International Journal of Research in Orthopaedics

Management of long bone non-unions and implant failures utilizing the diamond concept: a retrospective case series

Mon, 27 Apr 2026 00:00:00 +0530

The management of long bone non-unions and implant failures remains a significant orthopaedic challenge, imposing a substantial socio-economic burden on both the patient and the healthcare system. The "Diamond Concept" provides a comprehensive framework to address these complex scenarios by simultaneously optimizing mechanical stability and the biological healing environment. This study aims to evaluate the clinical and functional outcomes of recalcitrant non-unions treated according to this concept. A retrospective case series was conducted at a tertiary care center (SMIMER, Surat) between 2024 and 2026. Eighteen patients presenting with aseptic, infected, atrophic, or hypertrophic non-unions, as well as mechanical implant failures, were included. Treatment strategies were individualized to restore the physiological elements of fracture healing via revision osteosynthesis (single/dual plating or prosthesis) and biological augmentation (autologous bone grafting). The cohort consisted of 12 males and 6 females, with a mean duration of 7 months between the index surgery and revision. Ten cases involved the upper limb and eight involved the lower limb. Revision procedures utilized single implants (n=9), dual implants (n=7), and prosthetic replacements (n=2). Bone grafting was required in 13 cases. All followed patients achieved or are progressing toward solid clinical and radiological union, with a mean return-to-work time of 9 months from the index surgery. Precise identification of the etiology behind primary fixation failure is crucial. Adherence to the Diamond Concept through tailored mechanical stabilization and biological augmentation yields excellent union rates and functional recovery in complex non-unions.

Adderall use and the risk of fractures in the pediatric population: a retrospective cohort study

Mon, 27 Apr 2026 00:00:00 +0530

Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience higher injury rates than their peers, but the effect of stimulant therapy on fracture risk remains uncertain. To evaluate the association between amphetamine exposure and incident fractures of the distal radius, supracondylar humerus and clavicle in youth with ADHD.

Methods: Retrospective cohort study using the TriNetX global collaborative network. Patients aged 6–18 years with ADHD (ICD-10-CM F90) were classified as amphetamine-exposed (prescribed dextroamphetamine or amphetamine within six months of index) or unexposed. Outcomes were new distal radius (S52.5), supracondylar humerus (S42.41) and clavicle (S42.0) fractures. Incidence, risk ratios and hazard ratios were estimated with Kaplan–Meier and Cox models.

Results: After matching (n=226,620; 113,310 per cohort), amphetamine exposure was associated with significantly lower 30-day fracture risk. Distal radius fractures occurred in 0.44% of exposed vs 0.72% unexposed (RD −0.28%, RR 0.61, 95% CI 0.55–0.69, HR 0.46, 95% CI 0.41–0.51, p<0.001). Supracondylar fractures occurred in 0.04% vs 0.08% (RD −0.04%, RR 0.51, 95% CI 0.36–0.72, HR 0.41, 95% CI 0.29–0.57, p<0.001). Clavicle fracture risk was similar between cohorts (0.18% vs 0.21%, RD−0.03%, RR 0.76, 95% CI 0.63–0.93, p=0.084), although HR remained significant (HR 0.63, 95% CI 0.52–0.76, p<0.001).

Conclusions: Among children and adolescents with ADHD, amphetamine exposure was associated with significantly lower fracture incidence and hazard for distal radius, supracondylar humerus and clavicle injuries. These findings suggest stimulant treatment may reduce specific orthopaedic injuries and merit further investigation.

Association between radiological quality of reduction and functional outcome in posterior wall acetabular fractures treated with ORIF

Mon, 27 Apr 2026 00:00:00 +0530

Background: Posterior wall acetabular fractures represent the most common subtype of acetabular injuries, frequently caused by road traffic accidents and often associated with hip instability and dislocation. The quality of reduction achieved after open reduction and internal fixation (ORIF) remains a key determinant of prognosis, although other clinical and operative factors may also influence outcomes.

Methods: A prospective observational study was conducted at Dhaka Medical College Hospital from August 2020 to March 2022, including 20 patients (aged 18–60 years) with posterior wall acetabular fractures treated with ORIF. Radiological outcomes were assessed using Matta’s criteria, while functional outcomes were evaluated using the Merle D’Aubigné and Postel score. Associations with demographic, injury-related, and surgical factors were analyzed.

Results: The mean patient age was 38.3 years, with most cases resulting from road traffic accidents (90%). Anatomical reduction was achieved in 80%. Radiological outcomes were excellent in 45%, good in 40%, and fair in 15%. Functional outcomes were excellent in 50%, good in 40%, and fair in 10%. Overall satisfactory outcomes were observed in 90% of patients. Significant predictors of poorer outcomes included hip dislocation (p<0.001), gross displacement (p< 0.001), surgical delay >15 days (p=0.036), and postoperative complications (p=0.001). Demographic factors and fracture extent showed no significant association.

Conclusions: Achieving anatomical reduction is critical for favorable radiological and functional outcomes in posterior wall acetabular fractures. Early surgical intervention and avoidance of complications further optimize long-term prognosis.

Demographic and clinical characteristics of patients diagnosed with carpal tunnel syndrome

Mon, 27 Apr 2026 00:00:00 +0530

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. It is characterized by sensory and, in advanced cases, motor symptoms due to compression of the median nerve at the wrist. Understanding the demographic and clinical profile of CTS patients in a specific setting is important for clinical practice and healthcare planning.

Methods: This descriptive cross-sectional study included 100 consecutive adult patients diagnosed with CTS at a tertiary upper limb clinic. Data were extracted from medical records. Variables included age, sex, occupation, side involvement, symptom characteristics, duration of symptoms, and associated comorbidities. Continuous variables were reported as mean±standard deviation, and categorical variables were presented as frequencies and percentages.

Results: The mean age of patients was 53.9±14.7 years. Females accounted for 81% of the sample. Most patients were non-manual workers (94%). Right-sided involvement was present in 55% of cases. Numbness or paresthesia was reported in 97% of patients, pain in 93%, and night symptoms in 88%. The mean duration of symptoms was 29.2±39.0 months. Hypertension (35%) and diabetes mellitus (28%) were the most common comorbidities.

Conclusions: CTS in this cohort was more common in middle-aged women and was characterized by a high prevalence of sensory and nocturnal symptoms. Systemic comorbidities were frequent. These findings provide local descriptive data that may support clinical awareness and future research.

Continuous external compression with a dynamic axial fixator in the treatment of tibial nonunions: a single-center experience

Med A. Rekik, Amin Moalla, Tarek Bardaa, Sami Sallemi, Hassib Keskes — Mon, 27 Apr 2026 00:00:00 +0530

Background: Tibial nonunion remains a therapeutic challenge for orthopedic surgeons, particularly when associated with poor soft-tissue condition, bone defects, infection, or deformity. Continuous external compression with a dynamic axial fixator offers a biological and mechanical solution without the need for bone grafting. We report our single-center experience using this method.

Methods: We retrospectively reviewed 20 patients (mean age 39 years) with tibial nonunions treated between 2012 and 2017. The mean time from injury to treatment was 21.6 months. Eight cases were septic and received culture-specific antibiotics; no debridement was performed. One case with a 4 cm defect underwent corticotomy and bone transport, while the remaining patients were managed with acute compression only. Outcomes were evaluated clinically and radiographically using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.

Results: Bone union was achieved in all patients (100%). The mean time to union was 3.5 months. Nineteen patients were treated with compression alone, and one with lengthening followed by compression. No bone grafting was required. Bone results were excellent in 17 cases and good in 3. Functional results were excellent in 12 and good in 8. No poor outcomes were recorded. The main complication was pin-tract infection (20%).

Conclusions: Continuous external compression with a dynamic axial fixator is an effective method for the treatment of tibial nonunions, both septic and aseptic, and can achieve union without bone grafting even in the presence of bone loss.

Schatzker V-VI fractures of tibial plateau healed fast within 3.5 months: Ilizarov fixation with 6 weeks femoral ring offload

Mon, 27 Apr 2026 00:00:00 +0530

Background: Schatzker V and VI tibial plateau fractures with significant soft-tissue injury, the Ilizarov circular fixator provides essential, stable fixation while minimizing further disruption. A key advantage is the staged removal of the distal femoral ring, which allows for earlier knee mobilization and is critical for preserving long-term joint function. To evaluate the effectiveness of a three-and-a-half-month union strategy using Ilizarov fixation with distal femoral ring removal at six weeks in patients with Schatzker type V and VI tibial plateau fractures.

Methods: This prospective cohort study was conducted at Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh, Bangladesh, from January 2023 to December 2024. A 41-patient cohort undergoing Ilizarov fixation with femoral ring removal at six weeks was assessed for union, knee motion, alignment, weight-bearing, and complications. Data analysis was performed using SPSS version 23.0 to evaluate these outcomes.

Results: The study cohort (mean age 38.6±9.4 years, 70.7% male) showed favorable outcomes. Radiological union was achieved in 87.8% of patients at a mean of 14.2±1.6 weeks, with 90.2% maintaining acceptable alignment. Final mean knee flexion was 118°±12°. Complications included pin-tract infection (14.6%) and stiffness (9.8%), with no deep infections or non-unions.

Conclusions: Ilizarov fixation with planned distal femoral ring removal at six weeks is an effective strategy for managing Schatzker type V and VI tibial plateau fractures, promoting early union, functional recovery, and low complication rates.

Comparative effectiveness of the Ilizarov method versus internal fixation for complex tibial fractures

Mon, 27 Apr 2026 00:00:00 +0530

Background: Complex tibial fractures often occur with high-energy trauma and significant soft tissue injury. Optimal management remains controversial due to infection risks, nonunion and functional impairment. Both internal fixation and the Ilizarov method are widely used, yet comparative data in resource-limited settings remain limited. This study compared clinical, radiological and functional outcomes of the Ilizarov method versus internal fixation in complex tibial fractures.

Methods: This comparative observational study was conducted in the Department of Orthopedics at 250 Bed General Hospital, Pabna and City Health Aid Hospital, Pabna, Bangladesh, from January 2024 to January 2025. A total of 30 patients with complex tibial fractures were enrolled and allocated into two groups based on the surgical intervention received. Fifteen patients underwent Ilizarov external fixation and fifteen received internal fixation. Operative parameters, union time, complications and 12-month functional outcomes were assessed. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 25.0.

