International Journal of Research in Orthopaedics <p>International Journal of Research in Orthopaedics is an open access, international, peer-reviewed journal that publishes original research work across all disciplines of orthopaedics and allied sciences. The journal's full text is available online at The journal allows free access to its contents. The journal aims to provide a platform for the exchange of information about all areas of orthopaedics and to promote the discipline of orthopaedics throughout the world. International Journal of Research in Orthopaedics is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, analytic reviews such as meta-analyses, insightful editorials, medical news, case reports, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new techniques. It is published every two months and available in print and online version. International Journal of Research in Orthopaedics complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 6 per year</strong></p> <p><strong>Email: <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></strong></p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix: 10.18203</strong></p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Research in Orthopaedics accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>About the Journal &gt; <a title="Online Submissions" href="" target="_blank" rel="noopener">Online Submissions</a></p> <p>Registration and login are required to submit items online and to check the status of current submissions.</p> <p>Please check out the video on our YouTube Channel:</p> <p>Steps to register and submit a manuscript:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>Problem Logging In-Clear cookies:<br /><a href="" target="_blank" rel="noopener"></a></p> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p> </p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Res Orthop.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The journal is indexed with </p> <p><a title="PubMed and PubMed Central (PMC)" href="" target="_blank" rel="noopener">PubMed and PubMed Central (PMC)</a> (NLM ID: 101775784, Selected citations only), </p> <p><a title="Scilit (MDPI)" href="" target="_blank" rel="noopener">Scilit (MDPI)</a>, </p> <p><a href=";journalId=44185" target="_blank" rel="noopener">Index Copernicus</a>, </p> <p><a title=";referer=brief_results" href=";referer=brief_results" target="_blank" rel="noopener">OCLC (WorldCat)</a>,</p> <p><a href="" target="_blank" rel="noopener">CrossRef</a>, </p> <p><a title="LOCKSS" href="http://localhost/index.php/ijoro/gateway/lockss" target="_blank" rel="noopener">LOCKSS</a>, </p> <p><a href="" target="_blank" rel="noopener">Google Scholar</a>,</p> <p><a href="" target="_blank" rel="noopener">ICMJE</a>, </p> <p><a href="" target="_blank" rel="noopener">J-Gate</a>, </p> <p><a title=";subAction=pub&amp;publisherID=3072&amp;journalID=37625&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" href=";subAction=pub&amp;publisherID=3072&amp;journalID=37625&amp;pageb=1&amp;userQueryID=66977&amp;sort=&amp;local_page=1&amp;sorType=&amp;sorCol=1" target="_blank" rel="noopener">JournalTOCs</a>,</p> <p><a href="" target="_blank" rel="noopener">ResearchBib</a>.</p> en-US (Editor) (Editor) Wed, 26 Jun 2024 19:10:36 +0530 OJS 60 Muscular hydatidosis about an exceptional form <p>The preferred localizations of human echinococcosis are the liver and the lungs, of which they represent 85% of cases. They generally pose few diagnostic problems, because they are familiar and frequent. The involvement of the soft parts is exceptional, it represents less than 1% of the localizations of human echinococcosis, frequently constituting surprises of anatomical-pathological or radiological examination. We report the rare observation of a hydatid cyst of the adductors of the thigh and discuss the contribution of magnetic resonance imaging (MRI) in this context and the therapeutic modalities. Certainly; it is a rare case but we must think about this diagnosis, especially in subjects from a country with high endemic, and ask for the necessary explorations in order to make the diagnosis in time and avoid therapeutic errors.</p> <p> </p> Hicham Bousbaa, Hassane Zejjari, Taoufik Cherrad Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Metachronous osteoid osteoma in adjacent proximal phalanges: a case report and literature review <p>Osteoid osteoma (OO) is a benign bone tumor commonly affecting long bones, and in rare cases, involves small bones such as hand phalanges. The presenting symptom is usually nocturnal inflammatory pain. OO is in the majority of cases a solitary lesion, with very rare reported cases of metachronous lesions in different locations. We present a case of a 31-year-old female patient who presented for severe pain and swelling over her fourth finger proximal interphalangeal joint (PIPJ) of the right hand. After thorough radiological investigations, a presumptive diagnosis of OO was made and the patient underwent surgical excision and curettage with resolution of her symptoms post-operatively. Six years after remission, the patient presented again to our clinics with the same clinical picture in the third finger PIPJ of the right hand. Clinical and radiological investigations revealed a metachronous OO in the adjacent phalanx of the previous surgical site. Similar management consisting of excision and curettage was performed, resulting in a symptom-free follow up. To our knowledge, this is the first case of metachronous OO in adjacent proximal phalanges of the hand. This case highlights the importance of considering metachronous OO in the differential diagnosis of patients previously diagnosed and treated for OO and presenting with a similar clinical and radiological picture.