International Journal of Research in Orthopaedics

Functional outcomes of two-stage flexor tendon reconstruction in zone 2 of the hand

Ahmed H. Alshukaili, Gopal Malhotra, Patil R. Krishnarao — Tue, 25 Aug 2026 00:00:00 +0530

Zone II flexor tendon injuries with delayed presentation or failed primary repair remain among the most challenging conditions in hand surgery due to adhesion formation and compromised pulley systems. Two-stage reconstruction using the Paneva-Holevich technique has demonstrated favorable outcomes internationally; however, data from the Middle Eastern region are scarce. We present a retrospective case series of 21 patients who underwent two-stage flexor tendon reconstruction in zone II at a tertiary referral center in Oman between 2012 and 2020. Functional outcomes were assessed using total active motion (TAM), Adjusted Strickland score, Buck-Gramko rating system, and QuickDASH questionnaire. The mean TAM was 85.4% of the contralateral digit, and the mean Adjusted Strickland score was 82.2%. According to Buck-Gramko criteria, 90.5% achieved excellent outcomes. The mean QuickDASH score was 8.5, indicating minimal disability. Patient satisfaction was 95%, and 85% returned to their previous occupation. Complications requiring reoperation occurred in 28.6% of patients. This case series demonstrates that the Paneva-Holevich technique provides reliable functional restoration in complex Zone II injuries within our population.

Progressive radiological and clinical outcomes of minimally invasive cannulated cancellous screw fixation in intra-articular calcaneal fractures: a case series

Mihir A. Tejura, Kaneriya A. Rajendrakumar — Tue, 25 Aug 2026 00:00:00 +0530

Displaced intra-articular calcaneal fractures (DIACFs) pose a significant reconstructive challenge. Minimally invasive cannulated cancellous (CC) screw fixation has emerged as an optimal alternative to extensile lateral plating. This case series analyzes the progressive radiological and clinical outcomes over a 6-month follow-up, evaluating the impact of preoperative deformity severity while highlighting the operational and rehabilitative benefits of the percutaneous approach. A retrospective review was conducted on 16 DIACF cases. Standardized operative maneuvers utilizing Steinmann pin manipulation and CC screw fixation were employed. Serial assessments of Böhler’s angle, Gissane’s angle, Varus angle, and visual analog scale (VAS) pain scores were recorded preoperatively, immediately postoperatively, and at 1, 3, and 6 months. Progressive trends were analyzed using Friedman tests, and patients were stratified by the severity of their preoperative articular depression. Significant progressive corrections were observed across all parameters (p<0.001). Preoperative Böhler’s angle (5.88°±5.30°) improved immediately (26.38°±3.50°) and was sustained at 6 months (26.62°±3.54°). VAS scores plummeted from 8.50±0.73 preoperatively to 0.38±0.50 at 6 months. Subgroup analysis revealed that patients with severe preoperative Böhler’s depression (≤ 0°) achieved massive corrective improvements (mean 24.50°), reaching final outcomes parallel to those with mild initial deformity. CC screw fixation provides robust, sustained restoration of calcaneal anatomy regardless of initial deformity severity. Furthermore, it affords the added benefits of dramatically reduced wound complications, shorter operative times, lower operative morbidity, early rehabilitation, and superior cost-effectiveness compared to traditional open procedures.

Results of platelet-rich plasma intra-articular injection in all stages of osteoarthritis of the knee

Nishchay Bandi, Devesh Jain, Sudhir Kumar Rawat, Karan Kant Prasad — Tue, 25 Aug 2026 00:00:00 +0530

Osteoarthritis (OA) of the knee is a common degenerative joint disorder leading to chronic pain, stiffness, and functional limitation. Conventional treatments provide only symptomatic relief and do not reverse the disease process. Platelet-rich plasma (PRP), a regenerative therapy rich in growth factors, has emerged as a promising modality for improving joint function and reducing pain in OA. Aim was to evaluate the clinical outcomes of intra-articular PRP injections in patients with knee OA across different stages. This prospective case series included 10 patients with knee OA treated with a single intra-articular PRP injection. PRP was prepared by centrifugation at 2200 rpm for 8 minutes and injected using an inferolateral approach under aseptic precautions. Patients were followed up at 48 hours, 1 month, 3 months, and 6 months. Outcome measures included pain assessment using the visual analogue scale (VAS) and functional evaluation using WOMAC and knee society score (KSS). The mean VAS score significantly decreased from 7.5±1.1 at baseline to 3.4±1.3 at 6 months, indicating substantial pain relief. Functional outcomes showed progressive improvement, with WOMAC scores decreasing and KSS scores increasing over time. Eight patients (80%) showed significant improvement, while two patients (20%) demonstrated moderate improvement, particularly in advanced stages of OA. Patients with early-stage disease showed better response compared to those with severe disease. No major adverse effects were observed. Intra-articular PRP injection is a safe and effective treatment for knee OA, providing significant pain relief and functional improvement, especially in early to moderate stages. It can be considered a promising non-surgical option for managing knee OA.

Artificial intelligence-driven gait analysis in knee osteoarthritis: redefining real-time biomechanical precision for personalized rehabilitation

Aavrati Rastogi, Roop B. Kalia, Vivek K. Singh, Pradeep K. Meena — Tue, 25 Aug 2026 00:00:00 +0530

Globally, knee osteoarthritis (KOA) is an important contributor to pain, limited mobility, and long-term disability. Conventional assessment methods still primarily rely on radiographic results, subjective complaint reporting, and episodic clinical examination, despite advancements in musculoskeletal rehabilitation. However, the dynamic biomechanical dysfunction that underlies discomfort, instability, and increasing functional loss in people with KOA is often missed by these methods.

Factors associated with delayed presentation of musculoskeletal complaints in primary care clinics in Jordan

Tue, 25 Aug 2026 00:00:00 +0530

Background: Musculoskeletal (MSK) complaints are common in primary care clinics. Delayed presentation may worsen symptoms and reduce quality of life. Limited data are available from Jordan regarding delayed presentation among patients with MSK complaints. This study aims to evaluate delayed presentation and describe the characteristics of patients presenting with MSK complaints in primary care in Jordan.

Methods: This cross-sectional study was conducted at the family medicine clinics of Jordan University Hospital. A total of 100 adult patients with MSK complaints were included. Data regarding demographics, symptom duration, healthcare experience, emotional impact, and comorbidities were collected from electronic records and a previously established database. Delayed presentation was defined as presentation more than four weeks after symptom onset.

Results: The mean age was 47.4±5.4 years, and 55% of patients were female. The mean symptom duration before presentation was 4.1±1.8 weeks. Delayed presentation was observed in 49% of patients. Functional limitation was reported in 58% of patients, while 53% reported reduced daily activity. Emotional distress related to symptoms was common, with a mean anxiety/frustration score of 6.6±1.9. Most patients had at least one chronic medical condition.

Conclusions: Delayed presentation among patients with musculoskeletal complaints was common. MSK symptoms were associated with important functional and emotional effects. These findings highlight the importance of early medical consultation and improving musculoskeletal care in primary healthcare settings.

Single center experience: midterm functional outcome of knee megaprosthesis after sarcoma resection

Sat, 04 Jul 2026 00:00:00 +0530

Background: Endoprosthetic reconstruction following bone tumor resection is a well-known and popular method for preserving limbs. Endoprosthetic functional outcomes following reconstructions have been the topic of numerous studies the majority of which used subjective parameters like the Musculoskeletal tumor society (MSTS) score.

Methods: A retrospective consecutive sampling strategy was used, and all eligible patients with knee tumours treated at Nariman hospital between 2020 and 2023 were identified from medical records and included. Due to the rarity of knee tumours and the limited annual case volume of approximately 8-10 cases, no formal a priori sample size calculation was performed. The final cohort consisted of all available eligible cases during the study period (n=40). Patients were followed for functional outcomes at 6 months, 1 year, and 2 years, with an average follow-up duration of 38 months (range: 30-71 months). Cases with failure, infection, local recurrence, death, or unavailable functional follow-up were reported separately in the attrition/outcome flow.

Results: The functional outcome of knee tumor prosthesis was excellent with mean functional score for all patients were 68.71%. The mean functional score for distal femur patients was 71.94% while the mean functional score for proximal tibia cases was 63.85%. Younger patients with distal femur lesions showed better functional score, also patients with early management and early post-operative mobilization showed better results. The prosthesis survival was 90%.

Conclusions: Limb salvage surgeries are complex surgeries which need multidisciplinary teamwork. Tumor endoprosthesis is the best option for limb reconstruction following tumor excision around the knee joint allowing early mobilization with low rate of infection and local recurrence.

Clinical and functional outcome of total hip replacement/arthroplasty for avascular necrosis of the femoral head

Rezwan-Ud-Daula — Tue, 25 Aug 2026 00:00:00 +0530

Background: Avascular necrosis (AVN) of the femoral head is a progressive condition leading to femoral head collapse, particularly affecting young to middle-aged adults. Total hip replacement (THR) is the gold-standard salvage procedure for end-stage disease.

Methods: This prospective observational study was conducted at Khwaja Yunus Ali Medical College and Hospital, Bangladesh, from January 2024 to January 2026. Forty-five patients with ARCO stage III or IV AVN underwent THR via the Hardinge lateral approach. Outcomes were assessed using the Harris hip score (HHS) preoperatively and at 6, 12, and 24 weeks postoperatively. Complications were recorded throughout follow-up.

Results: The mean age was 42.8±10.7 years, with male predominance (73.3%). Corticosteroid use (35.6%) was the most common cause, followed by alcohol abuse (22.2%). Most patients (62.2%) had ARCO stage IV disease. The mean HHS improved from 45.2±8.7 preoperatively to 92.6±4.8 at 24 weeks (p<0.001). Excellent-to-good outcomes were in 84.4%. Complications included limb length discrepancy (6.7%), superficial wound infection (4.4%), Trendelenburg gait (4.4%), and dislocation (2.2%). No deep infections, nerve injuries, or fractures.

Conclusions: Total hip replacement via the Hardinge lateral approach offers excellent pain relief, notable functional gains, and low complication rates in advanced AVN of the femoral head. Longer-term studies are needed to evaluate implant survivorship.

Arthroscopically assisted medial plication combined with lateral retinaculum release in cases of lateral patellar instability in comparison with medial patellofemoral ligament reconstruction: a short term comparative study

Deyaaeldin M. Elleithi, Emad S. Hussein, Abdel S. M. Halawa, Adel H. Adawy — Tue, 25 Aug 2026 00:00:00 +0530

Background: The stability of patellofemoral joint in a healthy knee depends on bony structure of the joint and multiple static and dynamic soft tissue structures. Of them, the most important structure is the medial patellofemoral ligament (MPFL). The aim of this study is to evaluate the results of the arthroscopically assisted medial plication and lateral retinacular release in cases of lateral patellar instability in comparison to medial patellofemoral ligament reconstruction in a short term follow up study in patients with no or minimal bony deformities.

Methods: This prospective randomized comparative clinical study was conducted on 40 patients with lateral patellar instability attending the Orthopedic Clinic at Benha University Hospital. Patients were randomly divided into two equal groups: group I (n=20) underwent arthroscopic medial retinaculum plication with lateral retinaculum release, and group II (n=20) underwent open MPFL reconstruction using a gracilis tendon graft. All patients underwent standardized clinical, and radiological assessment. Outcomes included operative time, complications, hospital stay, time to mobilization and weight bearing, radiological patellar tracking, and functional outcomes assessed by western Ontario and McMaster universities osteoarthritis index (WOMAC) and Lysholm scores over 6-24 months.

Results: There were no significant differences between both groups regarding baseline or radiological data. However, group II showed significantly longer operative time, greater perioperative blood loss, and longer hospital stay. Although re-dislocation and patellar instability rates were higher in group I (10% and 20% versus 0% and 5% in group II), the differences were not significant, with a non-significant higher failure rate in group I (p=0.091). Postoperatively, group II demonstrated significantly greater radiological improvement, earlier mobilization, and superior functional outcomes with higher Lysholm and lower WOMAC scores at follow-up (p<0.05 to p<0.001).

Conclusions: MPFL reconstruction yields better patellar alignment and functional outcomes with lower re-dislocation and instability rates and greater radiological improvement than arthroscopic medial plication with lateral release, but it is associated with longer operative time and increased blood loss.

How immediate or delayed postoperative x-ray affect reoperation for pedicle screws misplacement following lumbar spine surgery at the National Orthopedic Hospital Dala Kano, Nigeria

Tue, 25 Aug 2026 00:00:00 +0530

Background: Pedicle screw misplacement is a recognised complication of lumbar spine surgery. The timing of postoperative imaging may influence the detection and subsequent management of misplaced screws. This study aimed to determine whether immediate (within 48 hours) versus delayed (after 48 hours) postoperative x‑ray affects the reoperation rate for pedicle screw misplacement following lumbar spine surgery at a Nigerian tertiary hospital.

