefits of reduced blood loss against the need for drainage and associated risks, considering individual patient factors and surgical circumstances.

Clinical outcome of Bankart repair with remplissage for recurrent shoulder dislocation with less than 20% glenoid bone loss

Rajesh B. Naik, Prathamesh Hanchinal — Tue, 24 Jun 2025 00:00:00 +0530

Background: The goal was to assess the functional result and recurrence rate of anterior shoulder instability after arthroscopic Bankart’s surgery with Remplissage.

Methods: This was a prospective study on 30 patients who were operated with arthroscopic Bankart’s repair between April 2022 to March 2024. Pre-op scores and regular follow-up scores were taken using ROWE score, ASES score and Quick DASH for minimum duration of 6 months post-op to assess functional outcome.

Results: Mean VAS score improved from pre-op value of 7.2 to post-op value of 1.8 at the end of 6 months follow-up. Mean ROWE score improved from pre-op value of 24.6 to post-op value of 91.1 at the end of 6 months follow-up. Mean Quick DASH score improved from pre-op value of 44 to post-op value of 11.4 at the end of 6 months follow-up.

Conclusions: We conclude that the arthroscopic Bankart repair with Remplissage surgery is a beneficial and efficient remedy for anterior shoulder instability. Identifying and choosing the right patient is still crucial to the repair’s effectiveness.

GeneXpert versus histopathological examination and culture as a diagnostic tool for spinal tuberculosis: a comparative analysis

Nishant Mirchandani, Sanjay N. Patil, Gopal T. Pundkare — Tue, 24 Jun 2025 00:00:00 +0530

Background: Spinal tuberculosis, a common type of osteoarticular tuberculosis accounts for a significant proportion of extrapulmonary tuberculosis cases. This study compares the sensitivity, specificity of GeneXpert with histopathology and acid-fast bacilli (AFB) culture.

Methods: This study conducted at a tertiary health care and teaching institution from October 2018 to October 2023 included 60 patients with suspected spinal tuberculosis. Samples including vertebral tissue and pus, obtained by open biopsy, fluoroscopy or computed tomography (CT) guided percutaneous vertebral body biopsy were collected in sterile containers with 2-3 ml of saline and immediately sent for testing with GeneXpert and AFB culture. Histopathological samples were placed in 10% formalin prior to examination.

Results: When comparing GeneXpert with AFB culture, Sensitivity was found to be 82.2%, specificity 40.0%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 42.9% and accuracy was 71.7%. When comparing GeneXpert with histopathological examination (HPE), sensitivity was found to be 84.8%, specificity 50.0%, PPV 84.8%, NPV 50.0% and accuracy was 76.7%.

Conclusions: Despite longer diagnostic time as compared to GeneXpert, AFB culture is still the gold standard diagnostic modality.

Comparative analysis of in vitro biofilm formation in gram-positive and gram-negative pathogens from orthopaedic implant infections: a retrospective cross-sectional study in a tertiary care centre

Ipsita Paul, Anil Kumar Bilolikar, Srinivas Kasha, Krishnaveni Malisetti — Tue, 24 Jun 2025 00:00:00 +0530

Background: Orthopaedic implant infections (ODRI) remain a significant clinical challenge due to their association with persistent biofilm formation, which complicates treatment. 1.2 Objective: This study aimed to investigate the biofilm-forming potential of Gram-positive and Gram-negative pathogens isolated from orthopaedic implant infections in a tertiary care setting.

Methods: A retrospective cross-sectional study was conducted at the Krishna Institute of Medical Sciences, Secunderabad, India, from February 2023 to January 2024. Clinical samples from orthopaedic implant infections, were processed for bacterial culture and biofilm formation using the Tissue Culture Plate (TCP) method in triplicates. Bacterial identification was performed using the Vitek 2 Compact system.

Results: Of 87 patients diagnosed with orthopaedic implant infections, 62 (71.26%) were culture-positive, with 35 (56.45%) Gram-negative bacilli and 27 (43.54%) Gram-positive cocci. Biofilm formation was observed in 59.25% of Gram-positive isolates, with 18.51% strong biofilm producers, 40.74% moderate producers, and 40.74% weak/non-producers. Among Gram-negative isolates, 31.42% were biofilm producers, with 5.71% strong, 25.71% moderate, and 68.57% weak/non-producers. A higher prevalence of biofilm production was noted in Gram-positive organisms compared to Gram-negative bacteria.