</p> Rabih Kortbawi, Dany Aouad, Edouard Kunegel, Azadeh Sattari, Wissam El Kazzi Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 A rare case of a floating knee concomitant with an ipsilateral floating hip and a bimalleolar fracture <p class="abstract" style="margin-bottom: 0cm;"><span lang="EN-US">An ipsilateral floating knee and hip is an extremely rare condition that is associated with a life threatening condition. So its correct management, is essential to mantain a stable hemodynamic condition. We reported our management for this fracture in order to underline the rareness, the severity of this entity and highlight the importance of damage control to respond to this. A 71-year-old female referred to our hospital after motor vehicle accident. At arrival, the patient was hemodynamically unstable and went directly to the emergency room, which was reverted. In physical examination there was a swollen thigh, without neurovascular deficits. X-rays reveal a LC type 1 fracture with sacrum, superior and inferior pubic ramus compression fracture, a wedge extra-articular distal femur fracture, a transverse tibial shaft fracture and a bimalleolar fracture. Then in the operation room the patient become unstable hemodynamically, and it was decided to do a reduction and fixation with an external fixator in the femur shaft and in the tibiotarsi joint, which enable the patient recovery. After 7 days, the patient still stable hemodynamically and a retrograde femoral nailing and an anterograde tibial nailing was made. Due to lack of skin conditions, the bimalleolar fixation was postponed to thirteen days after when its osteosynthesis was performed. The LC type 1 fracture underwent osteosynthesis with two percutaneous partially-threaded screws. Then the patient underwent to a rehabilitation protocol. Follow-up appointments showed good radiologic and clinically evolution. At 6 months revealed a complete return to normal daily life, without limitation or pain. In our work, we highlight the rareness and the severity of this injuries and the need of the damage control approach due to the hemodynamic unstableness of this kind of patients. </span></p> Joao Pires, Ana Inês, Leonardo Miraldo, Diogo Gameiro, Daniel Peixoto Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Use of Hartshill rectangle with sublaminar wiring for posterior stabilization of D7-D9 tubercular spondylodiscitis with paraplegia: a cost effective treatment <p>Tuberculosis presents a significant health challenge, with extrapulmonary cases comprising 15-20%. Spinal tuberculosis often leads to neurological deficits, requiring surgical intervention such as Hartshill system fixation. Various posterior instrumentation methods are employed, with sublaminar wiring pioneered by Luque and enhanced by Dove's Hartshill system for superior biomechanical performance. This case underscores Hartshill system's efficacy in stabilizing the spine post-tubercular destruction, offering a cost-effective alternative to pedicle screws. An 18-year-old presented with 6-month upper back pain, progressing weakness in lower limbs, weight loss, and fever. Radiographs revealed D7-D9 vertebral destruction, leading to kyphosis. MRI showed paradiscal bony destruction and abscess, suggestive of tubercular spondylodiscitis. Surgery with Hartshill rectangle and sublaminar wiring provided kyphosis correction. Post-operative Gene-Xpert confirmed tuberculosis. Mobilization and chemotherapy led to limb power restoration within 3 months, with ongoing rehabilitation and consolidation of affected segments with complete recovery by eight months. Instrumented stabilization in spinal TB prevents kyphosis and graft complications; Hartshill loop rectangle and sublaminar wire fixation, cost-effective and suitable for resource-poor settings, offer comparable outcomes to pedicle screws, enabling hybrid fixation, especially in low-income countries.</p> Tanmay A. Avhad, Vanksha Shrivastava, Siddharth Gunay, Ankush Misal, Saurabh Bhangde Copyright (c) 2024 International Journal of Research in Orthopaedics Thu, 30 May 2024 00:00:00 +0530 Aneurysmal cyst of the thumb in young adults: about an exceptional case <p>The aneurysmal bone cyst is a benign, locally aggressive tumour. It affects children and young adults with a preference for the long bones and the vertebrae, rarely the hand. Involvement of the thumb is exceptional, the author reports an observation in a young 18-year-old patient, complaining of a painful swelling of the right thumb. The positive diagnosis is evoked on radiography, confirmed by the histology after surgical biopsy. Radical excision was opted for our patient, who, unlike conservative treatments, seems to avoid recurrence.</p> Hicham Bousbaa, Hassane Zejjari, Taoufik Cherrad Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Conversion of the primary aneurysmal bone cyst into osteogenic sarcoma following treatment with percutaneous sclerotherapy using polidocanol injection <p>The intralesional injection of sclerosing agents has been identified as a safe method for treating primary aneurysmal bone cysts (ABC). However, to the best of our knowledge, there have been no reported instances in the literature of a primary ABC transforming into osteogenic sarcoma following complete healing facilitated by an intralesional sclerosing agent, such as polidocanol. We present the case of a 20-year-old female diagnosed with a histologically proven primary ABC located at the distal end of the tibia. She underwent a series of 5 intralesional injections of 3% polidocanol (hydroxypolyaethoxydodecan) and achieved complete clinical and radiological healing. However, after 10 years, her symptoms resurfaced, and subsequent histological examinations revealed osteogenic sarcoma. Surgical excision was performed, followed by bone grafting and ankle arthrodesis. This case suggests that intralesional alcohol injections might not prevent the inherent potential for malignant transformation of primary ABCs. To ascertain whether such injections increase the risk of sarcomatous conversion, further long-term follow-up studies are imperative.