Methods: A retrospective review of 397 consecutive lumbar spine surgeries performed at the National Orthopedic Hospital Dala, Kano, from January 2019 to December 2025 was conducted. Patients with pedicle screw misplacement detected on postoperative x‑ray were identified. Patients were divided into two groups: those who had x‑ray within 48 hours of surgery (early group) and those who had x‑ray after 48 hours (delayed group). The primary outcome was reoperation for screw misplacement. Multivariate logistic regression was used to identify factors influencing reoperation.

Results: Pedicle screw misplacement was identified in 39 patients (9.8% of all surgeries). In the early x‑ray group (n=11), 2 patients (18.2%) required reoperation. In the delayed x‑ray group (n=28), 19 patients (67.9%) required reoperation (p<0.001). On multivariate analysis, delayed x‑ray was the strongest independent predictor of reoperation (adjusted OR = 8.9, 95% CI: 2.4-33.1, p=0.001). Other significant predictors included the severity of screw breach (Gertzbein‑Robbins grade C-E) (OR=5.6, 95% CI: 1.8-17.4) and the presence of neurological symptoms (OR=4.2, 95% CI: 1.4-12.6).

Conclusions: Delayed postoperative x‑ray (>48 hours) is strongly associated with a higher reoperation rate for pedicle screw misplacement. Early detection within 48 hours allows timely intervention and potentially reduces the need for reoperation. Routine early postoperative imaging should be considered to optimize patient outcomes.

Functional and radiological outcomes of unstable acetabular fractures with or without quadrilateral plate involvement

Tue, 25 Aug 2026 00:00:00 +0530

Background: Acetabular fractures are complex injuries that may result in poor hip function, arthritis, and long-term disability if not accurately reduced and fixed. Quadrilateral plate (QP) involvement increases fracture complexity and is often associated with medial femoral head displacement. Aim was to compare the functional and radiological outcomes of unstable acetabular fractures with and without QP involvement among surgically treated patients at NITOR, Dhaka.

Methods: This hospital-based comparative observational study was conducted in the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh, from January 2024 to January 2026. Thirty patients with surgically treated unstable acetabular fractures were divided into two groups: with QP involvement (n=18) and without QP involvement (n=12). Demographic, clinical, radiological, operative, and follow-up data were analyzed using SPSS version 26.0, with p<0.05 considered significant.

Results: Patients with QP involvement had significantly more complex fracture patterns (p=0.012), greater preoperative displacement (8.4±2.7 mm vs 5.9±1.8 mm, p=0.008), and more frequent medial femoral head displacement (72.2% vs 16.7%, p=0.008). Operative duration (176.4±34.5 vs 142.5±28.7 minutes, p=0.008) and blood loss (780.0±210.0 vs 560.0±175.0 ml, p=0.005) were significantly higher. Excellent/good functional outcomes (61.1% vs 83.3%) and radiological outcomes (61.1% vs 83.4%) were lower, while complications were more frequent (38.9% vs 16.7%).

Conclusions: QP involvement was associated with greater fracture complexity, increased operative difficulty, and a trend toward poorer outcomes, highlighting the importance of meticulous preoperative planning, stable fixation, and close follow-up.

Surgeon perspectives on musculoskeletal injury and trauma system gaps in The Gambia: a qualitative analysis

Tue, 25 Aug 2026 00:00:00 +0530

Background: In The Gambia, Edward Francis Small Teaching Hospital (EFSTH) is unique in being the only tertiary hospital with a dedicated orthopaedic and trauma department, providing critical insights into the challenges of delivering trauma and orthopaedic care in the country. This qualitative study explored surgeon perspectives on musculoskeletal injury and barriers to trauma care delivery in The Gambia using the socioecological model.

Methods: The study was conducted in January 2025 at EFSTH. Structured interviews were conducted, audio-recorded, and transcribed verbatim. Data were analyzed using inductive and deductive thematic analysis by two independent reviewers.

Results: Five EFSTH surgeons participated in the study, representing multiple surgical specialties involved in musculoskeletal trauma, including orthopaedic surgery (n=2), urology (n=1), general surgery (n=1), and neurosurgery (n=1). Barriers to trauma and orthopaedic care were identified across socioecological levels. At the individual level, gaps in trauma and emergency training were noted. Interpersonal and community-level barriers included limited prehospital care and the absence of trained first responders. Institutional barriers involved weak referral pathways, poor inter-facility communication, and inadequate infrastructure, particularly in rural settings. At the policy level, participants highlighted misalignment between national priorities, funding, and implementation mechanisms.

Conclusions: This study demonstrates that the burden of musculoskeletal injury in The Gambia is driven not only by injury mechanisms but by interconnected barriers spanning individual knowledge, interpersonal connections, community norms, institutional capacity, and national policy. Addressing these challenges will require deliberate investment in trauma systems, workforce development, and injury prevention strategies grounded in the Gambian context.

Management strategies for osteoporotic vertebral compression fractures: a prospective multicentric study

Bijay Kumar Lamay, Gopal Krishna Hembram, Amaresh Prasad Mohapatra — Sat, 04 Jul 2026 00:00:00 +0530

Background: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity among the elderly population, leading to pain, reduced mobility, and diminished quality of life. Various management strategies exist, including conservative treatment, vertebroplasty, and kyphoplasty; however, optimal treatment remains controversial.

Methods: A prospective observational study was conducted across three tertiary care centres in Odisha, India, from December 2023 to December 2025. A total of 220 patients diagnosed with OVCFs were enrolled. Patients were categorized into three groups: conservative management (Group A), vertebroplasty (Group B), and kyphoplasty (Group C). Outcomes were assessed using Visual analog scale (VAS), Oswestry disability index (ODI), and radiological parameters at baseline, 3 months, 6 months, and 12 months.

Results: Significant improvement in pain and functional outcomes was observed in all groups (p<0.001). Kyphoplasty demonstrated superior pain relief and vertebral height restoration compared to other modalities (p<0.05). Vertebroplasty showed faster early pain relief compared to conservative treatment.

Conclusions: Kyphoplasty offers better long-term outcomes in OVCFs, while vertebroplasty provides rapid pain relief. Conservative treatment remains suitable for mild cases.

Defining the end point of drug therapy in tuberculosis of the spine

Anshuman Sahoo, Biplabi Sarangadhar Das, Soma Suprava — Wed, 05 Aug 2026 00:00:00 +0530

Background: Tuberculosis (TB) of the spine (Pott's disease) remains one of the most common forms of skeletal tuberculosis and is an important cause of pain, neurological deficits, spinal deformity, and long-term disability, particularly in developing countries. Although antitubercular therapy (ATT) is the cornerstone of treatment, the optimal endpoint for discontinuing therapy remains controversial because clinical recovery, laboratory improvement, and radiological healing often occur at different stages. This study evaluated the clinical, laboratory, and radiological parameters used to determine the endpoint of ATT in patients with spinal TB.

Methods: A retrospective observational study was conducted in the Department of Orthopaedics at Padmini Care Hospital, Tangi, Cuttack, Odisha, India, between October 2022 and May 2024. Medical records of 50 patients with spinal TB who completed standard first-line ATT were reviewed. Clinical improvement, neurological status, inflammatory markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), and serial radiological findings were analyzed to identify reliable indicators for treatment completion. Statistical analysis was performed using paired Student's t-test and Chi-square test, with p<0.05 considered statistically significant.

Results: The mean age of the patients was 42.8±13.1 years, with males comprising 62.0% of the study population. Significant clinical improvement was observed during treatment, with mean visual analogue scale pain scores decreasing from 7.8±1.1 to 2.1±0.9 (p<0.001). Neurological improvement occurred in 75.0% of patients with baseline neurological deficits. Mean ESR decreased from 63.5±17.2 mm/hour to 18.9±8.4 mm/hour, and mean CRP declined from 31.4±11.8 mg/l to 5.8±3.1 mg/l (both p<0.001). Although complete radiological healing was observed in 38.0% of patients, 94.0% demonstrated radiological stability without disease progression. No clinical relapse was documented during follow-up after discontinuation of ATT.

Conclusions: Clinical recovery, normalization of inflammatory markers, and radiological stability together provide a practical and reliable basis for determining the endpoint of antitubercular therapy in spinal TB. Complete radiological resolution should not be considered mandatory before treatment discontinuation. A multidisciplinary assessment may help prevent unnecessary prolongation of therapy while maintaining favorable clinical outcomes.

A cross-sectional survey assessing clinical utilization and physician perspectives on PEA-based therapy in the management of neuropathic pain

Ajitkumar Gondane, Kushal Sarda, Akhilesh Sharma — Mon, 06 Jul 2026 00:00:00 +0530

Background: Neuropathic pain is a chronic condition associated with substantial morbidity and impaired quality of life. Palmitoylethanolamide (PEA), an endogenous lipid mediator with anti-inflammatory and neuroprotective properties, has emerged as a potential adjunctive therapy for neuropathic pain. This survey evaluated physicians’ utilization patterns, therapeutic positioning, perceived effectiveness, and safety of PEA-based formulations in routine clinical practice.

Methods: A descriptive, questionnaire-based cross-sectional survey was conducted among orthopedic surgeons attending IOACON-2025, Guwahati, India. A structured nine-item questionnaire was administered electronically, and responses from 93 physicians were analyzed using descriptive statistics.

Results: Most physicians reported frequent (49.5%) or very frequent (9.7%) prescribing of PEA-based formulations. Neuropathic pain (71.0%), chronic low back pain (60.2%), and peripheral nerve injury (57.0%) were the most common indications. More than half of the respondents (60.2%) initiated PEA-based therapy as an early adjunct to first-line treatment, while 26.9% prescribed it following an inadequate response to gabapentinoids. Overall efficacy was rated as highly effective by 24.7% and moderately effective by 69.9% of physicians. Symptom improvement was observed within 1-2 weeks by 40.9% of respondents and within 2-4 weeks by 30.1%. PEA-based formulations were considered highly or moderately effective in improving pain, burning sensation, tingling, paresthesia, and sleep disturbances by 94.6% of physicians. Most respondents (83.9%) reported excellent tolerability with minimal adverse effects. Once-daily dosing and improved patient compliance were identified as the most important factors influencing prescribing preference. Additionally, 94.6% considered PEA-based formulations suitable for routine or selective long-term maintenance therapy.

Conclusions: PEA-based formulations are widely utilized in clinical practice and are perceived by physicians as effective, well tolerated, and suitable for both adjunctive and long-term management of neuropathic pain. These findings support the growing role of PEA-based therapy in contemporary neuropathic pain management.

Functional outcome of hip hemiarthroplasty done through modified Hardinge approach in femoral neck fractures: a prospective study of 50 cases

Parshva Gangeshbhai Sharma, Chintak Harshadbhai Patel, Sahil Rajnikant Dhingani — Fri, 14 Aug 2026 00:00:00 +0530

Background: Femoral neck fractures are common injuries in older adults and are associated with substantial morbidity and mortality. Arthroplasty is widely used for displaced intracapsular femoral neck fractures in older patients, while the choice of surgical approach and implant fixation remains an important part of perioperative decision-making.

Methods: This prospective study included 50 patients with femoral neck fractures treated between March 2023 and February 2025. Patients were followed for 6 months to 1 year. Functional outcomes were assessed using the Harris hip score (HHS).

Results: The mean age was 72±8.16 years. Women comprised 60% of the cohort and men 40%. Left-sided fractures accounted for 52% and right-sided fractures for 48%. Most injuries followed low-energy trauma. Uncemented implants were used in 47 patients (94%) and cemented implants in 3 (6%). The mean interval from injury to surgery was 5.5 days. At final follow-up, 72% of patients had good, 18% excellent, 8% fair, and 2% poor functional outcomes. Overall, complications occurred in 20% of patients.

Conclusions: Hip hemiarthroplasty through the modified Hardinge approach was associated with favorable functional outcomes in this prospective cohort, with most patients achieving good-to-excellent HHS and a relatively low frequency of major complications.

Functional and radiological outcome of total knee arthroplasty in varus knee: a prospective observational study

Sai Vamshi B., Bhushan Chickle, Kiran Kumar A. S. — Tue, 18 Aug 2026 00:00:00 +0530

Background: Varus deformity in osteoarthritic knees causes medial compartment overload, pain, instability, and progressive functional limitation. Total knee arthroplasty (TKA) is an established treatment for advanced disease. This study evaluated the clinical and radiological outcomes of TKA in patients with varus knee deformity.