Results: Operative time was longer in the Ilizarov group (p=0.004). Time to full weight bearing (p=0.006) and radiological union (p=0.049) were significantly shorter with Ilizarov fixation. Knee society scores (p=0.016) and Oxford knee scores (p=0.009) were significantly higher in the Ilizarov group at 12 months. Pin tract infection occurred in 26.7% of Ilizarov cases, while deep infection and nonunion were more frequent in the internal fixation group. Overall complication rates did not differ significantly.

Conclusions: The Ilizarov method provided earlier rehabilitation and superior functional outcomes compared to internal fixation in complex tibial fractures.

Surgical approaches and postoperative outcomes in acromioclavicular joint fractures: a retrospective study of patient demographics, effectiveness and plate removal timing

Mon, 27 Apr 2026 00:00:00 +0530

Background: Acromioclavicular (AC) joint fractures and dislocations are common shoulder injuries, particularly among young active males. Despite the widespread use of various fixation techniques, optimal management and implant removal timing remain topics of ongoing debate. This study retrospectively evaluates patient demographics, surgical approaches, postoperative outcomes, and plate removal timing among individuals treated for AC joint fractures at a major trauma center.

Methods: A retrospective observational study was conducted at Rashid Hospital, Dubai, including 187 patients aged ≥18 years who underwent operative or conservative management for AC joint fractures between 2018 and 2025. Sociodemographic data, treatment modality, surgical technique, complications, functional outcomes, and implant removal times were extracted from electronic medical records. Descriptive statistics were performed using SPSS v29.

Results: The cohort was predominantly male (93%), with most patients aged ≤40 years (69%). Hook plates were the primary fixation method (86.6%). Postoperatively, 47.8% reported pain, while 52.2% remained pain-free. Range-of-motion limitations were noted in 45.2% of patients, with adduction deficits being most common. Reoperation was primarily for implant removal, occurred in 79.7% of cases. Most plate removals occurred between 4–6 months, peaking at 5 months (41 cases). Early removal at 3 months was uncommon, and 37 patients had no removal at the time of review.

Conclusions: Hook plate fixation remains the predominant surgical approach for AC joint fractures at our institution, with generally favorable postoperative outcomes. Functional recovery was preserved in over half of the patients, and implant removal most occurred within 4–6 months. These findings highlight the importance of timely postoperative evaluation and individualized decision-making regarding plate removal to optimize long-term outcomes.

Functional and radiological outcomes after posterior decompression and pedicle screw stabilization in thoracolumbar spinal tuberculosis

Mon, 27 Apr 2026 00:00:00 +0530

Background: Tuberculosis (TB) remains a major global health concern, and spinal TB (Pott’s disease) is the most common and severe form of skeletal tuberculosis, frequently involving the thoracolumbar region and potentially leading to neurological deficit, deformity, and functional impairment. Therefore, this study aimed to evaluate the functional and radiological outcomes of posterior decompression with pedicle screw stabilization in patients with thoracolumbar spinal tuberculosis.

Methods: This prospective interventional study at the Department of Orthopaedic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh (July 2017–June 2019) included 18 patients with thoracolumbar spinal tuberculosis who underwent posterior decompression and pedicle screw fixation, with pre- and postoperative evaluation using ASIA grading, radiographs, and Modified Macnab criteria; data were analyzed with SPSS v20.0 (p < 0.05).

Results: Among 18 patients, most were 21–30 years (6,33.3%) and female (12,66.7%). Lesions were mainly dorsal (11, 61.1%) and lumbar (6,33.3%). Postoperative complications were rare (1, 5.6%). Neurological recovery improved (ASIA E: 9, 50%), normal ambulation in 11 (61.1%), VAS decreased 6.94→2.33, Cobb angle 28.7°→12.5°, and 17 (94.4%) achieved satisfactory functional outcomes.

Conclusions: Posterior decompression with pedicle screw stabilization is a safe and effective approach that provides significant neurological, functional, and radiological improvement in thoracolumbar spinal tuberculosis.

Electrodiagnostic severity distribution of carpal tunnel syndrome and its clinical correlates

Mon, 27 Apr 2026 00:00:00 +0530

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Nerve conduction studies are used to confirm the diagnosis and classify severity. Understanding the distribution of electrodiagnostic severity and its clinical correlates is important for patient management and healthcare planning.

Methods: This descriptive cross-sectional study included 100 consecutive adult patients with confirmed CTS and completed nerve conduction studies at Jordan University Hospital. Electrodiagnostic severity was classified as mild, moderate, or severe. Demographic characteristics, symptom duration, and comorbidities were analyzed using descriptive statistics. Cross-tabulation was used to examine severity in relation to selected variables.

Results: Severe CTS was the most common category, accounting for 67% of cases. Moderate CTS was observed in 21%, and mild CTS in 12%. Females represented 80% of the study population. Severe disease was proportionally more frequent among females. Patients with moderate and severe CTS were older than those with mild disease. Mean symptom duration increased slightly with greater severity. Hypertension and diabetes mellitus were common in moderate and severe groups. Other comorbidities were less frequent.

Conclusions: Severe electrodiagnostic CTS was predominant in this cohort. Female sex, older age, and certain systemic comorbidities were frequently observed in moderate and severe cases. These findings highlight the importance of early evaluation to reduce progression to advanced disease.

Histologic grade and surgical margin status as prognostic factors in chondrosarcoma: a retrospective single-center study

Serkan Gurcan, Yener Saglik — Mon, 27 Apr 2026 00:00:00 +0530

Background: Chondrosarcoma is a malignant cartilage-producing bone tumor in which prognosis is influenced by tumor biology and adequacy of surgical treatment. Histologic grade and surgical margin status are considered major prognostic factors. This study evaluated their impact in a retrospective institutional series.

Methods: Patients diagnosed with and treated for chondrosarcoma at a tertiary referral centre between 1986 and 2008 were retrospectively reviewed. Clinical, radiologic, pathologic, treatment, and follow-up data were analysed. Variables included tumour origin, location, histologic grade, Enneking stage, pulmonary metastasis at diagnosis, soft-tissue extension, surgical treatment, margin status, local recurrence, and survival. Associations were analysed using chi-square tests.

Results: A total of 144 patients were included (mean age 42.1±15.0 years; 57.6% male). Pulmonary metastasis at diagnosis was present in 10 patients (6.9%), and soft-tissue extension was identified in 61 (42.4%). Soft-tissue extension was significantly associated with pulmonary metastasis at presentation (p=0.002). Histologic grade and stage data were available for 110 patients; 54.5% had grade 1, 32.7% grade 2, and 12.7% grade 3 tumors. Local recurrence developed in 25 patients. Recurrence was observed in 58.8% of patients with positive surgical margins. In tumors with available grading data, recurrence occurred in 10.0% of grade 1, 36.1% of grade 2, and 35.7% of grade 3 lesions (p=0.004). Soft-tissue extension was also associated with recurrence (p=0.009). Overall mortality was 8.3%.

Conclusions: Histologic grade and surgical margin status were the main determinants of outcome in this series. Soft-tissue extension was associated with both recurrence and pulmonary metastasis at diagnosis.

Evaluating experiences and knowledge of developmental dysplasia of the hip management among healthcare professionals in Medina, Saudi Arabia

Mon, 27 Apr 2026 00:00:00 +0530

Background: Developmental dysplasia of the hip (DDH) is a leading pediatric orthopedic condition with serious long-term consequences if not identified and treated early; despite the preventability of its complications, delayed diagnoses remain common in Saudi Arabia, highlighting the need to assess healthcare providers’ knowledge and practices. This study aimed to evaluate the knowledge, experiences, and clinical practices related to DDH management among healthcare professionals in Medina, Saudi Arabia.

Methods: A cross-sectional design was used, involving 123 healthcare professionals who completed a validated self-administered questionnaire assessing knowledge of DDH risk factors, diagnosis, management, and screening practices, and the data were analyzed using descriptive statistics and chi-square tests to examine associations between demographic variables and knowledge levels.

Results: The results showed a mean knowledge score of 54.62% (±20.28%), with 44.7% of participants classified as having poor knowledge, 36.6% moderate knowledge, and only 18.7% demonstrating good knowledge, while no statistically significant associations were found between knowledge level and occupation, years of experience, workplace setting, or number of DDH cases encountered. Screening practices were inconsistent, as only 30.1% always examined infant hips and 46.3% did not perform assessments at every well-baby visit; although 60.2% relied on clinical examination for diagnosis, 42.3% reported a lack of access to ultrasonography, and 52% had not received formal training in DDH screening.

Conclusions: Despite these gaps, 86.2% of participants agreed that implementing standardized protocols would be beneficial, and overall, the findings indicate a clear deficiency in knowledge and inconsistency in screening and management practices, emphasizing the need for targeted training programs and standardized guidelines to enhance early detection and improve patient outcomes.

Management of distal tibial nonunion with tibiotalocalcaneal arthrodesis using tarsus nail: a retrospective study

Mohammad Ajed — Sat, 18 Apr 2026 00:00:00 +0530

Background: Distal tibial nonunion presents a significant challenge due to poor vascularity, limited soft tissue coverage, and mechanical instability. Conventional fixation methods often fail in complex cases, particularly when accompanied by bone loss, deformity, or infection. Tibiotalocalcaneal (TTC) arthrodesis using a tarsus nail has emerged as an effective strategy, providing stable fixation and supporting limb preservation. This study aims to evaluate the clinical and radiological outcomes of managing distal tibial nonunion with TTC arthrodesis using a tarsus nail.

Methods: This retrospective study included 40 patients with distal tibial nonunion who underwent TTC arthrodesis using a tarsus nail at a speciality hospital between 2024 and 2025. Functional outcomes were evaluated using standardized scoring systems, including the American Orthopaedic Foot and Ankle Society (AOFAS) score, pain intensity was analyzed by VAS and complications were recorded at one-year follow-up. Radiographic assessments were performed at regular intervals to evaluate bone union and alignment.