Conclusion: The study highlights the higher propensity of Gram-positive bacteria to form biofilms, which may contribute to the persistence and chronicity of orthopaedic implant infections.

Association of serum metallic ion levels in patients with total joint arthroplasty with their adverse effects: a comparative cross-sectional study

Tue, 24 Jun 2025 00:00:00 +0530

Background: Metallic implants used in joint arthroplasty release ions gradually sometimes resulting in their toxicity. Hence, data regarding exact correlation between serum metallic ion levels and toxicity occurrence is still lacking.

Methods: A total of 90 adult subjects, each with a single total joint arthroplasty (TJA between 1 to 5 years), or without were recruited. The serum levels of Cr, Co, Ni, & Mo in above 2 groups were estimated and correlated with signs and symptoms related to Cr, Co, Ni, & Mo ion toxicity Unpaired Student's t-test, Chi-square test and Pearson correlation coefficient were used to analyses data. A p value<0.05 was considered significant.

Results: The mean serum levels of Cr (21.53±7448 µg/l vs. 19.03±0.3372 µg/l; p=0.0026), Ni (9.643±0.2486 µg/l vs. 9.303±0.2729 µg/l; p=0.83), Co (5.482±0.20 µg/l vs. 5.573±0.21 µg/l; p=0.76), and Mo (5.573±0.2159 µg/l vs. 5.290±0.2208 µg/l; p=0.36) in subjects with implants were higher than in subjects without implants. Five subjects reported six adverse effects (AE) specifically numbness in hands (4), fatigue (1), and bone pain (1), which showed no significant association or correlation with the mean serum levels of the metallic ions.

Conclusion: Results showed increased mean serum chromium levels post one year of implant surgery, while mean serum levels of Co, Ni, and Mo did not demonstrate any significant elevation. No correlation between serum levels of Cr, Co, Ni, and Mo, duration of implant, and observed AE was seen. Causality assessment between reported AE and metal ions (Cr, Co, Ni, and Mo) levels was “possible."

Incidence and predictors of syndesmotic injuries in ankle fractures: a cross-sectional study correlating radiographic assessment with intraoperative findings

Sumit M. Saidapure, Gururaj Joshi, Gopal Pundkare — Tue, 24 Jun 2025 00:00:00 +0530

Background: Syndesmotic injuries are clinically significant ankle injuries that may lead to chronic instability and functional impairment when inadequately managed. While literature suggests these injuries occur in 10-20% of ankle fractures, their true incidence remains poorly characterized. This study aimed to determine the incidence of syndesmotic injuries in ankle fractures and evaluate the diagnostic accuracy of radiographic assessment compared to intraoperative findings.

Methods: This 18-month cross-sectional study conducted at a tertiary care center in Pune, India included 49 patients with ankle fractures requiring surgical intervention. Standardized radiographic evaluation was performed to assess syndesmotic parameters (tibiofibular clear space, tibiofibular overlap, and medial clear space). Fractures were classified using the Lauge-Hansen system, and intraoperative assessment was conducted using the Hook test as the reference standard. Statistical analysis included calculation of diagnostic accuracy metrics and multivariate logistic regression to identify independent predictors of syndesmotic injuries.

Results: Syndesmotic injuries were identified in 16 patients (32.7%, 95% CI: 19.9%-47.0%), with highest prevalence in Pronation-External Rotation fractures (46.7%) and those resulting from road traffic accidents (44.4%). Radiographic assessment demonstrated good diagnostic performance (sensitivity 87.5%, specificity 81.8%) compared to intraoperative findings. Multivariate analysis identified three independent predictors of syndesmotic injury: Pronation-External Rotation fracture pattern (OR 3.82, p=0.006), road traffic accident mechanism (OR 2.96, p=0.026), and tibiofibular clear space >6 mm (OR 8.35, p<0.001). Patients with syndesmotic injuries demonstrated significantly worse immediate post-operative pain scores (p<0.001) and functional outcomes (p<0.001).