Methods: This prospective observational study was conducted in the Indian tertiary-care teaching hospital, from May 2023 to January 2025. Institutional ethical committee clearance and informed consent from patient was taken. Fifty knees in patients aged 45-80 years with primary or secondary osteoarthritis or rheumatoid arthritis associated with varus deformity underwent posterior-stabilized TKA through a standardized medial parapatellar approach.

Results: Mean knee society clinical scores improved from 48.2 to 84.6 and functional scores from 47.1 to 85.3. Alignment correction and outcome categories are to be reported as per final tables.

Conclusions: TKA provided significant functional improvement and reliable deformity correction.

Functional outcomes of kinematic alignment total knee arthroplasty in Indian patients: a retrospective cohort study

Sourav Shukla — Tue, 04 Aug 2026 00:00:00 +0530

Background: Kinematic alignment (KA) in total knee arthroplasty (TKA) aims to restore the pre-arthritic anatomy of the knee and may offer particular benefit to Indian patients, in whom constitutional varus is common. However, functional outcome data on KA TKA in Indian populations remain limited. This study aimed to assess the functional outcomes of KA TKA in Indian patients.

Methods: This retrospective cohort study included 75 patients who underwent TKA at a single centre in India between January 2018 and August 2019. Functional outcomes were evaluated using the Oxford knee score (OKS) and the visual analogue scale (VAS) for pain at baseline and at 3, 6 and 12 months postoperatively. OKS values were further categorised. The Wilcoxon signed-rank test was used to compare follow-up scores with baseline, with significance set at p<0.05.

Results: The cohort comprised 57 females (76%) and 18 males (24%), with a mean age of 66.75±6.95 years. The mean OKS improved from 18.6±0.87 at baseline to 50.5±1.19 at 12 months (p<0.001), with all patients reaching the ‘excellent’ category by the first follow-up. The mean VAS score fell from 5.4±0.49 to 1.0±0.00 at 12 months, an 81.4% reduction (p<0.001).

Conclusions: KA in TKA produced significant and sustained improvements in function and pain relief in Indian patients, supporting its feasibility in this population. Larger, multicentre studies are warranted to confirm these findings.

Squat mechanics as predictors of countermovement jump performance in healthy young adults: a cross-sectional study

Shobhit Raizaday, Satyam Khare, Shilpi Jain, Kamal Swarn — Tue, 18 Aug 2026 00:00:00 +0530

Background: Squat depth and dynamic knee valgus (DKV) are widely discussed determinants of lower-limb performance and injury risk, yet their independent contribution to jump performance has rarely been examined together, particularly using accessible, application-based tools. This study examined whether squat depth and DKV predict countermovement jump (CMJ) performance in healthy young adults.

Methods: In this cross-sectional study, 139 healthy young adults (71 men, 68 women; 18-25 years) underwent smartphone/tablet-based biomechanical assessment. Squat depth was quantified as trochanteric displacement normalised to femur length during a self-selected bodyweight squat; DKV was measured from frontal-plane video as peak medial knee displacement; CMJ, squat jump and horizontal jump performance were assessed using a validated flight-time application. Associations were examined using Spearman correlation, multiple linear regression (adjusted for age, sex and body mass index [BMI]), and squat-depth quartile comparison.

Results: Squat depth correlated strongly with CMJ height (r=0.72), squat jump height (r=0.76) and horizontal jump length (r=0.61, all p<0.001), and remained an independent predictor of CMJ height after adjustment (β=6.79 cm per unit depth, p<0.001; model R²=0.879). DKV was not associated with squat depth (r=-0.12, p=0.152) and showed only a borderline association with CMJ height (β=-0.383, p=0.051). A squat-depth×sex interaction on DKV approached but did not reach significance (β=1.44, p=0.078).

Conclusions: Squat depth, not DKV, was a strong, independent predictor of CMJ performance. Squat depth showed no meaningful relationship with knee valgus, suggesting the two are largely independent expressions of lower-limb function in healthy young adults.

The effectiveness and safety of triamcinolone hexacetonide intra-articular injection in adhesive capsulitis: results from a prospective, multicentre, single-arm, open-label, post-marketing observational study

Fri, 14 Aug 2026 00:00:00 +0530

Background: Adhesive capsulitis is a painful shoulder disorder causing progressive stiffness and restricted mobility. Despite widespread use of intra-articular corticosteroids, real-world evidence on triamcinolone hexacetonide in India remains limited. This prospective study assessed the effectiveness and safety of a single ultrasound-guided intra-articular injection in routine practice.

Methods: This prospective, multicenter, single-arm post-marketing observational study was conducted at four sites in India. Adults with symptomatic adhesive capsulitis received a single ultrasound-guided intra-articular injection of triamcinolone hexacetonide (20-40 mg). Effectiveness was measured by changes in SPADI total and subscale scores over 12 weeks, while safety was assessed through adverse event monitoring.

Results: A total of 60 patients (37 males, 23 females) with a mean (SD) age of 46.60 (15.56) years were enrolled, and all completed the study. Compared to the mean (SD) baseline score of 74.14 (14.40), total SPADI score declined significantly (p<0.0001) by 11.15 (8.19) and by 28.70 (27.19) points at week 4 and 12, respectively, with clinically meaningful improvement observed from week 1 and sustained through week 12. Pain and disability subscales demonstrated parallel statistically significant reductions. Treatment was well tolerated; mild, transient adverse events (AEs) were reported in 8.3% of patients and were not treatment-related.

Conclusions: In routine clinical practice, a single intra-articular injection of triamcinolone hexacetonide performed with ultrasound guidance was effective in alleviating pain and improving functional outcomes in patients with adhesive capsulitis, while demonstrating a favorable safety profile. These findings support its use as a practical treatment option for frozen shoulder and provide preliminary real-world evidence to inform future prospective studies.

Effect of lateral radiograph on interobserver agreement in Garden classification of intracapsular femoral neck fractures

Rajat Kumar, Pankaj Jain, Rajesh Kumar — Tue, 25 Aug 2026 00:00:00 +0530

Background: Garden classification is widely used to guide treatment of intracapsular femoral neck fractures, but interobserver reliability remains variable. This prospective observational study assessed agreement in Garden classification and management planning using anteroposterior radiographs alone versus combined anteroposterior and lateral radiographs.

Methods: Thirty-five anonymized radiographic sets from adults with intracapsular femoral neck fractures were independently reviewed by 10 orthopaedic observers. Fleiss kappa was used to quantify interobserver agreement.

Results: Agreement for Garden classification improved from kappa 0.64 on anteroposterior view alone to 0.76 after adding the lateral view. Agreement for management planning improved from kappa 0.56 to 0.74. Addition of the lateral view changed fracture classification in 61 of 350 observer-case assessments (17.43%) and changed proposed management in 111 of 350 assessments (31.71%). Observers with less than 5 years of experience showed more changes than those with 5-10 years of experience.

Conclusions: Addition of the lateral radiograph improved consistency of both Garden classification and treatment planning for intracapsular femoral neck fractures.

Functional outcomes of augmented intramedullary nailing for unstable intertrochanteric fractures with lateral wall deficiency in elderly patients with Dorr type C femur: a prospective observational study

Ajay Garg, Jitesh Sharma, Aman Bubna, Samridhi Wadhwa — Tue, 25 Aug 2026 00:00:00 +0530

Background: Managing unstable intertrochanteric femur fractures in older adults remains challenging, particularly when lateral wall disruption coexists with severe osteoporosis. In patients with Dorr type C femoral morphology, compromised bone quality further reduces fixation stability and increases the risk of mechanical failure. Although intramedullary nailing is widely accepted for unstable fracture patterns, additional lateral wall reconstruction using an extramedullary implant may provide enhanced structural support. Evidence regarding the clinical effectiveness of this combined fixation strategy in elderly osteoporotic patients remains limited. This study evaluated the functional and radiological outcomes of augmented intramedullary fixation in this high-risk population.

Methods: A prospective observational study was conducted in 30 patients aged 65–75 years presenting with unstable intertrochanteric fractures associated with lateral wall deficiency and Dorr type C femoral morphology. All participants underwent fixation using a proximal femoral intramedullary nail supplemented with an extramedullary implant. Clinical assessment, radiographic evaluation and functional outcome measurement were performed at 2 weeks, 2 months and 6 months after surgery. Functional recovery was assessed using the Harris Hip Score (HHS), while fracture union, postoperative complications and the timing of weight bearing were also recorded.

Results: The mean patient age was 69.5±2.59 years and females represented 53.3% of the study population. Low-energy falls accounted for most injuries (80%). Radiographic union was achieved within 15–20 weeks in 80% of patients. Partial weight bearing commenced within 5–6 postoperative days in 53.3% of cases. Functional performance improved steadily during follow-up, with the mean Harris Hip Score increasing from 47.73±3.08 at two weeks to 86.60±5.96 at six months (p<0.001). At final evaluation, excellent and good functional outcomes were observed in 46.7% and 43.3% of patients, respectively. An uncomplicated postoperative course was documented in 86.7% of patients, while implant-related complications were uncommon.

Conclusions: Augmentation of intramedullary fixation with an extramedullary implant provides stable fixation for unstable intertrochanteric fractures with lateral wall deficiency in elderly patients with Dorr type C femora. The technique supports early mobilisation, facilitates timely fracture healing and results in favourable functional recovery with a low incidence of postoperative complications. These findings suggest that augmented fixation is a reliable treatment option for complex osteoporotic intertrochanteric fractures.

Functional and radiological outcomes of medial minimally invasive percutaneous plate osteosynthesis in distal tibial pilon fractures: a prospective study

Abdul Kadar, Chittaranjan Karuppanan, Chackopaul Joseph, Vinod Kumar — Tue, 25 Aug 2026 00:00:00 +0530

Background: Distal tibial fractures represent 5-10% of all tibia fractures, with challenges arising from soft tissue damage and complications like nonunion and infection. Minimally invasive percutaneous plate osteosynthesis (MIPPO) is a biological plating technique for treatment these fractures, aiming to reduce complications by preserving periosteal blood supply and minimizing tissue disruption. This study evaluates the radiological and clinical outcomes of distal tibial fractures treated using biological plating with the radiographic union scale for tibia (RUST) and the American Orthopaedic Foot and Ankle Society (AOFAS) score system.

Methods: This prospective study conducted for 18 months involving 22 patients with distal tibial fractures, treated with MIPPO using distal tibial locking compression plates followed up. The inclusion criteria were patients aged above 18 years with fractures of AO classification types 43C, 43B, and 43A. Patients were followed up at 1, 2, 3 and 6 months postoperatively, with radiological assessments based on RUST score for fracture union and functional outcomes using the AOFAS score. Statistical package for the social sciences (SPSS) used for data analysis.

Results: The study included patients age averaging 48.4 years and consisted of 72.7% males. The primary cause of injury was road traffic accidents (54.5%). Fracture union was achieved in an average of 15 weeks using RUST score. AOFAS outcomes showed 54.5% of patients with excellent, 31.8% with good, and 13.6% with fair results. Complications such as infection and malalignment were observed in 27.3% of patients.

Conclusions: Biological plating using MIPPO technique offers reliable clinical and radiological outcomes for distal tibial fractures, with high union rates and favorable AOFAS scores. Despite few complications, Biological plating remains an effective method for the treatment of distal tibial fractures, particularly in cases requiring soft tissue preservation. Further research into long-term complications and functional outcomes is recommended.

Functional outcomes of a perforator-based bipedicled flap for reconstruction of post-traumatic anteromedial leg defects: a prospective study of 76 patients

Lekhashree G., Jacob K. Ipe, Sharathgowda K. N., Saksham Gupta — Tue, 25 Aug 2026 00:00:00 +0530

Background: Reconstruction of post-traumatic soft tissue defects over the anteromedial leg is challenging owing to the subcutaneous position of tibia, sparse local muscle coverage, tenuous skin vascularity. Conventional options: local fasciocutaneous flaps and microsurgical free tissue transfer are effective, but associated with technical complexity, donor site morbidity and significant resource requirements. This study prospectively evaluates the outcomes of perforator-based-bipedicled-flap technique as a reliable primary reconstructive option.

Methods: A prospective-observational-study was conducted at a single tertiary-care centre between January 2023 and January 2026. 76 patients with open tibial fractures (Gustilo-Anderson types IIIA/IIIB) and associated anteromedial soft tissue defects underwent perforator-based-bipedicled-flap-reconstruction. Posterior tibial artery perforators were directly visualised and preserved during flap elevation. Primary outcome-complete flap survival; secondary outcomes included complication rates, donor site morbidity, functional status at 12 months follow-up.