</p> Kamal Kishor, Ashish Ragase, Love Kapoor, Venkateshan S. Kumar, Asit R. Mirdha, Shah A. Khan Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Hoffa’s fat pad ganglion cyst protruding from lateral retinacular rent: a case report <p>Ganglion cyst in and around the knee are quite rare occurrences. They are usually encountered as incidental findings in magnetic resonance imaging (MRI), or in arthroscopy. They may originate from both the cruciate ligaments and the menisci, from the popliteus tendon and alar folds, infrapatellar fat pad of Hoffa, and subchondral bone cysts. Those cysts which arise from fat pad, present as palpable mass at the anterior aspect of the knee. 45-year male, presented with a painless gradually increasing swelling at the anterior aspect of the left knee of 11 months’ duration. Patient complaints of discomfort in the left knee, occasional pain on walking, and climbing stairs. MRI scan revealed a multilobulated, cyst with septations within the anterior aspect of the knee joint, just inferolateral to the patella, with deep extension into the infrapatellar fat pad, and superficial extension into the subcutaneous space across the retinaculum. Proper preoperative evaluation of MR images of these cases is very important. Subcutaneous extension through lateral retinaculum renders these cyst incomplete resection via arthroscopic excision. There-fore open excision was performed.</p> Yogesh D. Narkhede Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 A rare presentation of intramuscular ganglion cyst in gastrocnemius muscle: a case report <p>Ganglion cyst is a common benign cystic lesion but its presence at intramuscular region is rare. There are very few such reported cases in literature which are confirmed by histopathology. Here we are reporting a rare case of ganglion cyst in medial head of gastrocnemius muscle in a 20 year old male who presented with complaints of swelling in proximal aspect of left leg associated with occasional pain. The diagnosis was made on the basis of MRI and was confirmed histopathologically.</p> Ravi Bhushan, Harnam S. Madan, Siddharth Goel, Nupoor Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Isolated traumatic hip dislocation along with ipsilateral femur shaft fracture: rare case report with review of literature <p>Hip dislocation accompanied by an ipsilateral fracture of femur shaft is an uncommon injury usually seen after high-velocity trauma and often coincides with multiple systemic injuries. This case report describes a 27-year-old male who suffered a posterior hip dislocation and ipsilateral fracture of femur shaft following a motorcycle-car collision accident with no associated fractures of the acetabulum and femoral neck. He was treated with fixator-assisted hip reduction and intramedullary femur interlock nailing in lateral position in a same setting. The advantage of this method is that the rate of AVN of femoral head is decreased by decreasing the overall timing of surgery and it also allow early successful reduction of the hip. The risk of AVN should be explained to the patient beforehand even if the surgery is done within 6 hours. This case highlights the importance of timely intervention and effective surgical techniques in managing such complex injuries and also aims to share our experience in managing such rare injuries and review the existing literature on this rare injury.</p> Sandeep Marotirao Tukade, Binoti A. Sheth, Nagesh Akhade, Sourav Laldas Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Bilateral simultaneous neck of femur fractures from a single injury in a high-risk patient <p>Simultaneous bilateral neck of femur fractures resulting from a single traumatic event are exceptionally rare. Often these patients have underlying metabolic bone disorders like renal osteodystrophy, osteomalacia, long term steroid intake, osteoporosis, hyperparathyroidism etc. We present a unique case of bilateral neck femur fractures in a patient with no history or objective proof of metabolic bone disease. This case underscores the significance of recognizing atypical presentations and the need for individualized management. A 70-year-old male patient presented with altered sensorium, disorientation, and bilateral hip fractures following a self-fall at home. The absence of metabolic bone abnormalities, along with pre-existing systemic hypertension and coronary artery disease, made this presentation remarkable. Diagnostic workup revealed hyponatremic encephalopathy, further complicating the high-risk surgical status of the patient. A two-stage approach with bipolar uncemented hemiarthroplasty was chosen, and early mobilization was initiated. Remarkably, the patient returned to pre-injury mobility soon after surgery, illustrating the successful outcome. This case highlights the rarity of simultaneous bilateral neck of femur fractures in patients even without metabolic bone disease, emphasizing the need for careful evaluation and customized management. The collaborative efforts of surgeons, physicians, and anesthetists were pivotal in achieving a positive outcome, demonstrating the remarkable potential of multidisciplinary teamwork in challenging medical scenarios. This case serves as a testament to the dedication and expertise of the medical community in the face of extraordinary challenges.</p> Mainak Roy, Deepanjan Das, Prashant Bhavani, Samir Dwidmuthe, Saurabh Sah, Amey S. Sadar Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Musculoskeletal ultrasound as a diagnostic tool in quadriceps tendon rupture <p>Quadriceps tendon ruptures are relatively rare injuries, particularly in young adults, and their diagnosis can be challenging. This case report presents a case of traumatic quadriceps tendon rupture in a young adult and highlights the use of ultrasound Imaging as a diagnostic tool. Quadriceps rupture is uncommon in young adults in contrast to patellar tendon rupture but in this case young patient presented with acute knee pain and an inability to extend the leg after a sudden H/o fall, leading to a loss of continuity between the quadriceps muscle and the patella. Musculoskeletal Ultrasound examination revealed a complete tear of the quadriceps tendon, confirming the diagnosis. The patient underwent surgical repair and achieved a favorable outcome with appropriate rehabilitation. This case report emphasizes the importance of considering quadriceps tendon rupture in the differential diagnosis of acute knee injuries and highlights the value of ultrasound in making an accurate and timely diagnosis.