Conclusions: Syndesmotic injuries are more common in ankle fractures than previously reported, particularly in high-energy trauma and specific fracture patterns. While systematic radiographic evaluation provides valuable diagnostic information, intraoperative assessment remains essential for definitive diagnosis. These findings emphasize the importance of maintaining a high index of suspicion for syndesmotic injuries in high-risk scenarios to optimize patient outcomes.

Comparative analysis of TAD and CalTAD in predicting lag screw cutout risk in trochanteric fractures treated with intramedullary devices: a retrospective study

Tue, 24 Jun 2025 00:00:00 +0530

Background: Cutout is one of the common cause of mechanical failure after internal fixation of trochanteric fractures using intramedullary devices. Tip apex distance (TAD) and Calcar referenced tip apex distance (CalTAD) are the radiographic parameters to predict the cutout risk. The aim of the study is to compare CalTAD with TAD in predicting the screw cutout risk and also to assesses other parameters responsible for it.

Methods: A total of 100 patients were included in this retrospective study. For each patient the following data were recorded. Number of cutouts, AO/OTA classification, quality of the reduction, type of nail, center column diaphyseal angle, type of distal locking, post-operative weight-bearing, TAD, CalTAD values and the position of the screw in the femoral head according to the Cleveland system.

Results: The incidence of cutout across the sample was 6%. The median TAD in cutout group was 32.2±6.5 (Mean±SD) while in no cutout group it was 20.7±5.1(p<0.001). Similarly, the median CalTAD in cutout group was 33±5.6 (Mean±SD) while in no cutout group it was 21.1±4.6 (p<0.001). The highest value of sensitivity and specificity showed that the best cut off values of TAD is 30.06 (95% CI: 0.823-1.000, P<0.001) and Cal TAD is 30.93 (95% CI: 0.835-1.000, p<0.001).

Conclusions: In order to reduce the incidence of cutout it is advisable to achieve positive cortical reduction, placing the lag screw in centre-centre or centre-inferior in femoral head (Preferably in Cleveland Zone-5) and avoid TAD>30.06 and Cal TAD>30.93.

Comparative study of functional outcome of inter-trochanteric fractures in adult population treated with modified first generation proximal femoral nail versus second generation proximal femoral nail- PFN-A2

Tue, 24 Jun 2025 00:00:00 +0530

Background: Intertrochanteric fractures are fairly prevalent in elderly, owing to osteoporosis. High velocity trauma is a common cause in younger age groups. Surgical fixation is the choice of treatment. Closed reduction being minimally invasive has lower infection rates and higher union rate. Providing early mobility lowers morbidity. Over time, there have been multiple changes in the implant design. Two screws in femoral head are used in the first generation PFN, compared to a single helical bolt in the subsequent modification i.e. PFNA2.

Methods: Prospective and comparative study was undertaken, from January 2023 to June 2024, including 52 adults (17 males and 35 females) of either sex, with intertrochanteric fracture femur. 26 patients underwent first generation PFN (group A) and 26 underwent PFNA2 (group B). Clinico-radiological evaluation was done at 6 weeks, 3-, 6- and 12-months following surgery. Functional evaluation was based on the mean Harris hip score (HHS). Post-operative pain based on VAS, early mobilization and complications were taken into consideration. Statistics was analysed with Statistical Package for The Social Sciences (IBM SPSS version 22).

Results: There was 100% union rate. The average date of mobilization in group A patient was 1.9±0.8 days and in group B was 2.2±0.7 days. Group A has a statistically significant higher VAS score than group B at 24 hours post-surgery. Weight bearing as tolerated was started on day 1 post surgery in all patients. The mean HHS was significantly higher in group B (71.5±3.8) at 6 weeks follow-up, which on subsequent follow-ups was statistically insignificantly between the two groups. None of the patients had implant failure of any form.

Conclusions: The final outcome was statistically insignificant. There was negligible difference between the first generation PFN and PFNA2 in terms of post-operative stability and fracture union. Hence, both PFN and PFNA2 are equally suitable devices for fixation of inter-trochanteric fracture.