Results: The cohort comprised 70 males (92.1%) and 6 females (7.9%), predominantly in 30-50-year age group. Defects were frequently located in middle-third of the leg (56.6%). Mean defect dimensions were 3×4 cm. Complete flap survival was achieved in 73 cases (96.1%). Complications occurred in 3 patients (3.9%): 2 cases of wound edge necrosis managed with secondary skin-grafting, 1case of progressive limb ischaemia necessitating above-knee-amputation. No functional deficit attributable to the reconstruction was documented at final follow-up. Donor site morbidity was minimal.

Conclusions: The perforator-based bipedicled flap provides a technically straightforward, reproducible, cost-effective reconstructive solution for anteromedial leg defects following high-energy tibial fractures. Its favourable survival rate, low complication, inherent intraoperative convertibility makes it a valuable primary option, particularly in resource-constrained settings.

Functional outcome assessment of total knee arthroplasty using the knee society score: a prospective single-centre study from a tertiary care hospital in Lucknow, Uttar Pradesh

Ashutosh Yadav, Sachin Kumar Yadav, Ajay Kumar Yadav — Tue, 25 Aug 2026 00:00:00 +0530

Background: Knee osteoarthritis (OA) is a leading cause of chronic pain and functional disability, disproportionately affecting elderly individuals in low- and middle-income countries. Total knee arthroplasty (TKA) is the definitive treatment for end-stage disease, yet outcome data from tertiary care hospitals in Uttar Pradesh using validated scoring tools remain limited. Objectives were to assess the preoperative and postoperative functional outcomes of patients undergoing primary TKA using the Knee Society Score (KSS), and to examine associations between functional outcome and patient-level demographic variables.

Methods: A hospital-based prospective observational study was conducted in the Department of Orthopaedic Surgery, Balrampur Hospital, Lucknow, from September 2024 to August 2025. Sixty-five consecutive patients with primary knee OA undergoing primary TKA were enrolled. Patients with inflammatory or post-traumatic arthritis, revision surgery, active infection, or neuromuscular disorders were excluded. Functional outcome was assessed using the two-component KSS (Knee score and functional score) preoperatively and at 12-month follow-up. Preoperative-postoperative comparison was performed using paired t-test; associations between functional outcome category and demographic variables were assessed using the chi-square test (p<0.05 considered significant).

Results: Mean patient age was in the sixth decade, with female predominance (63.1%). The mean Knee Score improved from 41.6±8.9 preoperatively to 86.9±6.7 at 12 months (mean difference 45.3; p<0.001), and the mean functional score from 38.2±9.4 to 82.4±7.9 (mean difference 44.2; p<0.001). Excellent outcomes were achieved in 73.8% of patients and good outcomes in 18.5%, yielding a combined excellent-to-good rate of 92.3%. Patients aged ≥60 years demonstrated significantly better functional outcomes than younger patients (p=0.024). Gender and body mass index did not independently influence postoperative functional scores. No cases of deep infection or revision surgery were recorded during follow-up.

Conclusions: Primary TKA produces significant, sustained improvement in knee function and mobility at one year, achieving excellent-to-good outcomes in over 90% of patients. The KSS is a reliable and responsive instrument for routine outcome audit. Appropriate patient selection, structured rehabilitation, and targeted expectation management-particularly in younger patients-are key determinants of optimised postoperative results.

Preoperative prediction of length of the femoral tunnel in single bundle anterior cruciate ligament reconstruction in knee MRI

Vijay C., Santhosh M. S., Adarsh T., Rajesh D. S. — Tue, 25 Aug 2026 00:00:00 +0530

Background: This study aims to find the correlation between the length of the femoral tunnel and morphological parameters of the knee in the magnetic resonance imaging (MRI) before anatomical single-bundle anterior cruciate ligament (ACL) reconstruction and if these variables can be used for preoperative prediction.

Methods: A prospective study of 30 patients undergoing ACL reconstruction by the same surgeon. Anthropometric measurements (weight, height, BMI) and knee morphological parameters were assessed using MRI. These included anteroposterior (AP) knee length, trans-epicondylar length, axial notch area, notch outlet length, posterior condyle length, notch width index (NWI), Blumensaat's line length, and lateral wall of the notch dimensions. Intraoperative femoral tunnel length was measured and correlated with these parameters.

Results: A strong positive correlation was found between patient height and femoral tunnel length (r=0.797, p<0.001). Significant positive correlations were also observed between femoral tunnel length and both AP length of the knee (r=0.355, p=0.04) and trans-epicondylar length (r=0.377, p=0.040). Interestingly, a moderate negative correlation was found between BMI and femoral tunnel length (r=-0.425, p=0.019).

Conclusions: Patient height, AP knee length and trans-epicondylar length could be helpful predictors of femoral tunnel length in preoperative planning for in single-bundle ACL reconstruction.

Functional outcomes in arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon graft

Siddhartha Sablay, Nitin Thikare, Nitin Wagh, Vaibhav Pawar — Tue, 25 Aug 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) rupture is a common knee injury in active individuals, leading to instability, meniscal and chondral damage, and early osteoarthritis. Arthroscopic ACL reconstruction is the preferred treatment. The concerns about donor site morbidity have prompted interest in alternative grafts such as the peroneus longus tendon, which offers adequate strength and potentially lower morbidity. This study evaluates the functional outcomes of arthroscopic ACL reconstruction using peroneus longus tendon autograft.

Methods: This 30-month prospective study at a tertiary centre evaluated arthroscopic ACL reconstruction with ipsilateral peroneus longus autograft in ≥34 skeletally mature patients (≥18 years) with complete ACL rupture and instability. Single-bundle medial portal technique used Endo button and interference screw fixation. Outcomes assessed preoperatively and at 3, 6, and 9 months using Tegner-Lysholm (T-L), International Knee Documentation Committee (IKDC) knee, and AOFAS ankle scores.

Results: The mean age of patients was 30.41 years±5.83, with male predominance (61.76%). Sports injury was the most common cause (55.88%), 73.53% had a graft diameter of 9 mm. The mean T-L score improved significantly from 65.79±4.66 preoperatively to 90.85±2.10 at 9 months. The mean IKDC score increased from 59.91±7.23 to 92.02±2.34. The mean AOFAS score decreased from 100±0.00 to 98.29±1.91, remaining within excellent to good range.

Conclusions: Peroneus longus autograft ACL reconstruction delivers excellent functional recovery and minimal donor-site impact, ideal for active patients.

Unilateral biportal endoscopy for lumbar spinal stenosis: outcomes and potential to reduce fusion in Schizas grade D patients

Shardul M. Soman, Piyush W. Gadegone, Urmish Rathod — Tue, 25 Aug 2026 00:00:00 +0530

Background: Unilateral biportal endoscopy (UBE) is an established minimally invasive technique for the surgical management of lumbar spinal stenosis (LSS). However, prospective evidence regarding its effectiveness in severe stenosis, particularly Schizas Grade D disease, remains limited. This study evaluated the clinical and radiological outcomes of UBE with unilateral laminotomy for bilateral decompression in patients with LSS, with particular emphasis on severe stenosis.

Methods: This prospective single-surgeon study included 134 consecutive patients with LSS who underwent UBE decompression between April 2021 and September 2023. Patients with pre-existing instability or other indications for fusion were excluded. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) at a minimum follow-up of 12 months. Particular attention was paid to the outcomes of patients with Schizas Grade D stenosis.

Results: Of the 134 patients, 128 completed the 12-month follow-up. Mean VAS leg pain improved from 7.92 to 0.63 (p<0.001), while mean ODI improved from 69.66 to 39.34 (p<0.001). Among the 42 patients with Schizas Grade D stenosis, two patients (4.8%) required revision surgery, with one patient (2.4%) subsequently undergoing instrumented fusion. Two dural tears (4.8%) occurred in this subgroup. No patient developed postoperative instability requiring unplanned fusion during the follow-up period.

Conclusions: UBE provides safe and effective decompression for carefully selected patients with lumbar spinal stenosis, including severe Schizas Grade D disease, resulting in significant pain relief and functional improvement. The low revision and subsequent fusion rates observed in this series suggest that motion-preserving decompression may be a viable treatment strategy for selected stable spines, although larger comparative studies with longer follow-up are required.

Comparison of clinical and radiological outcomes of a proximal femoral nail with a helical screw versus a proximal femoral nail with two screws in elderly patients with intertrochanteric femur fractures

Deepak Mantri, Harshwardhan Dawar, Saket Sidhanta Singh — Tue, 25 Aug 2026 00:00:00 +0530

Background: Intertrochanteric femur fractures in the elderly carry high morbidity and mortality rates, while the Proximal Femoral Nail (PFN) is a standard treatment, debate persists regarding the optimal screw configuration. This study compares the clinical and radiological outcomes of the helical blade versus the two-screw PFN in elderly patients with unstable intertrochanteric fractures.

Methods: A prospective observational study was conducted on 70 patients aged >60 years with unstable intertrochanteric fractures. Patients were randomized into two groups (n=35 each). Functional outcomes were assessed using the Harris Hip Score (HHS) and radiological union time was evaluated. Operative time and postoperative complications were also recorded.

Results: The functional outcomes were comparable between the study groups, most patients demonstrated HHS scores greater than 80, suggestive of favorable functional recovery. A greater proportion of early unions (≤10 weeks) and fewer delayed unions (>16 weeks) were observed in the helical group compared to the 2-screw group. The mean duration of surgery was significantly lower in the helical group (37 minutes) compared to the 2-screw group (45 minutes). Complications occurred in 10 out of 70 patients, a comparatively better complication profile with the helical blade (3 patients) than 2 screw (7 patients) was observed.

Conclusions: Both the helical blade and two-screw are effective. However, the helical blade offers distinct advantages including shorter operative time, faster radiological union, and a lower complication profile, making it a preferable option for early mobilization in elderly patients.

Evaluation of distal tibial fractures with soft tissue injury treated using locking plate as an external fixator: a prospective study

Tue, 25 Aug 2026 00:00:00 +0530

Background: Distal tibial fractures are frequently associated with significant soft tissue injury because of the subcutaneous location and limited vascularity of the distal tibia. Management of these fractures remains challenging, as conventional internal fixation may increase the risk of wound complications, infection, and delayed healing. The use of a locking plate as an external fixator, also known as supercutaneous plating, has emerged as a minimally invasive alternative that provides stable fixation while preserving soft tissue integrity. Objective was to evaluate the clinical, functional, and radiological outcomes of distal tibial fractures associated with soft tissue injury treated using a locking plate as an external fixator.

Methods: This prospective hospital-based study included 32 patients with distal one-third tibial fractures associated with soft tissue injury treated between October 2022 and March 2024. Closed fractures with significant soft tissue compromise and open fractures up to Gustilo-Anderson type IIIA were included. Patients were followed up at regular intervals with clinical and radiological assessment. Outcome measures included time to fracture union, time to full weight bearing, complications, and functional outcomes assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS).

Results: The mean age of the patients was 42.9±11.4 years. Road traffic accidents were the most common mechanism of injury. Eighteen patients had open fractures. The mean time to radiological union was 15.66±2.25 weeks. Full weight bearing was achieved at a mean of 14.22±2.52 weeks, and the mean time to plate removal was 19.25±2.45 weeks. Pin tract infection occurred in 6 patients and was superficial in all cases. The mean postoperative AOFAS score was 93±2.59, indicating excellent functional outcome.

Conclusions: Locking plate used as an external fixator is a safe, effective, and minimally invasive technique for the management of distal tibial fractures associated with soft tissue injury, providing excellent functional and radiological outcomes with low complication rates.

Accuracy of pedicle screw fixation under O-arm and navigation guidance in thoracolumbar spine surgery

Tue, 25 Aug 2026 00:00:00 +0530

Background: Accurate pedicle screw placement is critical for successful thoracolumbar spine fixation. Misplacement can lead to complications such as neurological injury, vascular damage, and the need for revision surgeries. The use of 3D intraoperative imaging and navigation systems, such as the O-arm and Stealth system, has been proposed to improve screw placement accuracy. This study evaluates the efficacy and safety of these systems for pedicle screw insertion in the thoracolumbar spine.

Methods: A prospective, non-randomized study was conducted with 118 patients who underwent thoracolumbar spine fixation between July 2022 and April 2024. A total of 512 pedicle screws were inserted using the O-arm navigation system. Preoperative assessments included X-ray, MRI, and neurological evaluation using the ASIA scale and VAS. The O-arm system was used for real-time 3D imaging, guiding screw placement. Postoperative accuracy was evaluated with an O-arm confirmation scan and classified using the Gertzbein and Robbins scale.