</p> <p> </p> Depinder Kaur, Amit K. Choudhary, Rana P. Singh Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Post-resection complication of large dumbbell-shaped extradural schwannoma: a case report and literature review <p>Primary spinal tumors are rare neoplasms with an incidence of 0.3 to 0.5 cases/1 lakh population. Schwannomas are the most common benign tumors of the spinal cord, arising from the nerve sheath cells accounting for 25% of all the spinal tumors. Complete surgical resection of the tumor is the treatment of choice in spinal schwannomas. Post resection complications are uncommon based on the factors affecting the tumor. In this case report, patient with extradural spinal schwannoma located at thoracic region was resected. She was complicated with paraplegia post operatively and successfully recovered following the standard protocol and rehabilitation.</p> V. K. Verma, Pankaj Kumar Mishra, Mohit Issrani, Shekhar Mishra Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Synovial hemangioma: an unusual cause of chronic anterior knee pain in children <p>Synovial hemangioma is an uncommon cause of chronic anterior knee pain. The non-specific clinical presentation leads to delay in diagnosis. MRI is diagnostic and should be considered early in evaluation to plan treatment and prevent functional disability. We present a case of unilateral synovial hemangioma of the knee in a child with pain, swelling and restricted knee mobility. Arthroscopy can be diagnostic and therapeutic in such cases.</p> <p> </p> Purushotham Lingaiah, Vineet Thomas Abraham Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Terrible triad of elbow: a case managed with radial head prosthesis <p class="abstract" style="margin-bottom: 0cm;"><span lang="EN-US">The terrible triad of elbow consists of radial head fracture, coronoid process of ulna fracture, and posterior or posterolateral humero-ulnar joint dislocation. Favorable outcomes are expected in cases with early surgical intervention. Here we present a 48-year-old male patient with terrible triad of elbow injury following road traffic accident who underwent radial head replacement with temporary ulno-humeral transfixing K-wire. We came to a conclusion that planned and staged anatomical restoration of ligamentous and bony structures of the elbow with combative rehabilitation will give the best possible outcome. </span></p> S. T. Sanikop, Gangadhar Bhuti, Sarthak Jain, Rellu Sarath Chandra Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Outcome of radial head and neck fractures with radial head replacement <p>Radial head and neck fractures are a significant concern in elbow injuries, often stemming from incidents like falls or accidents, which can severely affect elbow stability and function. This study, conducted at Shadan Institute of Medical Sciences in Hyderabad, India, focused on 15 patients with severe radial head fractures classified as Mason type III and IV. The research aimed to evaluate the effectiveness of radial head replacement utilizing implants from leading manufacturers such as DePuy Synthes® and Zimmer Biomet®. The surgical procedures were carried out successfully without any notable intraoperative complications, with an average surgery duration of 60 minutes. Postoperative complications, though relatively rare, included issues such as elbow stiffness and peri-prosthetic osteolysis, which were manageable. However, the majority of patients exhibited improved functional outcomes, as indicated by excellent Mayo elbow performance scores during the 6-month follow-up. This intervention not only enhances elbow stability but also facilitates soft tissue healing and promotes better range of motion. Consequently, radial head replacement emerges as a highly effective approach for managing severe radial head fractures, leading to considerable improvements in patient outcomes and quality of life.</p> <p> </p> Mirza A. Baig, Srujith Kommera, Syed Z. Rafai Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Surgical and functional outcome of management of anterior column with posterior hemitransverse fracture of acetabulum <p class="abstract" style="margin-bottom: 0cm;"><span lang="EN-US">Fractures of acetabulum are relatively uncommon, but as they involve the major weight bearing joint in lower extremity, they assume great clinical importance. The displaced acetabular fracture fragments result in hip joint incongruity which in turn leads to abnormal pressure distribution over the articular cartilage surface. This may lead to accelerated breakdown of the articular cartilage, resulting in disabling irreversible arthritis of hip joint. The aim of treatment of these difficult acetabular fractures is concentric reduction of femur head under the weight bearing dome of acetabulum resulting in anatomic reduction and followed by a stable fixation. This can be achieved only by adequately exposing the acetabulum and by rigid internal fixation. In our series 20 patients were included. Majority of the patients were males with mean age of 43.85±16.88 years. Most common mechanism of injury was road traffic accident. Right side was most affected. Most of the cases were isolated injuries. Majority of the cases had no complications. At the final follow up, most of the cases had Excellent follow-up according to Modified Merle d’Aubigne and Postel score. Surgical management of Anterior column with posterior hemitransverse fracture