Results: A total of 40 patients (26 males, 14 females) with a mean age of 52.3±11.6 years were included. At one-year follow-up, radiographic union was achieved in all the patients, with satisfactory alignment in all cases. The mean AOFAS score improved significantly from 38.5±7.2 preoperatively to 78.9±6.8 postoperatively. Pain levels, as measured by the VAS, decreased from a preoperative mean of 7.2±1.1 to 2.1±0.9. No Complications were reported; no cases of implant failure were reported.

Conclusions: TTC arthrodesis using a tarsus nail is an effective and reliable procedure for distal tibial nonunion, providing high rates of bone union, significant improvement in functional outcomes, while maintaining limb alignment and stability.

Effectiveness of video-only strategies on knowledge regarding self-management of osteoarthritis among osteoarthritis patients visiting tertiary care hospital, Faridkot, Punjab

Jaspreet Kaur, Anil Kumar, Shaminder Kaur, Anshul Dahuja, Rohit Raina — Thu, 12 Mar 2026 00:00:00 +0530

Background: Osteoarthritis (OA) is a chronic degenerative joint disorder characterized by pain, stiffness, functional limitation and reduced quality of life. It is the second most prevalent rheumatologic condition worldwide and a leading cause of disability, particularly affecting the knee and hip joints. OA may be classified as primary, commonly associated with aging or secondary, resulting from underlying conditions. The burden of OA is substantial in India, where prevalence ranges from 22–39%, with higher incidence among women and older adults. Globally, OA prevalence has risen markedly over recent decades, emphasizing the need for effective self-management strategies. Aim of the study was to evaluate the effectiveness of video-only educational strategies on knowledge regarding self-management of osteoarthritis among patients.

Methods: A pre-experimental one-group pretest–posttest design was employed. The study included 130 osteoarthritis patients attending GGS Medical College and Hospital, Faridkot, Punjab. Knowledge regarding self-management of OA was assessed before and after the intervention. J.W. Kenny’s Open System Model served as the conceptual framework. Data were analysed using descriptive and inferential statistics.

Results: Findings demonstrated a significant improvement in participants’ knowledge following the video-based intervention. The mean knowledge score increased from 12.60±4.29 in the pretest to 22.23±3.29 in the posttest, with a mean difference of 9.63. The paired t-test value (t=38.41, p<0.001) indicated high statistical significance.

Conclusions: Video-only educational strategies are effective in enhancing knowledge related to self-management among patients with osteoarthritis.

Functional gait assessment after wide tumor resection and knee endoprosthesis reconstruction: a retrospective cross-sectional study

Rachit Bhatnagar, Sidharth Deshwal, Vivek Kumar Gautam — Fri, 03 Apr 2026 00:00:00 +0530

Background: Limb salvage surgery with endoprosthetic reconstruction around the knee is widely performed for primary malignant bone tumors and aggressive giant cell tumors. Although oncological control is well established, objective evaluation of postoperative gait and its correlation with functional outcome remains limited. This study aimed to assess gait pattern and functional outcome following wide tumor resection and knee endoprosthesis reconstruction.

Methods: This retrospective cross-sectional study included 20 patients who underwent wide resection and endoprosthesis reconstruction around the knee. Patients were evaluated at a minimum of six months postoperatively. Functional outcome was assessed using the musculoskeletal tumor society (MSTS) scoring system. Three-dimensional gait analysis was performed using a motion capture system based on the Helen Hayes protocol to measure walking velocity, stride length, stance phase, and knee range of motion. Statistical analysis was performed using appropriate parametric tests, with p<0.05 considered significant.

Results: The mean MSTS score was 22.95 out of 30, indicating good to excellent functional outcome in 90% of patients. The mean walking velocity was 0.92 m/s, representing a 31.31% reduction compared to normal reference values. Stride length and walking velocity were significantly reduced compared to normative data (p<0.001). Sixteen patients (80%) demonstrated a stiff knee gait, while two (10%) exhibited a flexed knee gait. Patients with distal femur reconstruction showed better functional outcomes than those with proximal tibia involvement.

Conclusions: Knee endoprosthesis reconstruction following tumor resection provides satisfactory functional outcomes despite measurable alterations in gait parameters. Objective gait analysis is a valuable tool for assessing postoperative functional recovery.

Role of platelet-rich plasma in treating chronic tendinopathies

Bijay Kumar Lamay, Laba Kumar Naik, Gopal Krishna Hembram — Tue, 07 Apr 2026 00:00:00 +0530

Background: Chronic tendinopathies often result in musculoskeletal pain and functional limitations, typically refractory to conventional conservative treatments. Platelet-rich plasma (PRP) therapy has emerged as a biologically derived strategy aimed at enhancing tendon healing through the provision of growth factors and cytokines.

Methods: This forward-looking multicentric study took place at VIMSAR Burla, FMCH Balasore, and GMC Sundargarh from December 2023 to December 2025. The study included 200 to 250 individuals with chronic tendinopathies. Patients received ultrasound-guided PRP injections and were then examined at regular intervals for pain relief and functional improvement.

Results: Patients saw a considerable improvement in both their pain scores and their ability to do things after PRP therapy. Most of them showed continuing clinical improvement during follow-up, with few issues.
Conclusions: PRP is a safe and effective way to treat chronic tendinopathies. It can help with pain and getting back to normal.

Functional outcomes of posterior cruciate ligament tibial avulsion fractures treated with open reduction and internal fixation and screw fixation: a retrospective study

Sunny K. Patel, Dharmik P. Solanki, Bhumil C. Rathod — Mon, 30 Mar 2026 00:00:00 +0530

Background: Posterior cruciate ligament (PCL) avulsion injuries can result in significant knee instability and long-term functional impairment if inadequately treated. Open reduction and internal fixation (ORIF) is widely employed to achieve anatomical restoration and preserve the native ligament. This study aimed to evaluate the clinical and functional outcomes of ORIF in patients with acute PCL avulsion injuries.

Methods: A retrospective study was conducted at a tertiary healthcare center including 30 patients treated with ORIF for acute PCL avulsion injuries between 2022 and 2025. Inclusion criteria comprised MRI-confirmed tibial PCL avulsion fractures and a minimum 12-month follow-up. Patients with chronic injuries or prior knee pathology were excluded. Functional outcomes were assessed using the Cincinnati knee rating system (CKRS), international knee documentation committee (IKDC) score, and Lysholm score preoperatively and at 12 months postoperatively.

Results: The cohort consisted of 24 males (80%) and 6 females (20%), with a mean age of 34.6±11.8 years. Road traffic accidents were the most common mechanism of injury (50%). Preoperative mean scores were CKRS 46.1±7.9, IKDC 49.3±7.2, and Lysholm 14.2±4.5. At 12 months, significant improvement was observed: CKRS 84.3±5.9, IKDC 86.7±5.5, and Lysholm 93.8±6.4 (p<0.001).

Conclusions: ORIF provides significant functional improvement and reliable restoration of knee stability in acute PCL avulsion injuries. Early surgical intervention combined with structured rehabilitation results in favorable one-year outcomes.

Functional outcome of surgical management of ankle fractures classified as per Lauge-Hansen classification

Nisarg R. Mehta, Prabhav P. Tijoriwala, Pratik V. Sidhdhapuria — Mon, 27 Apr 2026 00:00:00 +0530

Background: Ankle fractures are one of the common types of fractures treated by orthopaedic surgeons. There has been an increase in the prevalence of such fractures over the last two decades both in the young and active patients and in the elderly. The Lauge-Hansen classification system, based on the mechanism of injury, remains one of the most widely used methods for categorizing ankle fractures. It divides fractures into four main types-supination-adduction (SA), supination-external rotation (SER), pronation-abduction (PA), and pronation-external rotation (PER)-based on the position of the foot at time of injury and the direction of the applied force. Ankle injuries gain importance because the whole-body weight is transmitted through the ankle and locomotion depends upon the stability of the ankle joint

Methods: The inclusion criterion included all those ankle fracture more than 18 years and who consent to participate. The operative procedure was performed within 4 to 5 days of the injury. A preoperative clinical examination of the affected ankle was carried in all aspects like- abrasions, swelling, contusion, puckering and neurovascular deficit. Antero posterior (AP) and lateral (Lat) and mortise radiographs of the patient were evaluated.

Results: Out of the thirty patients followed up to a minimum of 18 months in the study twenty-one were males and nine were females. The mean age was 41.3 years (range 18 to>50 years). Eighteen out of thirty patients (60%) had the right side fractured and remaining twelve out of thirty had a left sided fracture (40%). In terms of anatomical classification trimalleollar fractures constituted the majority of cases (n=17,56.7%), followed by brimalleolar fractures (n=13, 43.3%). Five patients (16.7%) had open fractures classified as Gustilo-Anderson grade I or II, while the remaining 25 (83.3% presented with closed injuries.

Conclusions: Surgical treatment of ankle fractures, guided by accurate classification and operative principles, leads to favorable outcomes. The Lauge-Hansen system remains useful for diagnosis, prognosis, and surgical planning. Further multicenter studies with extended follow-up are needed to optimize care for complex fracture types.

Assessment of proximal tibial morphology and its association with anterior cruciate ligament injury: a magnetic resonance imaging-based comparative study

Mahammad Suhail, Arun Kumar Sharma — Mon, 27 Apr 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) injuries are common in active individuals and may be influenced by proximal tibial morphology. Increased posterior tibial slope (PTS) is linked to greater ACL strain and higher injury risk. This study aims to assess the association between proximal tibial morphology and ACL injury using magnetic resonance imaging (MRI) in a North Indian population.

Methods: A hospital-based cross-sectional study was conducted in the Orthopaedics Department of a tertiary care hospital in North India from November 2022 to January 2024. Eighty patients aged 20-60 were enrolled, divided into ACL injury (cases) and non-injury (controls) groups. MRI was used to assess proximal tibial morphology, focusing on PTS. Data were analyzed using unpaired t tests, Chi-square tests, logistic regression, and Pearson’s correlation. A p<0.05 was considered statistically significant.

Results: Most ACL injuries occurred in the 30-45 age group (45%), with fewer in 45-60 group (12.5%). Males were more affected (58%) than females (42%). Overweight individuals made up 72.5% of ACL cases. Posterior tibial medial slope showed no significant association with ACL injury (OR=1.150, p=0.882), while lateral slope showed a trend toward a protective effect (OR=0.135, p=0.093). Correlation analysis revealed a weak positive correlation for medial slope (r=0.024) and a moderate negative correlation for lateral slope (r=-0.190).