Results: The study group included 46 male and 72 female patients, with the mean age of 49.22 years. Degenerative diseases were the most common aetiology. Pedicle screw fixation was performed alone in 32 cases and in combination with decompression or TLIF in 86 cases. Of the 512 screws inserted, 486 (95%) were classified as Grade A (accurate placement). The overall breach rate was 5.07%, with 2.34% requiring intraoperative revision. Notably, no postoperative revisions or neurovascular injuries occurred, and there was no deterioration in ASIA grading or VAS scores.

Conclusions: The use of 3D intraoperative imaging and navigation significantly enhances the accuracy and safety of pedicle screw placement in thoracolumbar spine surgery. Routine use of this technology minimizes complications, reduces the need for revision surgeries, and ensures optimal patient outcomes.

Functional outcome of minimally invasive plate osteosynthesis technique in shaft of humerus fractures: a prospective cohort study

Tue, 25 Aug 2026 00:00:00 +0530

Background: Humeral shaft fractures require restoration of alignment while preserving soft tissue. Minimally invasive plate osteosynthesis (MIPO) with anterior bridge plating aims to achieve stable fixation with minimal soft‑tissue disruption. This study evaluated the functional, clinical, and radiological outcomes of anterior bridge plating using MIPO for humeral shaft fractures.

Methods: Prospective observational cohort study at the Department of Orthopaedics, Zydus Medical College and Hospital, Dahod, Gujarat, from October 2023 to December 2025. Twenty‑four patients (18-50 years) with closed or Gustilo grade I open humeral shaft fractures underwent MIPO using locking compression plates (LCP) via an anterior brachialis‑splitting approach. Outcomes assessed were Constant‑Murley score (CMS) and Mayo elbow performance score (MEPS) at 3 weeks, 6 weeks, 3 months, 6 months, and 12 months, along with radiological union time, operative time, blood loss, and complications.

Results: Mean age was 35.2±9.4 years; 91.7% were male. AO type 12A fractures comprised 87.5% of cases. Mean operative time was 72.5±7.7 minutes and mean blood loss 119±14 mL. Mean radiological union time was 14.2±2.7 weeks. At final follow‑up mean CMS was 90.0±4.0 and mean MEPS 94.1±3.8; 91.7% of patients achieved excellent or good functional outcomes. Three complications occurred: one delayed union, one nonunion, and one deep infection. No iatrogenic radial nerve palsy was observed.

Conclusions: Anterior bridge‑plate MIPO for humeral shaft fractures is safe and reproducible, yielding high rates of union and excellent functional outcomes with a low complication profile. Its minimal soft‑tissue disruption makes it well suited to resource‑limited settings.

Elastic stable intramedullary nailing for pediatric tibial shaft fractures: a prospective observational study of clinical, radiological and functional outcomes

Tue, 25 Aug 2026 00:00:00 +0530

Background: Pediatric tibial shaft fractures are among the most common long-bone injuries in children. Although stable fractures can be managed conservatively, unstable or displaced fractures often require surgical stabilization. Elastic stable intramedullary nailing (ESIN) provides minimally invasive fixation while preserving fracture biology and allowing early mobilization. This study evaluated the clinical, radiological, and functional outcomes of ESIN in pediatric tibial shaft fractures.

Methods: This prospective observational study included 40 children aged 3–15 years with closed or Gustilo–Anderson grade I open tibial shaft fractures treated with ESIN at a tertiary care centre between October 2023 and November 2025. Patients were followed for 12 months. Outcome measures included radiological union using the modified radiographic union score for tibial fractures (mRUST), pain using the visual analogue scale (VAS), knee and ankle range of motion (ROM), time to weight-bearing, alignment, complications, and functional outcome using Flynn's criteria.

Results: The mean age was 10.7±2.9 years, and 72.5% of patients were male. Mean operative time was 60.5±9.5 minutes with mean blood loss of 20.8±7.3 ml. Radiological healing, pain, and functional outcomes improved significantly throughout follow-up (all p<0.001). Mean time to radiological union was 9.4±1.9 weeks, with full weight-bearing achieved at 10.7±2.1 weeks. At 12 months, 85% of patients had excellent and 15% had satisfactory outcomes according to Flynn's criteria. One patient (2.5%) developed a superficial wound infection; no non-union, malalignment, or significant limb-length discrepancy was observed.

Conclusions: ESIN is a safe, effective, and minimally invasive treatment for pediatric tibial shaft fractures, providing reliable fracture union, excellent functional recovery, and a low complication rate.

Role of antibiotic-coated intramedullary nails and antibiotic beads in the management of infected nonunion of long bones

Raghavendra R., Prakash A. Sasnur — Tue, 25 Aug 2026 00:00:00 +0530

Background: Infected non-union of long bones remains a challenging condition in orthopaedic practice because of the coexistence of infection, bone instability and impaired fracture healing. Antibiotic-coated intramedullary nails and antibiotic beads provide simultaneous local antibiotic delivery and mechanical stabilization, thereby improving infection control and fracture union. To evaluate the clinical and functional outcomes of antibiotic-coated intramedullary nails and antibiotic beads in the management of infected non-union of long bones.

Methods: This prospective study included 20 patients with infected non-union of long bones treated with antibiotic-coated intramedullary nails and antibiotic beads between January 2024 and January 2026. Clinical, microbiological, radiological and functional outcomes were assessed. Infection control, fracture union, time to union, complications and functional outcomes according to the Paley scoring system were evaluated during follow-up.

Results: The majority of patients belonged to the 21–30 years age group (35%). The tibia was the most commonly affected bone (60%), followed by the femur (40%). Staphylococcus aureus was the most common organism isolated (50%). Infection control was achieved in 70% of patients, while radiological union was observed in 80% of cases. The mean time to union was 26.25±5.57 weeks. According to the Paley functional scoring system, excellent and good outcomes were achieved in 45% and 25% of patients respectively. Postoperative complications were absent in 70% of patients, while reinfection occurred in 20%, implant failure in 5% and persistent sinus in 5% of cases.

Conclusions: Antibiotic-coated intramedullary nails and antibiotic beads are effective treatment modalities for infected non-union of long bones, providing satisfactory infection control, fracture union and functional outcomes. The combined advantages of local antibiotic delivery and mechanical stabilization make this technique a reliable option in the management of infected non-union.

A hospital-based prospective study comparing nonoperative and operative treatment of type 2 tibial spine fractures

Rajesh Kumar, Zakir Hussain, Rajat Kumar — Tue, 25 Aug 2026 00:00:00 +0530

Background: Type 2 tibial spine fractures present a therapeutic dilemma because both nonoperative and operative treatment are commonly used, with no universal consensus regarding the optimal approach.

Methods: This prospective hospital-based study included 60 patients with Type 2 tibial spine fractures treated at SMS Medical College, Jaipur, from August 2023 to July 2024. Thirty patients underwent operative fixation and 30 received nonoperative management. Outcomes assessed included complications, knee stability, range of motion, and subsequent surgical interventions.

Results: The operative group demonstrated significantly better knee flexion (132.40±5.29 degrees vs 124.33±6.58 degrees, p<0.001) and total arc of motion (132.53±5.36 degrees vs 124.07±6.53 degrees, p<0.001). Positive Lachman test was more frequent after nonoperative treatment (20.0% vs 6.7%). Arthrofibrosis occurred only in the operative group, whereas new ACL injury and re-fracture were observed only in the nonoperative group. Subsequent surgery was required in 6.7% of patients in each group.

Conclusions: Operative treatment was associated with better postoperative range of motion and less residual laxity, while nonoperative treatment showed more instability-related complications. Treatment should be individualized according to patient profile and injury characteristics.

Hemiarthroplasty versus total hip replacement in displaced femoral neck fractures among the elderly: a prospective comparative study

Narendra Pratap Singh, Shivendra Singh, Prakash Jha — Tue, 25 Aug 2026 00:00:00 +0530

Background: Displaced femoral neck fractures in elderly patients are associated with high morbidity, impaired mobility, and reduced quality of life. Although arthroplasty is the preferred treatment, the choice between hemiarthroplasty and total hip replacement remains debated. This study aimed to compare their functional outcomes, perioperative parameters, complications, and overall clinical results.

Methods: This prospective comparative study included 60 elderly patients with displaced intracapsular femoral neck fractures. Patients were divided into two equal groups: group A underwent hemiarthroplasty and group B underwent total hip replacement. Baseline demographic variables, comorbidities, operative time, intraoperative blood loss, transfusion requirement, hospital stay, mobilization time, complications, reoperation, mortality, and Harris hip score (HHS) were assessed during follow-up at 1, 3, 6, and 12 months.

Results: Baseline characteristics and comorbidities were comparable between the two groups. Hemiarthroplasty was associated with significantly shorter operative time than total hip replacement, 72.43±12.85 minutes versus 98.66±15.32 minutes, respectively (p<0.001). Mean intraoperative blood loss was also significantly lower in the hemiarthroplasty group, 286.75±74.52 ml compared with 421.33±96.25 ml in the total hip replacement group (p<0.001). Blood transfusion requirement was significantly lower after hemiarthroplasty than after total hip replacement, 26.7% versus 53.3% (p=0.035). Total hip replacement demonstrated significantly better HHS at 3 months (75.86±7.64 versus 70.53±8.22; p=0.012), 6 months (84.62±6.84 versus 77.95±7.56; p=0.001), and 12 months (89.15±6.46 versus 81.33±7.27; p=0.001). Excellent or good outcome was achieved in 83.3% of total hip replacement patients compared with 63.3% of hemiarthroplasty patients. Acetabular erosion was significantly more common after hemiarthroplasty, 13.3% versus 0.0% (p=0.0384).

Conclusions: Total hip replacement provides better functional recovery in active, medically fit elderly patients, whereas hemiarthroplasty offers perioperative advantages and remains suitable for frail or low-demand patients. Procedure selection should be individualized.

A comparative study to determine the incidence of post-operative wound infection in primary orthopaedics surgery with betasaline and normal saline intraoperative wound irrigation

Daanish Feraze, Surya Vijay Singh, Anurag Varshney, Deep Prakashbhai Desai — Tue, 25 Aug 2026 00:00:00 +0530

Background: Orthopaedic surgeries are susceptible to surgical site infections (SSIs) that highly contribute to postoperative morbidity and cost of health care. The importance of wound irrigation is a preventive measure, which is critical, yet the relative effectiveness of antiseptic solutions and regular saline should be assessed further. This study aimed to compare the incidence of postoperative wound infection and the general tissue healing of intraoperative betasaline (diluted povidone-iodine) with normal saline irrigation during primary orthopaedic surgeries.

Methods: A comparative study was done over 21 months on 200 adult patients undergoing primary orthopaedic surgeries. Group A (betasaline, n=100) and group B (normal saline, n=100), were randomized equally. The Southampton wound grading system was used to assess postoperative wounds on day (POD) 2, 7, 14 and 30.

Results: Baseline demographics were similar. Grade 3 changes (serous discharge) occurred in 4% (n=4) of the normal saline cohort on POD 2 compared to 0% grade 3 or grade 4 changes in the betasaline cohort. More importantly, grade 4 SSIs (purulent discharge) were not developed by either group. At POD 7, 50 per cent (n=50) patients in the betasaline group had grade 1 healing, as compared to 46 per cent (n=46) patients in the normal saline group. By POD 30, 100% of participants in both groups had achieved complete wound healing (grade 0). There were only minor, localized skin reactions in 6% (n=6) of the betasaline group with no systemic adverse effects observed.

Conclusions: Betasaline and normal saline are good agents of ensuring satisfactory wound healing. Nonetheless, intraoperative irrigation with betasaline shows a very promising clinical pattern of reducing early postoperative infections and speeding up the healing of tissue inflammation with an acceptable safety profile.

A prospective study on functional analysis and outcome of frozen shoulder following arthroscopic capsular release in resistant cases

Shinoj Saseendran, Bharath M., Vikash Singh Shekhawat — Tue, 25 Aug 2026 00:00:00 +0530

Background: Frozen shoulder or adhesive capsulitis, is characterized by pain and restricted shoulder motion, significantly impairing daily function. Assessment of functional outcomes after arthroscopic capsular release is essential to evaluate treatment efficacy and guide rehabilitation

Methods: This prospective observational study evaluated the efficacy of arthroscopic capsular release in 32 patients aged 45–60 years with refractory frozen shoulder. Patients with rotator cuff injuries or intra-articular fractures were excluded. Preoperative and postoperative assessments at 1, 3 and 6 months included range of motion (ROM), pain via Visual Analogue Scale (VAS), functional outcomes using Constant–Murley and ASES scores and quality of life measured by EQ-5D.