of acetabulum gives excellent outcomes with least number of complications. </span></p> Shivaraj A. Chatrashali, Alok C. Patil, Chetan M. Nataraja, Rakshith A. Gaddi Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Primary chondrosarcoma of bone: a clinicopathological and oncological outcome analysis <p>Chondrosarcomas are a heterogenous group of cartilaginous matrix-producing malignant neoplasms. They have varied morphological features and different clinical behaviors. The tumors usually range from benign low-grade tumors or intermediate atypical cartilaginous tumors (ACTs), to malignant, aggressive high-grade tumors. A multidisciplinary team at a tertiary sarcoma centre allows for optimal management of these patients. To determine the clinicopathological and survival outcomes of patients of chondrosarcoma, we report a total of 20 cases in the last 10 years at our institution. Our results have shown that chondrosarcomas occurred in different age groups and most common location was in axial skeleton. Most common histological type was conventional chondrosarcoma and majority were high grade tumors. All patients had undergone surgery and majority of the patients were alive after many years of treatment with an overall survival of 85%. Long term survival of patients is attributed to completeness of surgical resection.</p> <p><strong> </strong></p> S. Subbiah, Priya D. Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Medial open wedge high tibial osteotomy: an effective procedure for varus malunited neglected proximal tibial plateau fractures: a case series <p>Varus malunited tibial plateau fracture is a disabling condition causing varus thrust gait, instability, and secondary osteoarthrosis. There are few evidence-based guidelines for the management of symptomatic varus malunion in young patients. Our case series aims to review outcomes of open wedge high tibial osteotomy for varus malunited tibial medial plateau fractures. We present case series of three patients who presented with symptomatic varus malunion of proximal tibia with Kellgren-Lawrence stage II or less arthritic changes. All presented with varus thrust. Exclusion criteria for the procedure would be complex intra-articular step malunions and severe arthritic changes. Medial open wedge high tibial osteotomy was performed and stabilized with locking plate and tricortical autograft. Patients were followed up for 12 to 20 months. All achieved deformity correction, reported significant improvement in varus thrust and were satisfied with their improvement in stability and knee function. There was no complication related to wound healing and no delayed loss of correction. The osteotomy led to correction of the coronal deformity and ensured that the collateral balance is restored benefiting the overall gait of the patient. Also, if such a patient undergoes total knee replacement in future, the bone stock will be significantly better with this procedure. Medial open wedge high tibial osteotomy for varus malunited tibial plateau fractures is effective procedure that provides excellent functional and radiologic outcomes, and carries minimal complications.</p> Aruddha Sarkar, Biswarup Sen, Saurabh Sahni Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Blood management in total knee arthroplasty: an exploratory study regarding the use of drain and tranexamic acid in two types of instrumentation <p><strong>Background:</strong> This study investigates how presence or absence of drain or tranexamic acid (TXA) in 2 different types of instrumentation with invasion/sparing femoral canal affects hemoglobin drop after total knee arthroplasty (TKA).</p> <p><strong>Methods:</strong> This was a retrospective observational study that included 736 individuals divided in five groups, regarding conventional instrumentation (CI) or patient specific instrumentation (PSI), presence or absence of drain and TXA. Mean percentage of hemoglobin drop after the first postoperative day was compared for each group.</p> <p><strong>Results:</strong> Patients submitted to CI using drain and no TXA revealed the highest value (21,3%±9,1; p&lt;0,001). Groups who received TXA and drain was not used, presented the lowest blood loss. Moreover, with the introduction of TXA PSI lost its advantage over CI.</p> <p><strong>Conclusions:</strong> TKA using CI, without drain and with TXA administration showed better results, reducing mean percentage of hemoglobin drop after surgery.</p> Pedro Alexandre Dias, Sofia Caldeira-Dantas, Maria Miguel Carvalho, Ana Marreiros, Ana Paula Fontes, João Paulo Sousa Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Comparison of OpenSim and AnyBody modeling system™ predictions in biomechanical modeling of upper extremities <p><strong>Background:</strong> The study of muscle forces in upper extremities is pivotal for advancements in biomechanical modeling, contributing significantly to the field of orthopedics, rehabilitation, and sports science. Despite the prominence of OpenSim and AnyBody modeling system™ in this domain, a gap persists in comparative analyses specifically targeting muscle force predictions in upper extremity motions.</p> <p><strong>Methods:</strong> This study compares the predictions of muscle forces in static elbow flexion, shoulder flexion, and shoulder abduction using OpenSim and AnyBody modeling system<sup>TM</sup>, hypothesizing significant differences in predictions attributable to their distinct modeling methodologies and assumptions. This work utilized generic models without subject-specific data and conducted simulations in both software environments, focusing on the magnitude and activation of major muscle forces under predefined kinematics.