Conclusions: ACL injuries were more frequent in younger, overweight males. Lateral tibial slope showed a potential link to injury risk, suggesting proximal tibial morphology may influence ACL injury.

Functional outcome of proximal humerus fractures treated with open reduction and internal fixation using proximal humerus locking plate: a prospective hospital-based study

Rudra Sardar, Rajiv Roy, Arshad Ahmed, Dibakar Mallick, Rajkumar Poria — Mon, 27 Apr 2026 00:00:00 +0530

Background: Proximal humerus fractures account for 4-6% of all fractures and may result in significant functional impairment when displaced and inadequately treated.¹ Locking plate fixation offers angular stability and improved fixation, particularly in osteoporotic bone.^2,3

Methods: This prospective hospital-based study was conducted from June 2023 to July 2024. Thirty patients aged 18–65 years with acute displaced Neer two-part and three-part proximal humerus fractures were treated with open reduction and internal fixation using proximal humerus locking plates through a deltopectoral approach. Functional outcome was assessed using the Constant-Murley score and DASH score. Radiological union and complications were documented. Statistical analysis was performed using chi-square tests.

Results: The mean age was 44 years, with female predominance (60%). Two-part fractures constituted 60% and three-part fractures 40%. Radiological union was achieved in all cases. Functional outcomes were excellent in 20%, good in 50%, moderate in 20%, and poor in 10% of patients. Early surgery (≤5 days) and two-part fractures were significantly associated with better outcomes (p<0.05). Late complications such as stiffness and malunion negatively influenced outcomes (p=0.002).

Conclusions: Open reduction and internal fixation using proximal humerus locking plates provides reliable union and satisfactory functional outcomes in displaced proximal humerus fractures when performed early and with appropriate patient selection.

Functional and radiological outcome of intra articular distal radius fractures treated with variable-angle locking plate

Ananthabalaram B., Aswinlal K. S., Asgar Ali Usman, Abdul Asraf V. — Mon, 27 Apr 2026 00:00:00 +0530

Background: Intra-articular distal radius fractures are common injuries that require precise anatomical reduction to achieve optimal functional recovery. Variable-angle locking plates (VA-LCP) have been increasingly used due to their ability to stabilize periarticular fragments through polyaxial screw placement, potentially enhancing both radiological and clinical outcomes.

Methods: A prospective observational study was conducted among 85 patients with intra-articular distal radius fractures who underwent open reduction and internal fixation with VA-LCP at a tertiary care centre. Clinical and radiological assessments were performed at discharge, 4 weeks, and 6 months. Data were analysed using SPSS, with quantitative variables expressed as mean±SD and repeated-measures ANOVA applied for change over time.

Results: The mean age was 35.8 years, with males forming 72.9% of the cohort. Significant improvement was observed across all wrist movements (p<0.001), with ≥90% of normal range regained by 6 months. Mean Quick DASH score improved to 5.73, and MMWS increased to 92.59, with 76.5% achieving excellent functional outcomes. Radiological parameters were well maintained, and only 8.2% experienced minor complications.

Conclusions: VA-LCP provides stable fixation and results in excellent functional and radiological recovery for intra-articular distal radius fractures, with minimal complications.

Minimally invasive stabilization of midshaft clavicle fractures using TENS: Impact on functional recovery and early mobilization

S. T. Sanikop, Sarthak Jain, Gangadhar Bhuti — Mon, 27 Apr 2026 00:00:00 +0530

Background: Clavicle fractures are commonly seen in young population, notably in those who are more active in sports, on the contrary, in elderly and children they are attributed mostly to falls, accounting for around 2.6% of all the fractures. The most common site of fracture in the clavicle occurs at the middle third and which accounts for almost 80% of all clavicle fractures. To explain the faster pain relief, early return of function and restitution of clavicle length with the help of reduction and internal fixation of clavicle fracture creating an elastic stability at the fracture gap.

Methods: 32 patients presenting with mid shaft clavicle fractures in department of orthopaedics, KLEs Dr. Prabhakar Kore Hospital & Medical Research Centre and Charitable Hospital, were included in this study after taking their consent and fracture was stabilized using TENS nail.

Results: In this study, it was noted that males were predominantly involved, maximum incidence between 20-30 years. Most of the cases had RTA as a mode of injury with right clavicle fracture predominance. Post operatively, patients were followed up and Oxford Shoulder Score (OSS) was calculated at 4, 8, 16 weeks and the improvement in OSS score was found to be statistically significant.

Conclusions: We concluded that intramedullary fixation of displaced mid shaft clavicle fractures is a safe minimally invasive technique and is recommended in view of faster union, lesser morbidity, earlier rehabilitation and fewer complications.

Floating knee fractures: patterns, treatment strategies and outcomes of 30 patients

Mon, 27 Apr 2026 00:00:00 +0530

Background: The “floating knee,” described by Blake and McBryde in 1975, involves ipsilateral femur and tibia fractures, usually from high-energy trauma like RTAs or falls. Common in young males, presenting with polytrauma and severe soft tissue damage. Management is complex, requiring early surgical fixation and intensive rehabilitation. Classification systems like Fraser’s help guide treatment and predict complications, including vascular, neurological, and ligament injuries.

Methods: This retrospective study was conducted at a tertiary care hospital from March 2024-25, including 30 patients with surgically treated floating knee injuries. Fractures were classified using the Fraser system. Fixation methods and anaesthesia were selected based on clinical indications. Patients were followed up at 6 weeks, 6 months, 1 year. Data on demographics, surgical details, and functional outcomes were collected and analysed.

Results: Analysis of 30 floating knee injury cases revealed that most patients were young males (76.7%), commonly aged 20-39 years, and predominantly injured in road traffic accidents (RTAs) (66.7%). Pain (80%) and swelling (63.3%) were the most frequent symptoms. Fraser type I fractures (50%) and closed injuries (76.7%) were most common. Spinal anaesthesia (56.7%) and intramedullary nailing (56.7%) were the preferred surgical approaches. Outcomes were excellent in 30% and good in 20%, though 50% experienced some complications, including delayed union, stiffness, or persistent limp.

Conclusions: Floating knee injuries predominantly affect young males involved in high-energy trauma. Intramedullary nailing under spinal anaesthesia offers favourable outcomes with early mobilization and reduced morbidity. Despite good recovery in many cases, complications like stiffness and delayed union persist, underscoring the need for precise surgical technique, timely intervention, and comprehensive rehabilitation support.

Comparison of immediate effect of instrument assisted soft tissue mobilization versus muscle energy technique along with hot pack on pain and range of motion in individuals with heel pain

Swati V. Kubal, Mahek D. Lokwani — Mon, 27 Apr 2026 00:00:00 +0530

Background: Heel pain is a common musculoskeletal complaint that affects daily activities and mobility. Various therapeutic interventions, including instrument assisted soft tissue mobilization (IASTM) and muscle energy technique (MET), are employed to alleviate pain and improve range of motion (ROM). However, limited studies compare their immediate effectiveness. This study aimed to compare the immediate effects of IASTM versus MET along with hot pack on pain and ankle dorsiflexion ROM in individuals with unilateral heel pain.

Methods: A total of 60 participants with unilateral heel pain were randomly allocated into two groups: Group A (IASTM) and Group B (MET with hot pack), with 30 participants in each. Pain was assessed using the visual analog scale (VAS) and ankle dorsiflexion ROM was measured using a clinometer smartphone application. Pre- and post-intervention assessments were conducted. A Wilcoxon signed-rank test and paired t-tests were used for within-group comparisons, while the Mann-Whitney U Test and unpaired t-test were used for between-group comparisons.

Results: Both interventions significantly reduced pain and improved dorsiflexion ROM (p<0.001). However, the IASTM group exhibited a greater reduction in VAS scores (Z=-4.893, p<0.001) and significant increase in dorsiflexion ROM (t =-40.934, p<0.001) compared to the MET with hot pack group (Z=-4.977, p<0.001) (t=-15.642, p<0.001). Between-group analysis further confirmed that IASTM was superior to MET with a hot pack in both pain reduction (U=153, p<0.001) and ROM improvement (t=3.604, p=0.001).

Conclusions: Both IASTM and MET with a hot pack are effective in reducing heel pain and improving dorsiflexion ROM.

Efficacy of autologous platelet-rich plasma versus corticosteroid injections in degenerative facet joint syndrome

Aryadev Jayakrishnan, Hariprasad Seenappa — Mon, 27 Apr 2026 00:00:00 +0530

Background: Degenerative Facet Joint Syndrome (DFJS) is a common cause of chronic low back pain, particularly in the elderly. Current treatments, including intra-articular corticosteroid (CS) injections, offer short-term relief but are associated with adverse effects. Autologous platelet-rich plasma (PRP) injections have emerged as a potential alternative due to their regenerative properties and minimal side effects. This study compares the efficacy of single intra-articular PRP versus CS injections in managing DFJS. To evaluate and compare the short- and long-term functional outcomes of intra-articular PRP and CS injections in patients with DFJS.

Methods: This prospective, randomized controlled trial included 74 patients diagnosed with DFJS, randomly divided into two groups. Group A (n=37) received a single intra-articular PRP injection, while Group B (n=37) received a single intra-articular CS injection. Outcomes were assessed using the Visual Analog Scale, Present Pain Index, Modified Oswestry Disability Index, Roland-Morris Questionnaire, and Short Form Health-12 at 4 weeks, 8 weeks, 12 weeks, 6 months, and 1-year post-injection.

Results: Both groups showed significant reductions in pain and disability scores. In the short term, the CS group demonstrated greater improvement, though not statistically significant. However, at 1 year, the PRP group showed superior outcomes in pain reduction, functional ability, and quality of life, with long-term benefits surpassing those of CS.

Conclusions: Intra-articular PRP injections offer a safe and effective treatment option for DFJS, providing longer-lasting relief compared to CS. While both treatments are beneficial, PRP may be the preferable choice for patients seeking sustained improvement in pain and functionality.