Results: This study demonstrated significant improvements in shoulder ROM across all planes at 6 months (abduction: 65.2° to 140.3°, flexion: 70.4° to 145.8°, p<0.001). VAS scores decreased markedly from 7.8 to 1.0 (p<0.001). Functional scores improved substantially: Constant–Murley from 28.5 to 85.4, ASES from 32.7 to 88.2 and EQ-5D index from 0.45 to 0.91 (all p<0.001). Patients with primary etiology showed better functional recovery than secondary cases (Constant–Murley 88.2 vs. 79.4, p=0.003). Complications were minimal and transient.

Conclusions: Arthroscopic capsular release is a safe and effective intervention for frozen shoulder unresponsive to conservative treatment, resulting in significant pain relief, improved shoulder function and enhanced quality of life. Primary adhesive capsulitis patients experience superior outcomes. Further research with extended follow-up is warranted to optimize rehabilitation protocols.

A comparative study of platelet-rich plasma versus corticosteroid injections in the management of partial thickness rotator cuff tears

Tue, 25 Aug 2026 00:00:00 +0530

Background: Rotator cuff disease (RCD) affects over 60% of individuals above 80 years. Partial thickness rotator cuff tears (PTRCTs) cause persistent pain and functional limitation. Corticosteroid injections provide short-term relief but risk tendon degeneration. Platelet-rich plasma (PRP), enriched with TGF-β, VEGF, PDGF and EGF, promotes tendon regeneration and may offer durable benefit.

Methods: Prospective comparative study over 20 months (June 2023–February 2025). Forty-four patients (22 per group) with USG/MRI-confirmed PTRCTs were assigned to Group A (corticosteroid: triamcinolone acetonide 40 mg) or Group B (autologous PRP via MyCells System). Outcomes assessed using VAS (pain), ASES score (function) and shoulder goniometry at 4, 8 and 12 weeks. Chi-square test used; p<0.05 considered significant

Results: Both groups had moderate pain at 4 weeks. At 8 weeks, 36.4% of PRP patients improved to mild pain; all corticosteroid patients retained moderate pain. At 12 weeks, 100% of PRP patients had mild pain versus 63.6% moderate and 36.4% severe in the corticosteroid group (p<0.001). ASES score was 'better' in 100% of PRP patients versus 'good' in corticosteroid patients (p<0.001). USG confirmed tendon regeneration in 100% of PRP patients; persistent tear was noted in 100% of corticosteroid patients.

Conclusions: PRP is superior to corticosteroids for PTRCTs, offering better long-term pain relief, functional outcomes and sonographic tendon regeneration. PRP should be considered a preferred regenerative treatment for partial thickness rotator cuff tears.

Functional outcome of displaced distal radius fractures treated with the five K-wire fixation technique: a prospective observational study

Aman Bubna, Jitesh Sharma, Ajay Garg, Samridhi Wadhwa, Rajesh Yadav — Tue, 25 Aug 2026 00:00:00 +0530

Background: Distal radius fractures are among the most frequently encountered fractures in orthopaedic practice and can result in significant impairment of wrist function if inadequately managed. Although several surgical techniques are available for unstable distal radius fractures, the optimal fixation method remains controversial. The five K-wire fixation technique is a minimally invasive, cost-effective method that aims to provide stable fracture fixation while preserving soft tissue integrity and fracture biology. The present study evaluated the functional outcome of displaced distal radius fractures treated using this technique.

Methods: A prospective observational study was conducted over one year among 30 adult patients with displaced intra-articular distal radius fractures managed with the five K-wire fixation technique. Fractures were classified according to the Frykman classification. Functional outcome was assessed using the Modified Mayo Wrist Score (MMWS) at 6 weeks, 3 months and 6 months. Fracture union, wrist range of motion and postoperative complications were also evaluated. Statistical analysis was performed using SPSS version 26.0 and a p value <0.05 was considered statistically significant.

Results: The mean age of the participants was 44.13±14.22 years and 56.7% were male. Fall on an outstretched hand was the most common mechanism of injury (53.3%). Fracture union was achieved within 6–8 weeks in 86.7% of patients. The mean modified mayo wrist score improved significantly from 65.50±7.97 at 6 weeks to 76.60±8.77 at 3 months and 85.03±8.87 at 6 months (p<0.001). At final follow-up, 46.7% of patients had excellent functional outcomes, 36.7% had good outcomes and 16.7% had fair outcomes. Pin tract infection was the most frequent complication, occurring in 10% of patients.

Conclusions: The five K-wire fixation technique provides satisfactory fracture union, significant functional improvement, acceptable wrist mobility and a low complication rate. It represents a safe, minimally invasive and economical treatment option for displaced distal radius fractures, particularly in resource-constrained healthcare settings.

Outcomes of antiglide plate fixation for vertical medial malleolar fractures in supination-adduction ankle injuries: a prospective observational study

Jitesh Sharma, Ajay Garg, Aman Bubna, Samridhi Wadhwa — Tue, 25 Aug 2026 00:00:00 +0530

Background: Vertical fractures of the medial malleolus associated with supination-adduction ankle injuries represent an uncommon but inherently unstable fracture pattern because of the predominance of vertical shear forces across the fracture site. Conventional fixation techniques may fail to provide sufficient resistance to these forces, increasing the risk of displacement, delayed union and unsatisfactory functional recovery. Antiglide plate fixation has been proposed as a biomechanically advantageous method that enhances fracture stability by counteracting shear stresses.

Methods: A prospective observational study was conducted in the Department of Orthopaedics at a tertiary care teaching hospital. Twenty adult patients with vertical medial malleolar fractures resulting from supination-adduction ankle injuries were enrolled. All patients underwent open reduction and internal fixation using an antiglide plate. Clinical evaluation, radiographic assessment and functional outcome measurements were performed at 3 weeks, 6 weeks and 6 months following surgery. Functional recovery was assessed using the Olerud-Molander Ankle Score (OMAS).

Results: The study included patients with a mean age of 38.1±8.87 years, of whom 70% were men. Road traffic accidents accounted for the largest proportion of injuries (45%). Radiological union was achieved within 10–12 weeks in more than half of the patients (55%). At the final follow-up, 70% regained full ankle range of motion. The mean OMAS improved progressively from 34.05±5.93 at 3 weeks to 83.00±17.99 at 6 months. Functional outcomes were excellent in 50% of patients and good in 35%, while postoperative complications were uncommon, with 80% of patients experiencing an uncomplicated recovery.

Conclusions: Antiglide plate fixation offers reliable stabilization for vertical medial malleolar fractures associated with supination-adduction ankle injuries. The technique promotes satisfactory fracture healing, facilitates early rehabilitation and results in favorable functional outcomes with a low incidence of postoperative complications. These findings support its use as an effective surgical option for this challenging fracture pattern.

Clinical and radiological outcomes of core decompression for early osteonecrosis of the femoral head: a retrospective comparative study

Shekhar P. Malve, Utkarsh K. Vishwakarma, Sunil G. Kulkarni — Tue, 25 Aug 2026 00:00:00 +0530

Background: Osteonecrosis of the femoral head (ONFH) is a progressive disorder characterized by compromised blood supply, leading to femoral head collapse and secondary osteoarthritis. As the disease predominantly affects young adults, hip-preserving procedures remain the preferred treatment in pre-collapse stages. Core decompression (CD) with bone grafting is widely performed, while platelet-rich plasma (PRP) has emerged as a biological adjunct that may enhance angiogenesis and osteogenesis. This study compared the clinical and radiological outcomes of core decompression with bone grafting alone versus core decompression with bone grafting augmented with PRP.

Methods: This retrospective comparative study included 75 patients (78 hips) with ONFH treated between January 2015 and December 2024. Group A comprised 35 patients treated with core decompression and cancellous bone grafting, while Group B included 40 patients treated with core decompression, cancellous bone grafting and PRP. Clinical outcomes were assessed using the Harris hip score (HHS) and radiographic progression and conversion to total hip arthroplasty (THA) were recorded.

Results: Good-to-excellent outcomes were achieved in 77.5% of the PRP group compared with 57.1% of the conventional group. Poor functional outcomes were observed in 17.5% of the PRP group compared to 37.1% of the conventional group. THA conversion was lower in the PRP group (17.1%) as compared to the conventional group (35.1%), representing an 18.0% absolute risk reduction.

Conclusions: PRP augmentation demonstrated improved functional outcomes and reduced conversion to THA compared with bone grafting alone, suggesting a promising biological adjunct for hip preservation in early-stage ONFH.

Influence of diabetes mellitus on rotator cuff muscle strength recovery following arthroscopic rotator cuff repair: a prospective observational study

Henry Mathews, Nirma Joy — Tue, 25 Aug 2026 00:00:00 +0530

Background: Arthroscopic rotator cuff repair (ARCR) is an established treatment for symptomatic rotator cuff tears, resulting in significant improvements in pain and shoulder function. However, objective assessment of postoperative rotator cuff muscle strength and its relationship with functional recovery remains inadequately reported. This study evaluated changes in rotator cuff muscle strength following ARCR, investigated whether improvements in strength correlated with functional outcomes, and examined the influence of diabetes mellitus on recovery trajectories.

Methods: A prospective cohort study was conducted at a tertiary care teaching hospital between September 2017 and September 2019. Patients aged 18-60 years with reparable rotator cuff tears undergoing primary ARCR were enrolled. Clinical evaluation included preoperative and six-month postoperative assessment of isometric and isokinetic internal and external rotation strength using a Kin-Com 125 AP dynamometer. Functional outcomes were assessed using the American shoulder and elbow surgeons (ASES) score and Constant score. Paired comparisons were performed to evaluate postoperative changes, and correlation analysis was used to determine the association between strength recovery and functional outcomes.

Results: Twenty-six patients completed the six-month follow-up. The mean age was 48.3 years, with 15 males and 11 females. Significant improvements were observed in both functional outcome measures, with mean increases of 53.8 points in the ASES score and 38 points in the Constant score (both p<0.0001). Isometric internal and external rotation strength increased by 11.5 Nm and 8 Nm, respectively. Significant improvements were also observed in isokinetic strength at angular velocities of 60°/s and 120°/s for both internal and external rotation (all p<0.0001). Despite these improvements, no significant correlation was identified between gains in rotator cuff muscle strength and postoperative functional outcome scores. However, subgroup analysis revealed that patients with concurrent diabetes mellitus demonstrated a markedly blunted recovery trajectory in torque gains compared to non-diabetic participants.

Conclusions: ARCR resulted in significant improvements in objective rotator cuff muscle strength and shoulder function at six months. However, early postoperative functional recovery did not correlate with the magnitude of muscle strength recovery, suggesting that patient-reported functional improvement is influenced by factors beyond muscle strength alone.

Functional outcome of idiopathic congenital talipes equinovarus treated by the Ponseti method: a prospective observational study in a tertiary care hospital

Bala Kumar Dorai, A. Srinivasa Rao, Harsha Bhogadi — Tue, 25 Aug 2026 00:00:00 +0530

Background: Idiopathic congenital talipes equinovarus (CTEV), commonly known as clubfoot, is one of the most common congenital musculoskeletal deformities affecting children worldwide. If untreated, it may result in permanent deformity, gait abnormalities, pain, and lifelong disability. The Ponseti method has become the gold standard for the management of idiopathic clubfoot because it is minimally invasive, cost-effective, and associated with excellent functional outcomes. However, treatment success depends on early presentation, meticulous casting technique, Achilles tenotomy when indicated, and strict adherence to the foot abduction brace protocol.

Methods: A prospective observational study was conducted in the Department of Orthopaedics, Government General Hospital, Vijayawada, over a period of 24 months. Thirty children younger than two years with idiopathic CTEV were included. All patients underwent treatment using the standard Ponseti protocol consisting of serial manipulation and casting, percutaneous Achilles tenotomy when required, and maintenance using a foot abduction brace. Demographic characteristics, Pirani score, number of casts, tenotomy requirement, treatment-related complications, recurrence, and functional outcome were evaluated.

Results: Thirty patients with 43 affected feet were included. Most patients presented within the first six months of life. The majority of feet required six to seven casts for complete correction, while percutaneous Achilles tenotomy was required in 83.7% of feet. Following treatment, near-normal Pirani scores were achieved in most patients. Excellent functional outcomes were observed in 65.1% of feet and good outcomes in 23.3%, resulting in an overall excellent-to-good outcome rate of 88.4%. Treatment-related complications were minimal and managed conservatively.