</p> <p><strong>Results:</strong> OpenSim and AnyBody modeling system<sup>TM</sup> produced similar results when simulating elbow flexion, with both software predicting forces in the major muscles required to maintain the posture. However, discrepancies were observed between the two software for muscle force predictions during the shoulder flexion and abduction movements. AnyBody modeling system<sup>TM </sup>appeared to be more robust as it included all the upper extremity muscles and predicted the major muscles forces required for these movements more accurately compared to OpenSim.</p> <p><strong>Conclusions:</strong> The results of this study show significant differences in muscle force predictions between OpenSim and AnyBody modeling system<sup>TM</sup>, attributed to the unique modeling approaches, especially in representing muscle-tendon complexes and joint dynamics.</p> Kamal Gautam, Mohamed S. Hefzy, Abdul A. Mustapha, Behrens Kyle Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 The cost-effectiveness of an additional surgical scrub in reducing prosthetic joint infections in total hip and knee arthroplasty <p><strong>Background:</strong> Surgical skin preparation prior to total knee and hip arthroplasty is an important step in infection prevention. Compared to a single application, repeat skin preparation after draping demonstrates greater efficacy in reducing the overall occurrence of surgical site infections in total joint arthroplasty. We sought to find if the addition of an extra surgical scrub after draping is a cost-effective means of decreasing prosthetic joint infection (PJI), and if so, under what conditions it would be most cost-effective.</p> <p><strong>Methods:</strong> We employed a model to assess the cost-effectiveness of repeat skin preparation in total knee and hip arthroplasty. This model determines a threshold at which the expenses associated with a new intervention is offset by its ability to reduce overall costs. Literature review and records from our institution were used to draw average expenses for treatment of PJI, as well as surgical prep scrubs, to evaluate at their cost-effectiveness. We also compared against hypothetical higher and lower costs and infection rates to gain further information on the additional surgical prep’s cost-effectiveness.</p> <p><strong>Results:</strong> Each of the surgical scrubs is cost-effective at our institution's cost when an absolute risk reduction (ARR) of 0.01% is achieved. The cost-effectiveness was also noted with hypothetically higher infection rates and scrub cost prices. Lower potential two-stage revision costs make the additional surgical scrub less cost-effective. </p> <p><strong>Conclusions:</strong> Our findings demonstrate that an extra surgical scrub can be cost-effective way of decreasing PJI across a variety of different surgical scrub prices, arthroplasty revision costs, and PJI rates.</p> Cooper Tye, Jad Lawand, Vincent Moretti Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Functional outcome of transforaminal epidural steroid injection in lumber disc herniation with radiculopathy <p><strong>Background:</strong> Transforaminal epidural steroid injection (TFESI) is a useful therapeutic tool for lumber disc herniation with radiculopathy. TFESI reduce inflammation and edema around herniated disc and nerve root, thus alleviating pain and accelerating the natural history of the herniated disc by shrinkage. This study aims to determine the effectiveness of TFESI in lumber disc herniation with radiculopathy.</p> <p><strong>Methods:</strong> In this prospective observational study, 273 patients were included considering inclusion &amp; exclusion criteria. All subjects received TFESI for lumber disc herniation with radiculopathy. The primary outcome was assessed with a Bengali version of Oswestry disability index (ODI) score and Roland-Morris disability questionnaire (RMDQ) scores at 2 weeks, 1 month, 3 months and 1 year.</p> <p><strong>Results:</strong> From baseline (18.6±3.6), mean RMDQ score was significantly reduced at 2 weeks (14.4±3.7), at 1 month (13.8±3.8), at 3 months (11.6±3.6) and at 1 year (7.8±3.7) respectively. 69.2% patients had severe disability at baseline according to disability rank of ODI score; after procedure during follow up severe disability was found in 21.6% cases at 2 weeks, 9.1% at 1 month, 5.0% at 3 months and 1.2% at 1 year. The reduction of severe disability from baseline in subsequent follow up was significant. From baseline (45.7±10.0), mean ODI score was significantly reduced at 2 weeks (36.4±9.0), at 1 month (28.2±8.9), at 3 months (24.3±8.9) and at 1 year (18.9±10.5) respectively.</p> <p><strong>Conclusions:</strong> Transforaminal epidural steroid injection significantly reduced disability and provide improved functional outcome in patients with lumber disc herniation with radiculopathy.</p> Abdullah A. Rafi, Liton K. Roy, Kazi Shahadat Hossain, Mohammed Mahfoozur Rahman, Khorshedul Alam, Mohammed A. Kadir, Mujtaba T. A. Mahdee Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Inferior humeral head subluxation after acute humeral shaft fractures <p><strong>Background: </strong>Inferior humeral head subluxation (IHHS) is an abnormal inferior translation of the humeral head with respect to the glenoid. While well described for proximal humerus fractures there is little literature regarding IHHS in humeral shaft fractures and the impact of IHHS on fracture healing during non-operative treatment. This study characterized the prevalence and impact of IHHS among patients with acute humeral shaft fractures at a large urban trauma center.</p> <p><strong>Methods: </strong>This retrospective analysis included 62 patients treated conservatively for acute humeral shaft fractures at a single level I trauma center from 2018-2021. Occurrence of IHHS in millimeters was measured radiographically as the distance between the inferior glenoid edge and humeral anatomic neck, a distance greater than 10 mm was considered positive. Demographic data, injury mechanism, AO/OTA fracture classification, risk factors (history of stroke, smoking, diabetes mellitus, radial nerve palsy on presentation, any neurovascular disorder), and failure of conservative management (surgical fixation after a 90-day trial) was recorded. Statistical analyses were performed to evaluate association between risk factors, treatment outcome, and IHHS resolution.