A prospective and observational study of clinical and functional outcome of meta carpal fracture treated with osteosynthesis using plate

Vaishvik Patel, Sagar Shah, Jay S. Bothra, Sarvang M. Desai — Mon, 27 Apr 2026 00:00:00 +0530

Background: Metacarpal fractures are among the most common hand injuries encountered in orthopaedic practice and can significantly impair hand function if not managed appropriately. Stable fixation with early mobilization is essential for optimal functional recovery, particularly in unstable fracture patterns. Plate osteosynthesis provides rigid fixation and allows early rehabilitation, but its clinical and functional outcomes require systematic evaluation.

Methods: This prospective observational study was conducted in the Department of Orthopaedics at a tertiary care centre over a defined study period. A total of 20 skeletally mature patients with closed metacarpal fractures were included. All patients underwent open reduction and internal fixation using mini-plates and screws. Patients were followed up at regular intervals for a minimum period of three months. Clinical evaluation, radiological assessment of fracture union, postoperative complications, duration of hospital stay, return to work, and functional outcomes were assessed. Functional outcome was evaluated using the Total Active Flexion (TAF) scoring system recommended by the American Society for Surgery of the Hand.

Results: The majority of patients were young to middle-aged adults, with a male predominance. Transverse fractures and shaft-level involvement were the most common fracture characteristics. Radiological union was achieved within 6-7 weeks in 75% of patients. Excellent functional outcomes were observed in 75% of digits 2-5 and in all cases involving the thumb. Overall, 85% of patients achieved satisfactory functional outcomes. Most patients (70%) returned to work within 6-8 weeks. Postoperative complications were minimal, with stiffness observed in 15% of patients and infection in 5%. No cases of non-union, malunion, or implant failure were reported.

Conclusions: Plate osteosynthesis is a safe and effective method for the management of metacarpal fractures, providing stable fixation, early mobilization, and excellent functional outcomes with a low complication rate. Meticulous surgical technique and structured postoperative rehabilitation play a crucial role in achieving optimal results.

Comparison of synovial fluid IL-6 levels in post arthroscopic reconstruction of anterior cruciate ligament using press fit technique with BPTB graft versus bio-screw fixation

Mon, 27 Apr 2026 00:00:00 +0530

Background: Anterior cruciate ligament (ACL) injury causes an increase in synovial fluid concentrations of inflammatory cytokines and biomarkers of cartilage breakdown. ACL reconstruction reinitiates an "inflammatory hit" that leads to an increase in these markers and chondral degeneration, and is prolonged. A study aimed at comparing the IL-6 levels in patients undergoing ACL reconstruction with the press-fit technique and bio-screw fixation at different intervals.

Methods: A retrospective study of 60 subjects between 14 and 62 years with ACL tear were divided randomly into two groups, Group 1 and Group 2, undergoing arthroscopic ACL reconstruction using bio-screw fixation and press-fit technique (Implant-less), respectively. The synovial fluid levels of IL-6 were assessed in the affected knee at 3months, 6months and 12 months post-surgery. Tegner-Lysholm Knee Scores were also compared.

Results: It was found that at 6 months, IL-6 levels in Group 2 (average 47±0.2 pg/ml) were lower compared to Group 1 (average of 148±0.7 pg/ml). And at 12 months, Group 2 had an average of 41±0.5 pg/ml and Group 1 had an average of 84±0.3 pg/ml. Tegner-Lysholm scores in both groups were similar at the end of 12 months.

Conclusions: Press fit technique allows bone-to-bone healing and is devoid of problems associated with hardware fixation like biocompatibility, biodegradability, synovial reaction, chondral degeneration and tunnel enlargement, though clinical outcomes are similar.

Functional outcome of paediatric supracondylar humerus fractures treated with lateral crossed pinning and conventional crossed pinning with k-wires

Nadir Shajan Abdin, Abhijith Gopinathan, Jerin Jose, Ibin Varghese — Mon, 27 Apr 2026 00:00:00 +0530

Background: Supracondylar fractures of the humerus constitute the most common paediatric elbow injuries and often require surgical fixation when displaced. Conventional medial-lateral crossed pinning offers good stability but carries a risk of iatrogenic ulnar nerve injury. Lateral crossed pinning (Dorgan’s technique) has been proposed as a safer alternative. Objectives were to compare the functional outcomes of paediatric supracondylar humerus fractures treated with lateral crossed pinning (Dorgan’s technique) and conventional medial-lateral crossed pinning.

Methods: This observational study was conducted at a tertiary care teaching hospital over 1.5 years (June 2024-December 2025). A total of 52 children (<15 years) with displaced closed supracondylar humerus fractures (Gartland type II and III) underwent closed reduction and percutaneous K-wire fixation using either lateral crossed pinning (n=28) or conventional crossed pinning (n=24). Functional outcomes were assessed at 3 and 6 months using Flynn’s criteria, elbow range of motion (EROM), and carrying angle (CSA). Statistical analysis was performed using SPSS version 26.

Results: Most patients were aged 6-10 years (51.9%), with a male predominance (69.2%). At 6 months, excellent outcomes were observed in 50.0% and good outcomes in 25.0% of patients. Mean EROM loss at 6 months was 6.52±2.1° in the lateral crossed pinning group and 6.71±2.2° in the conventional crossed pinning group (p=0.41). Mean CSA loss was 5.87±1.9° and 6.05±2.0°, respectively (p=0.064). No significant difference in functional outcomes was noted. Ulnar nerve injury occurred only in the conventional crossed pinning group.

Conclusions: Lateral crossed pinning provides comparable functional outcomes with a lower risk of ulnar nerve injury, making it a safe and effective alternative.

Clinico radiological outcomes of thoracolumbar vertebral fractures: insights from a regional Indian cohort

Aniket Bandyopadhyay, Lakshmeesha Thammegowda — Mon, 27 Apr 2026 00:00:00 +0530

Background: Thoracolumbar fractures are one of the frequent spinal injuries especially in the developing areas where road accidents and occupational trauma are common. Their resource management in resource constrained health care setting is a special challenge. The paper is an evaluation of short-term (6 months) clinic radiological prognoses of patients with thoracolumbar fractures compared to clinical recovery as per radiological parameters in conventional conservative and surgical interventions.

Methods: This prospective observational study included 30 patients (26 males, 4 females) with traumatic thoracolumbar fractures treated between January 2023 and June 2024 at Hassan Institute of Medical Sciences. Patients were assessed using the American Spinal Injury Association (ASIA) spine chart, ASIA Impairment Scale (AIS), and radiological tools (X-rays, CT, MRI, and Thoracolumbar Injury Classification and Severity Score – TLICS). Surgical intervention was indicated for TLICS ≥5, progressive neurological deficits, or >50% vertebral height loss, whereas TLICS ≤3 were managed conservatively. Outcomes were followed up at admission, 7 days, 6 weeks, 12 weeks, and 24 weeks.

Results: Short-term clinic radiological evaluation demonstrates that individualized management—guided by TLICS and ASIA parameters—achieves satisfactory recovery in thoracolumbar fractures. Conservative management remains effective for stable injuries, while surgical stabilization provides structural benefits in unstable fractures. Larger multicentric studies with extended follow-up are needed to validate these findings.

Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

Non prosthetic peri-implant femur fracture classification system and treatment algorithm: a systematic review

Muhammad Irfan Akram, Mai Morita, Jie Ying Tee, Hadiya Golamgouse, Ryan Wood — Mon, 27 Apr 2026 00:00:00 +0530

Non-prosthetic peri-implant femoral fractures (NP-PIFFs) are an increasingly recognised complication of fracture fixation, particularly in elderly and osteoporotic patients. These fractures occur in femora containing retained fixation hardware and present unique biomechanical and surgical challenges. Despite their growing prevalence, current literature lacks consensus on classification systems and optimal management. This systematic review aimed to summarise existing classification systems, treatment strategies, and reported outcomes in NP-PIFFs. This review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251102564). Searches of Medline and Google Scholar were performed using the keywords peri-implant fracture, femur, classification, and treatment algorithm. Studies were included if they reported on NP-PIFF classification, management, and at least one outcome measure (union rate, one-year mortality, or complications). Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) tool, and data were synthesised narratively due to heterogeneity. Nineteen studies published between 2016 and 2025 met inclusion criteria, encompassing 984 patients (mean age 82 years). Seven distinct classification systems were identified, with Videla-Cés et al and Chan (NPPIF) being most commonly used. Reported treatment strategies consistently emphasised constructs spanning the entire femur, minimisation of stress risers, and preservation of stable implants to reduce operative trauma. Union rates were high (95-100%), but one-year mortality ranged from 2.7% to 36%, largely reflecting patient frailty. Complications included mechanical failure, loss of fixation, varus collapse, and medical issues such as pneumonia, delirium, and thromboembolic events. NP-PIFFs are complex injuries that remain inconsistently classified and managed across studies. Although union rates are favourable when biological fixation principles are respected, patient outcomes are significantly influenced by age, comorbidity, and systemic complications. Future research should focus on standardising classification systems, validating treatment algorithms, and developing multidisciplinary strategies to optimise both surgical and medical care.

Current trends in articular cartilage research: a bibliometric analysis of the 50 most-cited clinical articles over the last 10 years

Mon, 27 Apr 2026 00:00:00 +0530

Articular cartilage lesions are a frequently encountered pathology during arthroscopic procedures and present a significant challenge. The purpose of this study was to conduct a bibliometric analysis to identify the 50 most cited clinical publications on treatments for cartilage surgery from the past decade, providing an updated overview of influential research and emerging trends in treatment strategies. A literature search was performed in October 2025 using the search terms of “cartilage treatment” OR “cartilage surgery” OR “cartilage repair” were used and filtered to include only those published between 2015 through 2025. The 50 most cited articles were identified and independently reviewed by two authors. Methodological quality was assessed using the Modified Coleman Score, and randomized controlled trials (RCTs) were evaluated using the Revised Tool for Risk of Bias in Randomized Trials (RoB 2.0) tool. A total of 21,640 articles were identified in the initial search. The 50 most cited articles were published between January 2015 and January 2021 and had 6407 total citations (mean±standard deviation, 128.1±63.2) (range, 73-366). Study designs of most cited articles included case series (n=26 studies, 52%), RCTs (n=12 studies, 24%), and cohort (n=12 studies, 24%) designs. The mean modified Coleman was 68.0±8.8 (range, 53-85). The journals publishing the most cited articles were the American Journal of Sports Medicine and Cartilage. High-impact cartilage research has shifted toward MSC-based therapies, surpassing ACI/MACI, while overall methodological quality continues to improve.