Conclusions: The Ponseti method is a safe, reliable, and highly effective treatment for idiopathic clubfoot. Early initiation of treatment combined with appropriate Achilles tenotomy and good brace compliance results in excellent functional outcomes while minimizing complications and recurrence. The method should remain the first-line treatment for idiopathic CTEV, particularly in resource-limited healthcare settings.

Topical pain relief cream formulation in the management of knee osteoarthritis: a randomized, double-blind and placebo-controlled clinical study

Tue, 25 Aug 2026 00:00:00 +0530

Background: Topical formulations provide localized pain relief with improved safety profile. This study evaluated the efficacy and safety of a topical pain relief cream formulation in subjects with knee OA compared with placebo.

Methods: This multicentric, randomized, double-blind, placebo-controlled clinical study analyzed 335 subjects with clinically diagnosed knee OA who received either a topical pain relief cream formulation (Group B, n=166) or placebo (Group A, n=169) for 28 days. Primary efficacy endpoints were knee joint pain assessed using visual analog scale (VAS) and joint swelling. Secondary endpoints included modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, knee joint tenderness, warmth, onset and duration of action, global assessments, and safety.

Results: The topical pain relief cream formulation demonstrated significantly greater reductions in knee joint pain (19.7-21.4% at day 14 and 38.3-38.6% at day 28, p<0.001) and swelling (p<0.001) compared with placebo. Modified WOMAC scores for pain, stiffness, and difficulty in movements were also significantly (p<0.05) improved than placebo. The formulation demonstrated a significantly (p<0.001) faster onset and longer duration of action in terms of pain relief. Knee tenderness and rescue medication use were significantly (p<0.05) reduced. The formulation was well tolerated with no treatment-related adverse events (AEs).

Conclusions: The topical pain relief cream formulation significantly reduced knee joint pain and swelling while improving joint function. These findings support its potential as a safe, fast acting and effective topical therapy for managing knee OA.

The role of jumping and landing patterns in anterior cruciate ligament injury risk: a systematic review of assessment methods

Syed Maaz Uddin, Andrew Murphy — Tue, 25 Aug 2026 00:00:00 +0530

Anterior cruciate ligament (ACL) injuries are a major concern in orthopaedic and sports medicine, with non-contact mechanisms accounting for the majority of cases. Faulty jump-landing biomechanics, including altered joint kinematics and neuromuscular deficits, have been identified as key modifiable risk factors. This systematic review aimed to evaluate the role of jumping and landing patterns in ACL injury risk and to assess the effectiveness of biomechanical assessment tools and preventive interventions. A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases, including PubMed, ScienceDirect, and ClinicalTrials.gov, were searched up to October 2024. Studies involving adults (≥18 years) that assessed jump-landing biomechanics using validated tools such as three-dimensional motion analysis, electromyography, and force plates were included. A total of 120 studies were identified, of which 15 met the inclusion criteria. Data extraction and quality assessment were performed using a structured framework and the Critical appraisal skills programme checklist. Fifteen studies were included, encompassing various study designs and populations. The most consistent biomechanical risk factors identified were increased knee valgus, reduced knee flexion, and poor trunk stability during landing. Fatigue was found to exacerbate these deficits, leading to compromised neuromuscular control. Assessment tools such as motion analysis, electromyography, and force plates effectively identified these risk patterns. Preventive interventions, particularly neuromuscular and plyometric training, demonstrated significant improvements in landing mechanics and reduction in injury risk. Jump-landing biomechanics play a critical role in ACL injury risk. Identification of modifiable risk factors through validated assessment tools allows targeted preventive strategies. Neuromuscular training programs are effective in improving biomechanics and reducing injury incidence; however, broader clinical implementation and long-term adherence remain challenges.

Hip fractures in the elderly should not be dismissed as bad luck – a sign of proactive visual consultation: an artificial intelligence-based systematic review

Tarunika Garg, Gaurav Garg — Tue, 25 Aug 2026 00:00:00 +0530

Elderly persons with neglected visual problems face a heightened risk of fall and added mortality. Vision is essential for maintaining postural balance and spatial awareness. In order to prevent these falls, we need to know about the causative impaired vision patterns seen in these age groups. we decided to perform a systemic review using artificial intelligence (AI) based multiple tools, about the relationship between various causes of impaired vision in elderly and the risk of elderly hip fractures due to fall. We have conducted a comprehensive AI based research across multiple academic databases to identify research publications exploring the links between visual impairments, falls, and hip fractures among older adults. Studies were analysed based on the measure of vision or commonly reported eye diseases in elderly: refractive errors, cataract, glaucoma and macular degeneration, which were used as potential risk factors. This systematic review pooled data from 26 studies to evaluate the need for proactive ophthalmic consultation in elderly patients admitted with hip fractures. Visual assessment in older adults is essential to minimize fall-related complications and associated morbidity. Elderly’s sustaining a fragility hip fracture have impaired vision, much of which is easily treatable and can be detected effectively with pro-active eye consultation.

Innovating the surgical approach to a low grade fibromyxoid sarcoma of the subscapularis muscle

Tue, 25 Aug 2026 00:00:00 +0530

We report a 47-year-old female with pulmonary emphysema and an incidental subscapularis intramuscular lesion (76×35×17 mm). Biopsy confirmed low-grade fibromyxoid sarcoma (LGFMS). Surgical excision was performed through a novel modified Judet approach with scapular osteotomy, ensuring complete resection while preserving function. The patient remains asymptomatic at 12 months, with full mobility and no recurrence. This case highlights the importance of including LGFMS in the differential diagnosis of shoulder tumors and demonstrates the utility of a modified Judet approach as a safe, effective option for rare intramuscular sarcomas.

From a small heel lesion to calcaneal exposure in diabetic heel salvage complicated by ischemia and infection: a case report

Tue, 25 Aug 2026 00:00:00 +0530

Heel ulcers are among the most threatening manifestations of diabetic foot disease due to their lack of soft-tissue coverage, their critical location, which causes constant loading, and their reliance on distal perfusion. We report an unusual case of a woman who experienced rapid progression of a right heel lesion to necrosis with calcaneal exposure despite an assuring ankle-brachial index, highlighting the importance of distal perfusion assessment and a multimodality approach in the diagnostic workup. We report a case of a 54-year-old female who experienced rapid progression of a lesion in her right heel, eventually manifesting as necrosis with calcaneal exposure. Her ankle-brachial index was within normal limits (0.92), but her toe-brachial index was critically low (0.14). CT angiography confirmed severe peripheral arterial disease. As such, her treatment involved staged revascularization, debridement, and partial calcanectomy. Additionally, she received culture-directed antibiotics and negative-pressure wound therapy. She eventually recovered with improvement of her heel, and thus avoided the need for amputation. Management of diabetic heel ischemia and successful limb salvage requires multiple interventions, including revascularization, debridement, wound stabilization, and infection control through antibiotics. A normal ABI may be misleading; as such, other modalities should be used as part of the diagnostic workup.

Emergency bilateral proximal row carpectomy for Mayfield stage IV greater arc injuries: a case report in a restricted social environment

Tue, 25 Aug 2026 00:00:00 +0530

Bilateral trans-scaphoid perilunate fracture-dislocations (PLFD) with complete lunate enucleation (Mayfield IV-equivalent) represent a terminal stage of carpal instability. While anatomical reconstruction is traditionally favored in young patients, its success depends on intensive, long-term specialized hand therapy. We report a unique case where primary salvage was selected to ensure functional autonomy despite intraoperative findings of irreparability and systemic barriers to rehabilitation. A 22-year-old right-handed male smoker presented with bilateral trans-scaphoid PLFD following a 4-story fall. Intraoperative assessment revealed irreparable, devitalized lunates with 360° ligamentous disconnection and eroded cartilage. Given the lesion severity and documented barriers to accessing specialized physical therapy, bilateral emergency proximal row carpectomy (PRC) was performed 24 hours after trauma. At the 6-month follow-up, the patient was pain-free (VAS 1/10). The right wrist achieved 50° flexion/30° extension (80° arc), while the left achieved 40° flexion/10° extension (50° arc). The QuickDASH score of 25 points reflects moderate disability, influenced by the patient’s prioritization of his dominant side during autonomous rehabilitation. Early radiographic evaluation confirmed stable alignment. Emergency bilateral PRC is a pragmatic solution for severe carpal instability when anatomical repair is unattainable or when external constraints preclude standard reconstruction protocols. Long-term surveillance remains mandatory.

Complex ipsilateral segmental femur fracture involving subtrochanteric and distal femur: successful management with combined IM nail and lateral plate

Tue, 25 Aug 2026 00:00:00 +0530

Ipsilateral segmental femur fractures involving both the subtrochanteric and distal femur regions are rare high-energy injuries that present significant challenges in achieving stable fixation, maintaining alignment, and enabling early rehabilitation. We report the case of a 40- year-old male who sustained a complex ipsilateral segmental femur fracture following a high- velocity road traffic accident. Radiographic evaluation revealed comminated fractures involving the subtrochanteric region and distal femur. The patient was hemodynamically stable and had no associated life-threatening injuries. Surgical management consisted of closed reduction and intramedullary interlocking nailing for the subtrochanteric fracture, combined with open reduction and internal fixation of the distal femur using a lateral locking compression plate. A deliberate nail-plate construct was created by passing a distal interlocking screw of the intramedullary nail through the distal femur plate to improve overall construct stability. Early postoperative mobilization was initiated. Serial follow-up radiographs demonstrated satisfactory alignment and progressive callus formation at both fracture sites. The patient achieved good hip and knee range of motion and successfully returned to routine daily activities. This case highlights that a combined intramedullary nail and lateral plate construct provides superior biomechanical stability in ipsilateral subtrochanteric and distal femur fractures, facilitating early rehabilitation and favorable functional outcomes.

Patellar giant cell tumour treated with extended curettage, bone grafting and extensor mechanism augmentation: a case report

Tue, 25 Aug 2026 00:00:00 +0530

Giant cell tumour of bone (GCTB) rarely involves the patella and can present with persistent anterior knee pain and progressive functional limitation. In patellar lesions, joint-preserving tumour surgery must balance local control with preservation of the extensor mechanism. A 21-year-old man presented with six months of left anterior knee pain, present at rest and worsened with activity. Imaging demonstrated an expansile lytic patellar lesion. After an unavoidable delay of approximately three months in early 2020, the lesion progressed clinically with increasing functional limitation. He underwent extended curettage of the patellar lesion and reconstruction with autologous cancellous iliac crest bone graft. To protect the extensor mechanism following tumour excision and reconstruction, patellar tendon augmentation was performed using an ipsilateral hamstring autograft and suture tape reinforcement secured to the tibia through a transverse osseous tunnel. Histopathology confirmed a GCTB. The patient achieved excellent recovery within one year and maintained near-normal function at five-year follow-up without evidence of recurrence. In selected patellar giant cell tumours where extensor mechanism integrity is threatened after joint-preserving surgery, hamstring autograft augmentation with suture tape reinforcement may provide durable functional restoration.

Limb salvage with wide resection and endoprosthetic reconstruction for giant cell tumour of proximal tibia: a case report

Tue, 25 Aug 2026 00:00:00 +0530

Giant Cell Tumour of Bone (GCT)is a locally aggressive benign bone tumour commonly affecting the epiphyseal region of long bones in skeletally mature individuals. The proximal tibia is among the most frequently involved sites. Surgical management becomes challenging when the tumour extends into surrounding soft tissues and requires wide excision with reconstruction. A4I-year-old female presented with pain, swelling around the left knee joint, and difficulty in weight bearing for three months without a history of trauma. Clinical examination revealed swelling over the proximal tibia, tenderness, and painful restriction of terminal knee movements. Radiographs demonstrated a lytic lesion involving the proximal tibia, and MRI revealed a giant cell tumour with posterior extension. The patient underwent wide resection of the proximal tibia with limb salvage reconstruction using a proximal tibial endoprosthesis. Histopathological examination confirmed the diagnosis of giant cell tumour. Postoperative recovery was uneventful. Limb salvage with endoprosthetic reconstruction provided stable knee joint function and adequate oncological clearance. Wide excision with endoprosthetic reconstruction is an effective treatment option for giant cell tumours of the proximal tibia with extraosseous extension, providing both tumour control and functional limb preservation.