</p> <p><strong>Results: </strong>At an average follow-up of 18 weeks, IHHS was noted at any time point in 32.3% patients. All cases of IHHS resolved without formal treatment. No factors were significantly associated with the occurrence of IHHS. 17.7% patients failed conservative treatment, only three had IHHS.</p> <p><strong>Conclusions: </strong>Although IHHS occurred in one third of the study population, it was not significantly correlated with failed conservative management or the need for surgical intervention. This study expands the scope of this phenomenon to include humeral shaft fractures.</p> Henry M. Gass, Jesse Seilern, Nicolas Cantu, Corey A. Jones, Thomas J. Moore Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Incidence of K-wire fixation of upper limb fractures for road traffic accidents in Bangladesh <p><strong>Background:</strong> Road traffic accidents (RTAs) are a significant public health issue globally, particularly in developing countries like Bangladesh. This study focuses on the epidemiological and clinical aspects of upper limb fractures resulting from RTAs, with an emphasis on the treatment modalities employed.</p> <p><strong>Methods:</strong> This retrospective observational study analyzed hospital records of 40 patients with upper limb fractures due to RTAs at Chakaria Unique Hospital, Cox’s Bazar, Bangladesh, within the period of 1 year, from February 2023 to January 2024. The study included cases with comprehensive documentation of fractures resulting specifically from RTAs. Excluded were injuries not related to upper limb fractures and those not caused by RTAs. The focus was on patient demographics, the nature of the fractures, treatment methods (particularly K-wire fixation), and documented outcomes.</p> <p><strong>Results:</strong> The majority of the patients were young males, with the highest incidence in the 21-30 age group (40.00%). Two-wheeler vehicles were the leading cause of these injuries (57.50%). Treatment modalities varied, with open reduction and internal fixation (ORIF) combined with K-wire fixation being the most prevalent (35.00%). Other methods included ORIF alone and ORIF with plate-screw, each accounting for 25.00% of cases. Right-sided injuries were more common (57.50%) than left-sided (42.50%).</p> <p><strong>Conclusions:</strong> The study highlights the predominance of upper limb fractures in younger males due to two-wheeler accidents. The preference for combined ORIF and K-wire fixation in treatment reflects the complexity of these injuries. The findings call for enhanced road safety measures and further research into optimized treatment protocols for upper limb fractures in Bangladesh.</p> M. Mahamudul Amin, M. Asaduzzaman, Shamima Khatun, M. Abdullah Al-Maruf, A. K. M. Khalequzzaman Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Effectiveness of abduction orthoses in the management of developmental hip dysplasia: a comparative retrospective study <p><strong>Background:</strong> Developmental dysplasia of the hip (DDH) is a disorder marked by abnormal hip alignment or structure, often calling for orthopedic treatment. The purpose of this research was to compare the Aro and Milgram splints, two types of orthopedic splints, for use in treating diabetic foot disease.</p> <p><strong>Methods:</strong> Between three and four months of age, 53 patients were identified with hip dysplasia in a retrospective observational analysis. Beginning at six months of age, patients received treatment with either the aro splint or the milgram splint. At six and twelve months after the start of therapy, radiographic measures of the acetabular angle were made. Statistical analysis was done to assess the efficacy of the two splints and compare treatment results.</p> <p><strong>Results:</strong> The aro and milgram splints both reduced acetabular angles, and there was no discernible difference between them in terms of reaching the ideal angle. Most patients needed to get therapy for around five months to achieve the ideal angle. With both splints, there were notable decreases in acetabular angles, even though some patients were unable to achieve this angle. Eighty-one percent of the patients were female, which is consistent with established DDH demographics.</p> <p><strong>Conclusions:</strong> These findings suggest that both splints can lower acetabular angles and treat hip dysplasia in DDH patients. Both the aro and milgram splints lower acetabular angles and reverse hip dysplasia in DDH patients. Using either splint may enhance hip stability and function. Both splints are effective DDH therapeutic alternatives, according to these results.</p> <p> </p> Josselyn N. V. Enríquez, Mateo D. F. Vera, Juan C. P. Durán, Andres G. F. Vera Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Comparison between malleolar locking plate and metaphyseal locking plate for the management of the distal tibial fracture <p><strong>Background:</strong> A pilon fracture is a distal tibial metaphyseal fracture that involves the ankle joint. Distal tibia fractures include extra-articular fractures of the metaphysis and the more severe intraarticular tibial plafond or pilon fractures. Several treatment methods have been recommended for the treatment of these injuries, with a recent emphasis on minimally invasive techniques. This research studies the outcome of a malleolar locking plate (M) versus a metaphyseal locking plate (P) in the management of distal tibial (Pilon) fracture.</p> <p><strong>Methods:</strong> Distal tibial M and P were used to treat 80 cases of tibial pilon fracture. The study examined the use of anterior/ anteromedial approach for tibia and posterolateral/ lateral fibular fixation.