Management of massive and irreparable rotator cuff tears: an evidence-based review of joint-preserving treatment strategies

Karan S. Shiwtarkar, Pranav P. Rathi, Mukesh M. Devpura — Mon, 27 Apr 2026 00:00:00 +0530

Massive and irreparable rotator cuff tears are associated with substantial pain, weakness, and altered shoulder biomechanics. For younger or physically active individuals, surgeons typically prefer joint-preserving operations instead of arthroplasty to keep the original anatomy intact and postpone the need for prosthetic implants. This systematic review evaluates functional outcomes, range of motion, structural integrity, and complications of contemporary joint-preserving surgical options for massive and irreparable rotator cuff tears. A comprehensive search was performed according to PRISMA 2020 guidelines. Studies reporting outcomes of superior capsular reconstruction, tendon transfers, patch augmentation, graft interposition, long head of the biceps augmentation, and subacromial balloon spacers were included. Owing to heterogeneity, qualitative synthesis was conducted. Superior capsular reconstruction, particularly with fascia Lata autograft, demonstrated the most consistent improvements in functional scores and forward elevation. Tendon transfers, especially latissimus dorsi transfer, improved external rotation in selected patients. Patch augmentation and graft interposition reduced re-tear rates compared with partial repair. Less invasive options showed symptomatic benefit but variable structural durability. Joint-preserving procedures offer meaningful clinical improvement; however, further high-quality comparative trials are necessary.

Weight-bearing computed tomography versus standard imaging for the evaluation of complex foot and ankle pathology: a systematic review and meta-analysis on the change in surgical planning and diagnostic accuracy

Tue, 10 Mar 2026 00:00:00 +0530

Weight-bearing computed tomography (WBCT) is a paradigm change in imaging of the musculoskeletal system, as it records the foot and ankle in physiologic load. This systematic review is a critical appraisal of the diagnostic superiority and its impact on surgical decision-making of WBCT versus standard imaging (SI: radiographs and non-weight bearing CT) for complex foot and ankle conditions. Fifteen studies were included after a search of the literature, adherence to the PRISMA translation. A narrative synthesis and, where possible, a quantitative analysis was conducted. WBCT consistently showed significantly greater magnitude of deformity in conditions such as adult acquired flatfoot deformity (e.g., medial cuneiform-to-floor distance was reduced from 29 mm NWB to 18 mm WB) and highly reliable 3D biometrics (e.g., Foot and Ankle Offset ICCs 0.97 to 0.99). For Lisfranc injuries, WBCT was more sensitive for the detection of subtle instability. Crucially, WBCT was responsible for changing the surgical plan in a pooled 32% of cases (95% confidence interval (CI): 24–41%) with the most common changes made being addition or alteration of procedures. The quality of the included cohort studies was moderate and randomized trials showed some concerns regarding bias. While the technology provides better diagnostic insight and modification of preoperative planning in a large proportion of patients, the supporting evidence is largely from moderate quality, heterogeneous studies with a dearth of long-term outcome data. WBCT is an effective tool for assessment of load-dependent pathology and its incorporation of the diagnostic pathway for complex deformity and instability would seem to be justified.

Diagnostic pitfalls in shoulder impingement syndrome in overhead athletes: a narrative review

Jaxon S. Boley, Matthew Majer, Dona Hasou — Mon, 27 Apr 2026 00:00:00 +0530

Shoulder impingement syndrome is a frequently assigned diagnosis in overhead athletes presenting with shoulder pain, yet it often serves as a nonspecific label rather than a precise explanation of symptoms. In this population, impingement complaints are more commonly secondary to altered glenohumeral mechanics, scapular dyskinesis, instability, or kinetic chain dysfunction rather than primary structural narrowing of the subacromial space. As a result, misdiagnosis is common and may lead to prolonged symptoms, ineffective rehabilitation, or unsuccessful surgical intervention. This narrative review examines common diagnostic pitfalls encountered in the evaluation of shoulder impingement syndrome in overhead athletes, discusses the limitations of imaging, and emphasizes the importance of sport-specific clinical assessment. A structured diagnostic algorithm is proposed to improve diagnostic accuracy and guide management in this challenging patient population.

Effect of vitamin D supplementation on bone healing in patients with avascular necrosis of the hip: a narrative review

Mon, 27 Apr 2026 00:00:00 +0530

Vitamin D has been widely known for its role in maintenance and repair of skeletal system, where vitamin D deficiency (VDD) led to hindered effect on bone healing after fractures, bone defects and osteon formation in implants. Some studies have shown that increasing serum Vitamin D levels requires a significant period of time after the application of vitamin D for VDD. In addition, VDD at the time of bone (mainly hip) fracture is associated with an inflammatory response after the fracture. Avascular necrosis (AVN) is a serious complication of defective bone healing. VDD may be a potential risk factor for this incidence; however, further studies are required to validate this aspect in orthopedics. The crucial role of vitamin D in upregulating vascular endothelial growth factor on the proliferation of type-H vessels connects osteogenesis and angiogenesis pathways, thereby providing insight into how to tackle AVN. The primary aim of this review is to highlight the importance of vitamin D supplementation in patients with AVN during the bone regeneration phase.

Role of bone turnover markers in prediction of fracture healing: a contemporary evidence-based perspective

Hamza Ali, Adarsh Kumar Singh, Anurag Baghel, Shafaque Asif — Mon, 27 Apr 2026 00:00:00 +0530

Early and accurate assessment of fracture healing is limited by reliance on plain radiography, which detects only late mineralized changes and fails to capture early biological events, contributing to delayed union and non-union in 5-10% of cases. Bone turnover markers such as PINP, BALP, CTX, and TRACP-5b provide dynamic biochemical insight into osteoblast osteoclast activity and offer potential for earlier prediction of fracture healing outcomes. This review used a structured search of PubMed/MEDLINE, Scopus, Web of Science, and EMBASE up to December 2025 to synthesize mechanistic, diagnostic, and clinical evidence on BTMs in fracture healing. Successful fracture healing shows reproducible temporal BTM patterns, with early rises in CTX and TRACP-5b during days 3-7, followed by a 30-70% increase in PINP and BALP during weeks 2-4. Impaired healing is associated with blunted PINP and BALP responses and/or persistently elevated CTX beyond week 6, with reported odds ratios of 3-5 for delayed or non-union. Clinical application is limited by assay heterogeneity, circadian and metabolic variability, inconsistent sampling protocols, and the lack of fracture-specific cut-off values. An integrated Biochemical Biomechanical Radiological (BBR) Trifecta Model combining BTMs, mechanical stability metrics, and advanced imaging is proposed to improve prognostic accuracy. BTMs offer biologically sensitive and time-dependent information that complements radiography and enable early identification of patients at risk for delayed or impaired fracture healing. Integration through the proposed BBR model, supported by emerging biomarkers and AI-based analytics, may allow precise and personalized fracture monitoring.

Optimizing diagnostic yield in computed tomography-guided musculoskeletal bone biopsy: a narrative review

Mon, 27 Apr 2026 00:00:00 +0530

Computed tomography (CT) -guided percutaneous bone biopsy is a cornerstone technique in the diagnostic evaluation of musculoskeletal lesions, offering high diagnostic accuracy with lower morbidity and cost compared with open surgical biopsy. Despite its widespread use, diagnostic yield varies considerably across studies, influenced by lesion biology, anatomical location and modifiable technical factors. Non-diagnostic sampling remains a clinically relevant problem, particularly in sclerotic, occult and necrotic or cystic intraosseous lesions, often leading to repeat procedures and delayed definitive management. This narrative review synthesizes current evidence on the diagnostic performance of CT-guided musculoskeletal bone biopsy and organizes predictors of biopsy success into lesion-related, site-related and technique-related domains. Particular emphasis is placed on technical strategies aimed at optimizing diagnostic yield and specimen adequacy, including meticulous pre-procedural planning, appropriate needle selection, multi-core sampling, use of on-site cytologic or histologic assessment and advanced imaging guidance for challenging lesions. Emerging low-cost innovations such as the “sandwich technique” are discussed as potential solutions for traditionally low-yield scenarios, especially in resource-constrained settings. The review also highlights important gaps in the existing literature, which is dominated by retrospective single-centre studies from high-income environments and underscores the need for prospective, protocol-driven, multicentre research using standardized outcome definitions and inclusive of low- and middle-income settings. Continued refinement and validation of pragmatic biopsy strategies are essential to reduce non-diagnostic rates, minimize repeat procedures and improve the efficiency and equity of musculoskeletal biopsy care worldwide.

Rethinking routine drain usage in total knee arthroplasty: how tranexamic acid changed clinical practice – a review of literature

Albin Geo Babu, Vinay Reddy, Padma Kumar Sunil, Manjunatha Gugri Sunay — Mon, 27 Apr 2026 00:00:00 +0530

The routine uses of closed suction drainage in total knee arthroplasty has been a longstanding practice aimed at preventing hematoma formation and infection. However, the introduction of tranexamic acid has revolutionized blood loss management. This review evaluates the current utility of suction drains in primary total knee arthroplasty within the context of widespread tranexamic acid adoption. A comprehensive literature review was conducted, focusing on studies published between 2004 and 2025. Special emphasis was placed on randomized controlled trials and comparative cohort studies evaluating outcomes of drain versus no-drain protocols in patients receiving tranexamic acid. Key outcome measures included total blood loss, transfusion rates, length of hospital stay, infection rates, and functional outcomes. Historical meta-analyses conducted prior to the tranexamic acid era indicated increased transfusion requirements associated with drain use. Recent evidence from the tranexamic acid era, including a pivotal 2019 randomized controlled trial by Maniar et al and a 2023 retrospective cohort study by Albasha et al, demonstrates that drains offer no benefit regarding blood conservation or complication reduction. Albasha et al found that drain placement was associated with significantly longer hospital stays (10.7 versus 5.4 days), greater hemoglobin decline, and higher transfusion rates. No significant differences were observed in deep vein thrombosis or surgical site infection rates between groups. In the tranexamic acid era, the theoretical benefits of negative suction drains are outweighed by associated disadvantages, including increased hidden blood loss, higher transfusion costs, and prolonged hospitalization. Current evidence supports abandoning routine drainage in primary total knee arthroplasty when tranexamic acid is administered.