Premonitory hypoxia as an early indicator of perioperative fat embolism syndrome following closed tibial fracture: a case report

Devinder Kumar, Aakash Parashar, Kunal Goel, Lohith Y. N., Jainam Salot — Tue, 25 Aug 2026 00:00:00 +0530

Fat embolism syndrome (FES) is an uncommon but potentially life-threatening complication of long-bone fractures. Early diagnosis is challenging due to subtle and nonspecific initial manifestations, particularly in isolated injuries. We report a case of a young adult with an isolated closed tibial shaft fracture who developed unexplained preoperative hypoxia followed by rapid postoperative deterioration consistent with FES. A 24-year-old male developed hypoxia (SpO₂ 89% on room air) on the third day following injury without any clinical respiratory symptoms. After undergoing reamed intramedullary nailing, he developed acute respiratory distress, fever, thrombocytopenia, and bilateral pulmonary infiltrates. Infective causes were ruled out, and a diagnosis of FES was established using Gurd and Wilson’s criteria. The patient was managed with noninvasive ventilation and supportive care, resulting in gradual recovery over 10 days. Unexplained preoperative hypoxia may represent an early manifestation of FES. Early recognition and vigilant perioperative monitoring are essential to prevent rapid deterioration and improve outcomes.

Unstable sacral fracture with neurogenic bladder and bowel dysfunction following high energy trauma: a case report

Tue, 25 Aug 2026 00:00:00 +0530

Sacral fractures are uncommon but potentially devastating injuries, most commonly resulting from high-energy trauma. They are frequently associated with pelvic instability, neurological deficits, and multiple system injuries. Delayed diagnosis is common because of the complex sacral anatomy and limited sensitivity of plain radiographs. Early recognition and timely surgical management are essential for optimizing neurological and functional outcomes. We report the case of a 24-year-old female who sustained an unstable Denis zone II–III sacral fracture following a high-energy road traffic accident. The patient presented with severe lower back pain, urinary retention, decreased perianal sensation, and reduced voluntary anal contraction, consistent with neurogenic bladder and bowel dysfunction. Computed tomography confirmed an unstable sacral fracture involving the sacral foramina and central canal. The patient underwent early posterior decompression with lumbopelvic fixation to restore pelvic stability and decompress the neural elements. The postoperative course was uneventful. Progressive neurological recovery was observed, with restoration of bladder and bowel function, satisfactory pain relief, radiological evidence of stable fixation, and independent ambulation during follow-up. Early diagnosis using advanced imaging, prompt posterior decompression, and stable lumbopelvic fixation can provide excellent neurological and functional recovery in patients with unstable sacral fractures associated with neurogenic bladder and bowel dysfunction. This case supports the growing evidence favouring early surgical intervention in unstable sacral fractures with neurological compromise.

Advanced enchondroma of the phalanx treated by en bloc excision and tricortical iliac crest autograft

Sadiq Mohammad, Anudeep Manne, Krishna C. Chadalawada, B. Sai K. R. Mulagondla — Tue, 25 Aug 2026 00:00:00 +0530

Curettage with or without augmentation forms the mainstay of treatment in most cases of enchondroma of the hand. Studies have shown that the chances of re-fracture increase with the increase in the bony involvement by the tumor and recommend augmentation for the larger lesions. Structural grafts are seldom used in enchondromas. There is only one reported case of the use of structural allograft in a case of recurrent enchondroma of the metacarpal. We present a case of advanced enchondroma involving the entire proximal phalanx which was managed by enblock excision with intercalary tricortical iliac crest strut grafting. Use of structural allograft in a case of enchondroma helps in augmenting the bony framework, providing stability and thus decreasing the chance of re-fracture at the site of lesion. The use of a tri-cortical graft provides better outcomes due to its osteoinductive and osteoconductive properties.

Excellent functional recovery following bicolumnar plating, cerclage wires and nail through screw for peri-implant distal femur fracture after proximal femoral nail anti-rotation-II nailing: a case report from a resource-limited setting

Anish Jindal, Utkarsh Jain, Priyanshu Suman — Tue, 25 Aug 2026 00:00:00 +0530

Peri-implant distal femur fractures occurring before union of the index proximal femur fracture are rare and pose significant surgical challenges due to the presence of existing implants, compromised bone stock, and complex fracture patterns. Optimal management strategies remain poorly defined. A 27-year-old male previously treated with a proximal femoral nail anti-rotation (PFNA-II) for a right subtrochanteric femur fracture sustained a second high-energy road traffic accident approximately three months postoperatively, before radiological union of the index fracture. Radiographs demonstrated an extra-articular peri-implant distal femur fracture at the distal tip of the nail with metaphyseal comminution, displacement of the distal locking screws, and extension of the original subtrochanteric fracture line into the diaphysis. Surgical management consisted of a hybrid fixation construct comprising a lateral distal femoral locking plate, a plate-to-nail screw through the existing distal locking hole, two cerclage wires for fragment control, and a medial buttress plate to achieve bicolumnar fixation. At 12-month follow-up, complete radiological union was achieved at both the distal femur and subtrochanteric fracture sites. There was no implant failure, loss of reduction, or need for revision surgery. The patient regained full independent weight-bearing, demonstrated a full active straight-leg raise, and achieved knee flexion greater than 90°. Bicolumnar plating supplemented by a plate-to-nail screw and cerclage wiring provided stable fixation and successful union in this complex peri-implant fracture. This technique represents a practical and reproducible salvage option for managing distal femoral peri-implant fractures around an in-situ cephalomedullary nail, particularly in resource-constrained settings.

A combination of posterior fracture dislocation of shoulder and ipsilateral clavicle fracture following a road traffic accident: a rare injury pattern treated with internal fixation – a case report

Anand K. Somasundaram, Geevarghese Joy, Jerin George, Aiswarya A. Sreeja — Tue, 25 Aug 2026 00:00:00 +0530

Posterior fracture-dislocation of the shoulder is an uncommon injury accounting for a small percentage of all shoulder dislocations and is frequently missed during initial evaluation due to subtle clinical and radiographic findings. The association of posterior proximal humerus fracture-dislocation with an ipsilateral clavicle shaft fracture is exceedingly rare and poses significant diagnostic and therapeutic challenges. Early recognition and stable fixation are essential to restore shoulder girdle anatomy and facilitate rehabilitation and optimal shoulder function. A young man in his twenties presented to the Emergency department (ED) of a level 3 trauma facility following a road traffic accident with complaints of swelling and painful restriction movements of his left shoulder. On clinical and radiological evaluation, he was diagnosed to have a closed posterior fracture dislocation of his left proximal humerus and ipsilateral closed midshaft fracture of the clavicle, He underwent open reduction and internal fixation of both the fractures within 24 hours of his initial presentation. At one year follow up he retains full function of his left shoulder without evidence of any complication. This case highlights the importance of prompt diagnosis and early intervention utilizing meticulous surgical technique for fixing such complex injuries anatomically to restore acceptable shoulder function. This also underlines the importance of long term follow up of such patients to watch for potential complications including osteonecrosis of humeral head, shoulder arthritis and persistent instability.

Simultaneous ipsilateral fractures of both proximal and distal ends of radius or bipolar fracture of radius with olecranon fracture

Paragjyoti Gogoi, Vikash Agarwala, Aditi Das — Tue, 25 Aug 2026 00:00:00 +0530

The combination of simultaneous fractures of both the proximal and distal end of radius is rare. Only a few cases had been mentioned in the literature. They are also termed as “bipolar fractures of radius”. The association of olecranon fracture with this combination is again very rare. The management protocol is also not very clear. Maintenance of the radius length is perhaps the main crux of treatment, since it takes part in both the proximal and distal radio-ulnar joint. Implant choices can be varied from rigid platting to percutaneous fixation. Radial head can be reconstructed or replaced depending on the fracture comminution. Post-operative rehabilitations also need to be tailored. Rigid fixation like platting favored early mobilization, while semi rigid fixation may need a period of immobilization. Regular follow up and guided physiotherapy optimizes good clinical outcome in such rare combinations of fracture.

Surgical management of ventral scapular osteochondroma in a pediatric patient with multiple hereditary exostoses: a case report

Tue, 25 Aug 2026 00:00:00 +0530

Multiple hereditary exostoses (MHE) is a rare autosomal dominant disorder caused by EXT1/EXT2 gene mutations, characterized by multiple osteochondromas arising from the metaphyses of long and flat bones. Scapular osteochondromas are uncommon, representing only 3-4.6% of all cases, and ventral (subscapular) lesions are exceedingly rare with limited surgical literature. A 12-year-old male with no family history of MHE presented with a one-year history of progressive, hard swelling over the right scapular region along with bilateral wrist, foot, and right arm swellings. He reported pain on overhead activities and scapular movement, with normal scapulohumeral rhythm and no neurological deficits on examination. Imaging confirmed a pedunculated osteochondroma on the ventral surface of the right scapula and multiple additional lesions consistent with MHE. He underwent complete surgical excision via a posterior approach through the triangle of auscultation, with rhomboid muscle splitting. Histopathology confirmed benign osteochondroma. At 1-year follow-up, the patient was completely asymptomatic with full shoulder range of motion and a QuickDASH score of 0. No recurrence was detected on follow-up imaging. This case demonstrates that symptomatic ventral scapular osteochondromas in MHE can be successfully managed via a posterior approach, with excellent functional outcomes.

Is chronic pain in degenerative joint disease maintained by central pain memory rather than ongoing peripheral pathology?

Sara Karim — Tue, 25 Aug 2026 00:00:00 +0530

Chronic pain is a key feature of degenerative joint disease however pain severity often shows poor correlation with the degree of structural damage seen on imaging. This is commonly referred to as pain–structure discordance. It challenges the traditional view that joint pathology alone determines symptom severity. A number of pieces of evidence from pain science suggests that central mechanisms, including central sensitisation and maladaptive neuroplasticity, may contribute to the persistence of pain beyond the initial peripheral condition. These processes are sometimes described as “pain memory”. This involves the amplification of nociceptive signalling within the spinal cord and brain, which leads to heightened pain perception that may potentially become partially independent of ongoing joint pathology. This narrative review explores the concept that chronic pain in degenerative joint disease may be maintained, at least in part, by central pain mechanisms rather than solely by peripheral structural changes. Evidence from clinical observations and outcomes following joint replacement surgery is discussed to illustrate how pain can persist despite stable disease or removal of damaged joint tissue. Understanding the role of central pain mechanisms is essential for patient assessment and supports a more integrated model of degenerative joint disease pain that incorporates both peripheral and central factors.

The role of the immune system in the progression of osteoarthritis

Majid Negari — Tue, 25 Aug 2026 00:00:00 +0530

Osteoarthritis (OA) is traditionally viewed as a mechanical wear-and-tear disease. While mechanical loading remains a fundamental factor in joint degeneration, it does not fully explain why post-traumatic osteoarthritis (PTOA) progresses so aggressively. We propose a novel biological hypothesis suggesting that a secondary, parallel immunomediated mechanism coexists alongside this mechanical pathway. Articular cartilage normally acts similarly to immune-privileged sites, sequestering internal auto-antigens. However, joint injury breaches this barrier, exposing hidden cartilage proteins to the systemic immune system. This exposure triggers an autoimmune reaction driven by synovial macrophages and T-cells, creating a self-amplifying vicious cycle of immune recruitment and tissue destruction. This parallel cascade prevents joint healing and accelerates degeneration. To validate this model, we outline a pragmatic approach using ELISA to track phase-specific cytokines and animal models to observe progression after immunomodulation. Integrating this immunomediated continuum with classical mechanical theories shifts the therapeutic paradigm of PTOA toward targeted immunomodulatory interventions, offering a dual pathway to halt disease progression.

Obstetric brachial plexus palsy: a comprehensive review of evaluation and management

Vikaas E. Thuppale, Naveen Christopher — Tue, 25 Aug 2026 00:00:00 +0530

Obstetric brachial plexus palsy (OBPP) is the most common peripheral nerve injury associated with childbirth, with an incidence of 0.4–1.6 per 1000 live births. It typically results from traction on the brachial plexus during difficult deliveries and is associated with risk factors such as shoulder dystocia, fetal macrosomia, breech presentation, prolonged labour, and maternal diabetes. The severity of neurological involvement ranges from isolated upper trunk lesions (Erb’s palsy) to complete brachial plexus paralysis with associated Horner syndrome. Early and accurate clinical evaluation is critical for prognostication and treatment planning. Serial clinical examinations remain the cornerstone of assessment, while imaging and electrophysiological studies may aid in defining the level and severity of injury. Although spontaneous recovery occurs in a majority of infants, a significant subset requires timely surgical intervention. Advances in microsurgical techniques, including nerve grafting and distal nerve transfers, have improved functional outcomes. In addition to neural deficits, OBPP is associated with secondary musculoskeletal sequelae such as shoulder contractures and glenohumeral dysplasia. This review provides a comprehensive overview of the pathoanatomy, clinical evaluation, prognostic indicators, and contemporary management strategies for OBPP, with emphasis on surgical reconstruction and management of secondary deformities.