Patient outcomes following minimally invasive plate osteosynthesis for fractures of the distal tibia

Somnath Baskey, Manmatha Nayak, Jugaratna Khatua, Gopabandhu Patra — Tue, 06 May 2025 00:00:00 +0530

Background: Minimally invasive plate osteosynthesis (MIPO) has become the go-to method for treating fractures of distal tibia because of its several benefits over open procedures. Assessing the radiological and clinical results of participants undergoing MIPO to treat fractures of distal tibia was the main goal of this study.

Methods: The study was prospective-observational. It was conducted at Srirama Chandra Bhanja (S.C.B.) medical college and hospital, Cuttack, India for one year, i.e., from February 2024 to January 2025. This study included fifty-two individuals who had received MIPO for fractures of the distal tibia.

Results: Among all the 52 patients who participated in the study, 33 (63.4%) were men and 19 (36.5%) were women. A mean age of 52.3±6.5 years was found. Most of the patients, i.e., 38 (73.1%) of patients took 20-24 weeks. Six (11.5%) of patients took >24 weeks. And, lastly, 08 (15.4%) of patients took <20 weeks.

Conclusions: According to the study's findings, MIPO for distal tibia fractures produces good radiological and clinical outcomes, with the majority of patients having a strong functional recovery and union within 24 weeks.

Pediatric lateral condyle humerus fractures: a comparison of closed reduction with percutaneous pinning and open reduction with internal fixation for displacement over 2 mm

Tue, 24 Jun 2025 00:00:00 +0530

Background: Lateral condylar humerus fractures (LCHFs) with displacement over 2 mm are commonly treated with open reduction and internal fixation (ORIF). However, closed reduction and percutaneous pinning (CRPP) has been proposed as an alternative. Limited research compares these methods for such fractures. This study aimed to evaluate outcomes of CRPP versus ORIF.

Methods: We retrospectively reviewed pediatric patients with LCHFs displaced >2 mm, treated with CRPP or ORIF at five military hospitals between June 2018 and October 2023. Fractures were classified using the Song and Milch systems. We assessed age, sex, fracture characteristics, surgery duration, postoperative care, and complications.

Results: Of 273 patients, 82 had Milch type I and 191 had type II fractures; 78 were Song stage 3, 123 stage 4, and 72 stage 5. CRPP was used in 102 cases, ORIF in 171. Both groups were similar in age, sex, displacement, and immobilization time. CRPP had shorter surgeries and pin durations and did not need a second procedure for pin removal. Most fractures healed without major complications. Common issues included bone spurs, lateral prominences, and reduced carrying angle, but no functional deficits. Aesthetic scarring was more common in ORIF. Elbow function and range of motion were comparable.

Conclusions: CRPP and ORIF both yield good outcomes for pediatric LCHFs with >2 mm displacement. CRPP offers advantages like shorter surgery, no scarring, and avoiding additional procedures.

Complications and outcomes of curettage, chemical cauterization and bone graft in giant cell tumor of bone

Tue, 24 Jun 2025 00:00:00 +0530

Background: Giant cell tumor of bone (GCTB) is a locally aggressive benign bone neoplasm with a high potential for recurrence. While intralesional curettage remains the standard treatment, combining chemical cauterization and bone grafting may enhance therapeutic outcomes. This study aimed to evaluate the complications and outcomes of this combined approach in managing GCTB.

Methods: A prospective observational study was conducted at the national institute of traumatology and orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. A total of 32 patients diagnosed with GCTB were treated using curettage, chemical cauterization and bone grafting. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, while complications and recurrence rates were recorded. Statistical analysis was performed using Student’s t-test and Chi-square test, with significance set at p<0.05.

Results: The mean MSTS score significantly improved from 58.8%±15.4% preoperatively to 85.2%±15.9% at the last follow-up (p<0.01). A low recurrence rate of 6.25% was observed. Pain levels, assessed by the visual analogue scale (VAS), significantly decreased from 4.3±1.2 to 2.1±1.5 (p=0.00002). Complications included joint stiffness (25%), superficial infections (9.38%) and early osteoarthritis (6.25%).