Complex hallucal interphalangeal joint dislocation with incarcerated sesamoid: percutaneous reduction with K-wire and literature review

Suraj Sajeev, Amit Bharadwaj — Mon, 27 Apr 2026 00:00:00 +0530

Irreducible dislocation of the hallucal interphalangeal (IP) joint is an uncommon injury, often complicated by incarceration of the sesamoid–plantar plate complex. While traditional management has relied on open reduction with or without sesamoid excision, minimally invasive approaches are gaining traction. This report presents a rare case of Miki type 2 IP joint dislocation with sesamoid interposition in a 22-year-old male who sustained a dorsiflexion injury while playing badminton barefoot. Initial closed manipulation converted the pattern to type 1, resulting in an elongated, stiff toe. Under general anaesthesia, a 2-mm Kirschner wire (K-wire) was inserted medially into the IP joint and advanced dorsally to plantarly to disengage the incarcerated sesamoid. An audible click signified successful reduction, and stability was confirmed through 30° of passive dorsiflexion. The joint was immobilized with an extension-blocking thermoplastic splint for three weeks. The patient returned to full activity by two months and remained asymptomatic at one-year follow-up. A systematic review identified 31 reported cases of hallucal IP dislocation. Type 2 injuries with sesamoid entrapment were consistently resistant to closed reduction; while early literature favoured open approaches, recent reports demonstrate the efficacy of percutaneous or ultrasound-guided techniques. This case supports percutaneous K-wire manipulation as a safe, minimally invasive alternative to open reduction, offering tactile mechanical advantage and a reduced risk of chondral injury. Percutaneous reduction under true lateral fluoroscopic guidance provides a tissue-preserving solution with excellent functional outcomes when combined with early recognition of the injury pattern.

Supramalleolar dome osteotomy after a childhood ankle fracture malunion: a case report

Talal S. Alharkan, Raghad S. Alabbad, Yasser A. Alhaddab, Athkar H. Alhajjaj — Mon, 27 Apr 2026 00:00:00 +0530

Proper ankle alignment is essential for maintaining normal gait mechanics and balanced load transmission across the tibiotalar joint. Coronal plane malalignment, whether varus or valgus, alters joint loading patterns and increases stress on one side of the ankle, leading to progressive cartilage damage and the development of ankle osteoarthritis. If left uncorrected, such deformities may result in chronic pain, instability, functional decline, and reduced quality of life. We report the case of a 38-year-old woman with a residual varus ankle deformity secondary to childhood fracture malunion, who was successfully treated with dome supramalleolar osteotomy. This case highlights the role of the Dome shaped Supramalleolar osteotomy (SMO) as an effective joint-salvage procedure for distal tibial malalignment, demonstrating favorable clinical and patient-reported outcomes.

Strain-guided revision of failed femoral shaft nonunion using a hybrid dual-plane construct around a retained dynamic hip lag screw

Mon, 27 Apr 2026 00:00:00 +0530

Femoral shaft nonunion remains a challenging complication after high-energy trauma and internal fixation, and although exchange intramedullary nailing is widely accepted as the standard surgical strategy for aseptic femoral shaft nonunion, complex anatomical and mechanical situations may require alternative approaches. We report the case of a 45-year-old male who developed a painful aseptic femoral shaft nonunion with implant failure following fixation of an ipsilateral femoral shaft and femoral neck fracture. Revision surgery was performed using a strain-guided strategy. The dynamic hip screw (DHS) barrel plate was removed while the lag screw inserted for the femoral neck fracture was intentionally retained. Following meticulous debridement to bleeding bone, medullary canal recanalization and defect grafting, a hybrid dual-plane construct consisting of an anterior plate and a long barrel DHS plate was applied with controlled interfragmentary compression. Postoperatively, the patient progressed with protected weight bearing and subsequent gradual rehabilitation. Serial radiographs demonstrated maintained alignment, stable fixation and progressive bridging callus, and final follow-up confirmed solid fracture union with complete resolution of thigh pain and functional improvement. This case demonstrates that deliberate strain-guided construct redesign, selective implant retention and multiplanar stability can represent an effective and reproducible alternative strategy for femoral shaft nonunion in carefully selected patients, particularly when conventional exchange nailing is limited by associated proximal femoral fixation.

Hybrid external fixation with primary closure for a Gustilo-Anderson type III A proximal tibial fracture: a case report

M. Sulaiman, S. M. Masum Billah — Mon, 27 Apr 2026 00:00:00 +0530

Open fractures of the proximal tibia are associated with a high risk of infection because of limited soft-tissue coverage and compromised vascularity. Although staged management with delayed internal fixation is commonly practiced, external fixation may serve as a definitive option in selected Gustilo-Anderson type IIIA injuries with adequate soft tissue condition. A 19-year-old male sustained a right proximal third open tibial fracture following a road traffic accident on 30 October 2023. Intravenous broad-spectrum antibiotics and tetanus prophylaxis were administered immediately upon admission. Surgical treatment was performed on 31 October 2023 using hybrid external fixation with primary wound closure. Early callus formation was noted at six weeks, and bridging callus across all cortices was confirmed at approximately eighteen weeks. The external fixator was removed on 05 March 2024 following confirmation of union, followed by short-term protective casting. Radiographs at twenty-three months demonstrated maintained alignment and complete cortical remodelling. Hybrid external fixation with primary wound closure may provide a reliable definitive treatment option for carefully selected Gustilo-Anderson type IIIA proximal tibial fractures when adequate debridement and stable fixation are achieved.

Symptomatic fibular non-union after hybrid lateral closing wedge high tibial osteotomy: a report of two cases

Woon-Hwa Jung, Harshit Khare, Kaushik Are, Dong-Hyun Kim — Mon, 27 Apr 2026 00:00:00 +0530

Fibular osteotomy is an essential step in hybrid lateral closing wedge high tibial osteotomy (LCW-HTO), allowing adequate tibial correction in patients with varus malalignment. Although radiological fibular non-union following LCW-HTO is relatively common, it is predominantly asymptomatic and rarely affects clinical outcomes or requires further intervention. Consequently, fibular non-union is often considered a benign radiographic finding. We report two unusual cases of symptomatic fibular non-union following hybrid LCW-HTO. One patient developed non-union after an oblique mid-diaphyseal fibular osteotomy, while the other followed segmental fibular excision. Both patients presented more than one year postoperatively with persistent, localized lateral leg pain associated with a characteristic pricking sensation during weight bearing, despite satisfactory tibial osteotomy union and good knee function. Clinical examination revealed focal tenderness over the fibular site with no neurological deficits. Plain radiographs and CT confirmed fibular non-union in both cases. Given the duration of symptoms and lack of radiological union, surgical intervention was planned. Both patients underwent fibular plate fixation with autologous iliac crest bone grafting. Radiological union was achieved in both cases within 6 months, with complete resolution of pain and return to full function. This report highlights that, although fibular non-union after hybrid LCW-HTO is usually asymptomatic, a small subset of patients may develop persistent, clinically significant symptoms. Recognition of symptomatic fibular non-union is important, as timely surgical stabilization with bone grafting provides reliable union and excellent clinical outcomes.

Pirogoff amputation for foot osteomyelitis: a case report and review of literature

Mon, 27 Apr 2026 00:00:00 +0530

Deciding the level of amputation is influenced by healing potential of the stump and preservation of the limb length to optimise the mobility and energy requirement for walking. In 1854, the Russian surgeon Nikolay Ivanovich Pirogoff introduced a technique of foot amputation in which the heel is preserved and used as a base. The forefoot, midfoot, talus, distal part of the calcaneus, and distal tibial articular cartilage are removed. The plantar skin flap is left attached to the calcaneus, which is rotated 90 dorsally to create a sensate weight-bearing surface with minimal loss of leg length. Since the intact heel pad creates the plantar aspect of the stump, the patient is able to bear full weight on the limb, after bone-healing has occurred, with or without a prosthesis. We present a case of a patient who underwent an amputation with the Pirogoff technique following a traumatic compound Lisfranc’s injury and subsequent its progression to osteomyelitis of forefoot and midfoot. Eight months after the procedure, the patient was able to bear weight on the left lower extremity and was fitted with a definitive prosthesis with a long silicon liner. She was able to walk without pain or the aid of crutches. The rating according to the 100-point Taniguchi scale was 75 points, which indicated a very good result. This case adds to the body of evidence supporting the Pirogoff amputation as a valuable reconstructive option in challenging post traumatic severe forefoot injuries with osteomyelitis. The patient was informed and duly consented for publication of the data.

Management of severe varus knee osteoarthritis with unconstrained cruciate-retaining total knee arthroplasty using tibial stem and bone grafting: a case report

K. Balakondaiah, P. Ramanaidu, S. Rajkumar — Mon, 27 Apr 2026 00:00:00 +0530

Severe varus knee osteoarthritis associated with medial tibial bone loss presents significant challenges during total knee arthroplasty, particularly in achieving stable alignment while preserving ligament balance. We report the case of a 68-year-old female who presented with severe right knee pain, progressive varus deformity, and inability to ambulate independently. Radiographic evaluation revealed tricompartmental osteoarthritis with collapse of the medial tibial plateau and significant coronal deformity. The patient underwent primary unconstrained cruciate-retaining total knee arthroplasty using a tibial stem extension combined with reconstruction of the medial tibial defect using autologous bone graft and screw fixation. Intraoperative assessment demonstrated intact posterior cruciate and collateral ligaments, allowing the use of a cruciate-retaining implant despite severe deformity. Postoperative radiographs confirmed restoration of mechanical alignment and stable fixation of the components. At one-year follow-up, the patient achieved satisfactory range of motion, pain relief, and functional improvement without evidence of loosening or instability. This case highlights that cruciate-retaining total knee arthroplasty with tibial stem support and bone grafting can be an effective and cost-efficient treatment option for severe varus knees with preserved ligament competence, avoiding the need for constrained implants.