Conclusions: The combination of curettage, chemical cauterization and bone grafting proved to be an effective treatment strategy for GCTB, resulting in low recurrence, significant pain reduction and favorable functional outcomes. This approach should be considered a reliable management option, particularly in resource-limited settings.

A prospective comparative study of distal tibia and fibula fractures treated with tibial interlocking nailing with and without fibular plating

Ananya Mishra, Varshant Pareek, Mohit Yadav, Deepak Khandelwal, Kartik Yadav — Tue, 24 Jun 2025 00:00:00 +0530

Background: Distal both bone leg fractures present significant challenges in orthopedic surgery. The purpose of this study was to evaluate the functional and radiological outcomes of tibial interlocking nailing alone versus interlocking nail with supplementary fibular plating.

Methods: A hospital-based, prospective interventional study was conducted on 72 patients, divided into two groups. Karlstrom-Olerud scoring and radiographic assessment were used to evaluate outcomes. SPSS software will be used for all statistical calculations.

Results: Patients in the interlocking nail with fibular plating group demonstrated improved alignment values in varus/valgus angulation (p=0.00008) and anteroposterior angulation (p=0.00029), also Karlstrom Olerud score was significantly better in fibular plating group at 3 months (p=0.002). There was slightly earlier union time in fibular plating group than patients without fibular plating (14.86 and 15.55 respectively) and also there was higher rate of patients requiring secondary procedures in group without fibular plating (6) compared to group with fibular plating (2).

Conclusion: Patients with fibular plating group demonstrated significantly improved alignment and functional scores, suggesting that supplementary fibular plating enhances stability and reduces malalignment.

Clinical and radiological outcomes in treatment of Lichtman stage IIIB Kienböck’s disease by scaphocapitate fusion: hospital based prospective interventional study

Ravi Khurana, Narender Saini, Parakh Dhingra, Kartik Samria, Praveen Mahala — Tue, 24 Jun 2025 00:00:00 +0530

Background: This investigation assessed the effectiveness of scaphocapitate (SC) arthrodesis with lunate preservation in treating patients with stage IIIB Kienböck's disease, characterized by neutral ulnar variance. Additionally, the study sought to identify potential differences in treatment outcomes among patients with stage IIIB Kienböck's disease.

Methods: A total of 38 patients with stage IIIB Kienböck's disease underwent scaphocapitate arthrodesis, stabilized using Herbert compression screws. Each participant underwent comprehensive pre- and post-operative evaluations, including assessments of pain (VAS score), range of motion (ROM), grip strength and functional outcomes (DASH score and PRWE score).

Results: The mean follow-up period for all patients was 17.81 months. Bony union was achieved at an average of 14 weeks, with most patients returning to work within 24 weeks. Comparing pre- and post-operative outcomes, significant improvements were observed: VAS scores decreased from 39.34 to 15.53, grip strength increased from 18.03 to 29.47% and the RS angle was corrected from 84.08° to 59.34°.

Conclusions: This study demonstrates that surgical intervention can significantly enhance wrist mobility, increase grip strength and alleviate pain, ultimately facilitating patients' return to a higher level of functional ability and overall well- being.

Clinical, functional and radiological outcome of retrograde femoral nailing in femoral shaft fractures: an observational study

Velmurugan S., Kumar V. S. V., Muthu Adaikkappan A. S., Hemapriya A S — Tue, 24 Jun 2025 00:00:00 +0530

Background: Femoral shaft fractures require prompt and effective management to prevent long-term disability. Retrograde intramedullary nailing (RIMN) offers a reliable alternative to antegrade nailing, particularly when proximal access is limited. This study evaluates the clinical, functional, and radiological outcomes of RIMN to inform optimal fracture management.

Methods: An ambispective observational study was conducted at the Asian Orthopaedic Institute, SIMS Hospital, Chennai, from February 2023 to February 2024. A total of 38 patients with femoral shaft fractures treated using RIMN were included. Functional outcomes were assessed using the lower extremity functional scale (LEFS), pain using the Visual Analogue Scale (VAS), and radiological outcomes based on time to union. All patients were operated on by the same surgeon and followed for six months postoperatively.