Familial synpolydactyly with variable expressivity in two siblings: a case report and review of literature

Mon, 27 Apr 2026 00:00:00 +0530

Synpolydactyly (SPD), classified as syndactyly type II, is a rare congenital anomaly characterized by central digit syndactyly with associated digital duplication. Most nonsyndromic SPD cases arise from HOXD13 polyalanine repeat expansions, which demonstrate variable expressivity and incomplete penetrance. This case report describes two biological male siblings with congenital limb anomalies. Detailed clinical examination, radiographic analysis, developmental assessment, and family evaluation were conducted. A literature review was performed to contextualize the phenotypic variability of HOXD13-associated SPD. The elder sibling demonstrated complex polysyndactyly of both hands and feet, including postaxial polydactyly and hypoplastic accessory digits. The younger sibling exhibited milder features consisting of syndactyly and polydactyly of the hands and unilateral partial toe syndactyly. Both parents had normal limb examinations, supporting reduced penetrance, a known feature of HOXD13-associated SPD. These cases highlight the considerable intrafamilial phenotypic variability characteristic of HOXD13-related SPD. Recognition of reduced penetrance is essential for accurate counseling and recurrence-risk assessment. Early diagnosis permits timely surgical planning and referral for genetic counseling.

Comparison of two different orientations of advanced tight rope implant for distal radioulnar joint instability in same patient - efficacy, recovery and range of motion

Somasundar Krishnan, Anitha Nagarajan — Mon, 27 Apr 2026 00:00:00 +0530

The distal radioulnar joint (DRUJ) is the wrist joint that allows rotation of forearm. It involves two bones-The Ulna and the Radius. The distal radioulnar joint is stabilised by ligaments, muscles and bones. The wrist or the forearm joint allows 180 degrees of pronation and supination of forearm by 4 components namely the Radio capitellar joint, the proximal radioulnar joint, interosseous membrane and DRUJ. The triangular Fibrocartilage complex (TFCC) is the primary structure for intrinsic stability of DRUJ with predominantly radioulnar ligaments. Both superficial and deep radioulnar fibres of TFCC plays role in DRUJ stability. The triangular fibrocartilage complex being an essential stabiliser biomechanically furnishes unrestricted range of motion of forearm. In the tears of radioulnar ligaments, the ulnar sided ligament tears are detected to cause DRUJ instability more common. This article discusses a case of DRUJ instability of both right and left wrists in same patient due to trauma with symptoms at varied time period. The advanced tight rope implant was placed in the wrists to regain the function. This case report compares and discusses the efficacy, recovery and range of motion of two different orientations (straight and oblique) of the advanced tight rope implant in DRUJ instability.

Pipkin type I femoral head fracture managed by safe surgical dislocation through Gibson’s interval with Ganz trochanteric osteotomy: a case report

Mon, 27 Apr 2026 00:00:00 +0530

Femoral head fractures concurrent with posterior hip dislocations are rare and complex injuries that challenge conventional surgical exposure and fixation. This case significantly advances our knowledge for management of femoral head fractures. A 47-year-old male driver sustained a dashboard injury resulting in a posterior right hip dislocation, which was closed reduced at a local hospital. Imaging at our tertiary center confirmed a Pipkin type I femoral head fracture involving over 20% of the head. He underwent safe surgical dislocation through Gibson’s interval using the Ganz trochanteric flip osteotomy; the fragment was anatomically reduced with three 3.5‑mm headless cannulated screws, and the osteotomy was fixed using 6.5-mm cannulated screws. The Ganz approach facilitates anatomic exposure and fixation while preserving femoral head vascularity, making it a robust surgical method for such uncommon but technically demanding cases.

Traumatic pure radiocarpal dislocation: a rare case report

Mon, 27 Apr 2026 00:00:00 +0530

Radiocarpal joint dislocation is an extremely rare wrist injury, accounting for less than 1% of all traumatic wrist presentations. These injuries usually result from high-energy trauma and are frequently associated with severe ligamentous disruption, distal radioulnar joint (DRUJ) instability, or fractures. Early diagnosis and appropriate management are crucial to prevent long-term functional impairment. We report a case of a male patient who presented with severe wrist pain, swelling, and restricted movement one day following a road-traffic accident. Radiographic evaluation revealed dorsal radiocarpal dislocation (RCD) without associated fractures. Magnetic resonance imaging confirmed a pure ligamentous RCD with DRUJ instability. The patient was treated with closed reduction followed by percutaneous K-wire fixation of the radiocarpal joint and DRUJ. Immobilization was maintained for six weeks, after which progressive physiotherapy was initiated. At three-month follow-up, the patient was pain-free with significant improvement in wrist range of motion and grip strength. Follow-up radiographs demonstrated maintained radiocarpal alignment without evidence of subluxation or instability. Pure RCD is a rare but potentially disabling injury. Prompt diagnosis, early reduction, and appropriate stabilization are essential for favorable outcomes. Percutaneous K-wire fixation provides adequate stability in ligamentous injuries with persistent instability, while early rehabilitation is vital for optimal functional recovery.

A novel technique for precise rod contouring using template rod in minimally invasive spine fixation: a case report

Abhay Sudam Ghorpade, Ashutosh Sabnis, Amol Rege, Swapnil Kumar — Mon, 27 Apr 2026 00:00:00 +0530

To present an innovative rod templating technique that improves precision in rod contouring and insertion during minimally invasive spine fixation, particularly in cases involving osteoporosis and limited surgical exposure. After insertion of pedicle screws in a 72-year-old osteoporotic patient undergoing delta fixation for high-grade listhesis, an aluminium template rod was passed through the screw tulips and fixed with set screws to capture the spatial configuration of the construct. The contoured template was then used to shape the final titanium rod, which was inserted and secured to achieve in-situ fixation. The templating technique facilitated precise rod contouring, smooth rod passage, and secure fixation without screw backout. The patient experienced significant pain relief and was able to ambulate early. Follow-up at six months showed stable implant positioning with no evidence of screw loosening or pullout. This template-based rod contouring method enhances biomechanical alignment, reduces operative time, and minimises the risk of screw pullout in minimally invasive spine fixation, offering improved surgical efficiency and construct stability in challenging osteoporotic cases.

Ortho-biological management of osteonecrosis in sickle cell disease using core decompression with platelet-rich plasma: a case report

Mon, 27 Apr 2026 00:00:00 +0530

Avascular necrosis (AVN) is a debilitating manifestation of sickle cell disease (SCD) caused due to structural abnormality of the red blood cells and the precarious blood supply of the femoral head. Prompt identification of the condition in susceptible individuals is of utmost importance. Here, we present a case of SCD with bilateral AVN in Ficat-Arlet stages IIb (left hip) and I (right hip) which was managed by core decompression augmented with platelet rich plasma.

Juvenile non-familial bilateral hallux valgus managed with bilateral chevron osteotomy: a case report

Sayan Mistri, D. Ramkishan, Sateesh Chandra P., P. Neetha, K. Thulasiram — Mon, 27 Apr 2026 00:00:00 +0530

Juvenile non-familial bilateral hallux valgus is an uncommon presentation of a progressive multiplanar forefoot deformity that may result in significant pain, functional limitation, and cosmetic concern. We report the case of a 17-year-old female who presented with bilateral medial forefoot pain aggravated by footwear and progressive deformity of both great toes over a two-year duration, without any history of trauma or family predisposition. Clinical examination revealed lateral deviation of both halluces with prominent medial eminence and tenderness over the first metatarsophalangeal (MTP) joints. Radiographic assessment demonstrated hallux valgus angles (HVA) of 39° on the left and 34° on the right, with intermetatarsal angles (IMA) of 15° bilaterally, consistent with moderate deformity. The patient underwent bilateral distal chevron osteotomy with medial capsulorrhaphy and Kirschner wire fixation. At one-year follow-up, she achieved complete pain relief, improved footwear tolerance, satisfactory cosmetic correction, and maintained radiographic alignment without recurrence. This case highlights that distal chevron osteotomy is an effective and reliable surgical option for symptomatic adolescent patients with moderate bilateral hallux valgus when appropriately selected and meticulously performed.

Recurrent posterior talar osteochondroma in a child managed with medial malleolar osteotomy: a case report

Jishnu Shilu, Mohammad Sageer — Mon, 27 Apr 2026 00:00:00 +0530

Osteochondromas are the most common benign bone tumours in children and adolescents. They usually arise from the metaphyseal regions of long bones, and hence involvement of the talus is uncommon. Posterior talar osteochondromas in children are extremely rare and may mimic dysplasia epiphysealis hemimelica (Trevor’s disease). An 11-year-old girl presented with recurrent pain and swelling over the posteromedial aspect of the left ankle following excision biopsy of a similar lesion from the same site 11 months earlier. Radiographs demonstrated a pedunculated exostosis arising from the posterior talus with cortical and medullary continuity. Magnetic resonance imaging showed a 2.5×1.8 cm lesion with a thin cartilaginous cap and no features suggestive of malignancy. The lesion was excised en bloc through a medial malleolar osteotomy approach. The approach provided excellent exposure of the posterior talus and allowed complete removal of the tumour. Histopathology confirmed osteochondroma. At 24-month follow-up the patient was asymptomatic with full ankle range of motion, radiological union of the osteotomy and no evidence of recurrence. The American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 98/100. Medial malleolar osteotomy provides safe and effective exposure for complete excision of recurrent posterior talar osteochondromas in paediatric patients while preserving ankle function.

Gossypiboma mimicking myositis ossificans: a rare diagnostic masquerade

Meera T. P., Sonal Raut — Mon, 27 Apr 2026 00:00:00 +0530

Gossypiboma refers to retained surgical material, most commonly a sponge or gauze, inadvertently left within the body after a surgical or medical procedure. Although rare, it represents an important preventable complication with potential medico legal implications. Its clinical and radiological manifestations can mimic various pathological conditions. We report the case of a 50-year-old male presenting with a swelling in the right calf associated with intermittent pain for two years. Ultrasonography revealed a heterogeneous lesion with calcifications in the deep intermuscular plane abutting the tibia, suggestive of Myositis Ossificans. Wide local excision was performed. Gross examination revealed a cystic lesion containing retained gauze material. Microscopic examination demonstrated a thick fibrous cyst wall with extensive foreign-body giant cell reaction, xanthogranulomatous inflammation, and entrapped cotton fibres, consistent with gossypiboma. This case highlights the diagnostic challenge posed by long-standing gossypiboma, which may clinically and radiologically mimic other soft tissue lesions. Histopathological examination plays a crucial role in establishing the definitive diagnosis.