Results: The mean age was 42.3±0.9 years, with a female predominance (55%). Slip and fall was the most common cause (53%), and A1-type fractures were most frequent. The mean time to union was 14.5±4.4 weeks. LEFS scores improved from 23.76 to 63.29, VAS scores declined from 4.95 to 0.34, and knee ROM increased from 77.37° to 112.63° (p<0.001). One malunion was reported; no other complications occurred. No significant association was found between demographic variables and time to union.

Conclusion: RIMN is a safe and effective treatment for femoral shaft fractures, enabling early mobilization and favourable clinical outcomes.

Evaluating the effectiveness of peroneus longus tendon as an autograft for primary anterior cruciate ligament reconstruction: a prospective study

Tue, 24 Jun 2025 00:00:00 +0530

Background: The most common significant ligamentous injury to the knee joint is an anterior cruciate ligament (ACL) tear. The ACL reconstruction aims to restore knee stability, allow the patient to return to regular activities, including sports, and delay the onset of osteoarthritis. The choice of graft plays a vital role and the most popular autograft for reconstruction is the hamstring tendon graft. Many Orthopaedic surgeons use peroneus longus tendon autograft, and it is biomechanically comparable to a hamstring tendon autograft. The aim of this study is to assess the functional outcome and donor site morbidity and analyses complications of using peroneus longus autograft in ACL reconstruction.

Methods: Study was conducted from October 2023 to March 2024 in Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka. Using Consecutive sampling technique, a total of 30 patients who fulfilled the criteria were included and observed prospectively for a period of 1 year. Functional scores were recorded preoperatively and 1 year after surgery using IKDC and lysholm scores. Donor site morbidities were assessed with AOFAS score and MRC grading- plantarflexion at ankle and eversion at subtalar joint.

Results: Ankle functions at donor site are preserved well in almost all patients with excellent AOFAS score and attained excellent functional outcome in lysholm as well as IKDC knee score.

Conclusion: Peroneus longus tendon serves as a suitable autograft option for ACL reconstruction, due to the convenience of its harvest, an aesthetically pleasing outcome, and the better postoperative knee scores. Additionally, the excision of the peroneus longus tendon has not resulted in ankle instability, making it viable for use as an autogenous graft in ACL reconstruction procedures.

Functional outcome in adults treated for both bone forearm fractures with intramedullary square nails

Vidisha S. Kulkarni, Utkarsh K. Vishwakarma, Sunil G. Kulkarni — Tue, 24 Jun 2025 00:00:00 +0530

Background: The forearm fractures are considered intraarticular due to functional characteristics and spatial orientation. These fractures require anatomic reduction to maintain axial and rotational stability and preserve bone length with absolute stability for adequate healing to restore function. Open reduction and internal fixation is accepted as the treatment of choice for both bone forearm fractures according to many studies. However, it can result in complications like extensive soft tissue damage, evacuation of fracture hematoma, periosteal damage, radioulnar synostosis, neurovascular injury, compartment syndrome, delayed union, non-union, infection, refracture after implant removal. Intramedullary nailing is an alternative technique to avoid the above problems, with the advantages of minimal incision, no periosteal stripping, faster healing and biologic fixation. This study evaluates the functional outcome in adults treated for both bone forearm fractures with intramedullary square nail fixation at our institute.

Methods: 113 patients with closed both bone forearm fractures were treated with Intramedullary square nail fixation between January 2014 to December 2023. There were 54 (22A) type fractures, 44 (22B) type fractures, 15 (22C) type fractures. Functional outcome was assessed based on Anderson’s criteria.

Results: 105 patients had excellent to satisfactory results while fixation in 8 patients resulted in failures based on Anderson’s criteria.

Conclusions: Intramedullary nailing is a simple, safe and effective method of alternative fixation of both bone forearm fractures that is associated with closed reduction, early union, biologic fixation, low infection rate, small cosmetic scars, less blood loss, shorter operating time, and less risk of compartment syndrome.