</p> <p><strong>Results:</strong> The male to female gender ratio was 2.63 in M and 1.35 in P. Mean age was 57.03±15.93 (M) and 52.1±12.788 (P). Surgeries were mostly done within 1 day to 1 week. Mean hospital stay was 6.43±4.545 (M) and 4.93±4.676 (P). The mean lower extremity functional score (LEFS) was 66.55 (M) and 67.15 (P) with 83.56% maximal function. 3 P cases had infections. No infections were seen in M group at the end of the 12<sup>th</sup> week follow-up.</p> <p><strong>Conclusions:</strong> The results of the study indicate that there is no significant difference in terms of LEFS criteria, union, fracture alignment, range of motion (knee and ankle), infection, and other outcome measures between M fixation and P in the treatment of distal tibia fracture in adults.</p> M. Gulam Mustofa, Avishek Bhadra, Sushmoy Saha, Sabbir Ahmed Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Comparative analysis of clinical and functional outcomes in late adolescents with genu valgum undergoing corrective osteotomy: a study of K-wire fixation versus plate osteosynthesis <p><strong>Background:</strong> Knee alignment typically transitions from varus to valgus during growth, stabilizing around 6° valgus by age 11, with interventions necessary for exaggerated valgus in adolescence. Surgical options for genu valgum correction involve osteotomy or guided growth procedures, with distal femur osteotomy being common in late adolescents and adults, though limited literature exists on outcomes with Kirschner wires (K-wires) and plate fixation. A prospective study is proposed to assess clinical, radiological, and functional outcomes in correcting genu valgum from the distal femur.</p> <p><strong>Methods:</strong> A prospective, randomized, single-center clinical trial with 50 patients with genu valgum deformity not responsive to conservative management. Patients underwent thorough pre-operative evaluation followed by medial closed wedge osteotomy with K-wire or plate fixation. Assessment at 24 weeks included Bostman et al knee scoring, visual analog scale (VAS), passive range of motion evaluation, Likert scale and findings were compared.</p> <p><strong>Results:</strong> Cohort of 50 patients, comprising 55% females and 45% males, with a mean age of 20.76 years, no significant differences were observed in age distribution or gender between the two treatment groups (K wire fixation and plate osteosynthesis). At 24 weeks, there were no significant differences between the groups in terms of Bostman knee score, VAS score, or range of motion, indicating similar outcomes with both treatment modalities.</p> <p><strong>Conclusions:</strong> Distal femoral medial closing wedge osteotomy with K-wire fixation offers a cost-effective and practical solution for genu valgum correction, particularly beneficial in resource-limited settings like India, providing comparable outcomes to plate fixation in late adolescents.</p> Tanmay A. Avhad, Neeraj Kalra, Sahil Lombar Copyright (c) 2024 International Journal of Research in Orthopaedics Thu, 06 Jun 2024 00:00:00 +0530 A case control study to compare the effect of dynamisation of tibia nail in union of tibia shaft fracture versus non-dynamisation <p><strong>Background:</strong> Tibial shaft fractures are commonly treated with intramedullary nails (IMN), with union rates of 90-100%, but complications such as delayed union occur in up to 40%. The rise of technology and urbanization has led to an increase in road traffic injuries and deaths. The treatment of distal tibia fractures has undergone various modifications over the years, with emphasis on preserving local biology and soft tissue handling.</p> <p><strong>Methods:</strong> A retrospective case-control study involving 132 patients with closed or open grade 1 tibia shaft fractures was conducted from September 2021 to May 2022. Patients received tibia IMN with either dynamic locking (group A) or static (group B). Patients were evaluated for fracture healing and clinical condition, with variables including presence or absence of union and time to union. Follow-up clinical evaluations were conducted monthly for six months.</p> <p><strong>Results:</strong> The association between union of bones seen at 1.5 and 3 months between group A and group B was extremely statistically significant (p&lt;0.0001).</p> <p><strong>Conclusions:</strong> Intramedullary nailing with dynamic nailing assemblies is safe and effective for closed or type I open tibial fractures with limited comminution. This approach may reduce complications and re-operations and allow for early weight-bearing. Proper management of tibial fractures requires an interprofessional team.</p> <p> </p> Siddharth Gunay, Tanmay A. Avhad, Shubham Tungenwar, Sanket Jethlia Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Comparison of clinical and functional outcomes of physical therapy alone versus additional intraarticular injection of platelet rich plasma in treatment of frozen shoulder in Indian population <p><strong>Background:</strong> Frozen shoulder (adhesive capsulitis) involves significant restriction of shoulder motion due to an inflammatory process and typically follows stages of pain, stiffness, and recovery over 2-3 years. This study explores the efficacy of platelet-rich plasma (PRP) injections, alongside conventional physiotherapy, as a non-operative treatment to enhance recovery in patients with adhesive capsulitis.</p> <p><strong>Methods:</strong> This prospective, randomized, open, blinded, single-center clinical study involving 50 patients with adhesive capsulitis, comparing intra-articular PRP injections and physical therapy with physical therapy alone over 24 weeks. Primary outcomes were assessed using the shoulder pain and disability index (SPADI) and visual analog scale (VAS), with follow-ups at 6, 12, and 24 weeks to evaluate pain, function, and patient satisfaction.</p> <p><strong>Results:</strong> In adhesive capsulitis (AC), intra-articular platelet-rich plasma (IA-PRP) injections with physical therapy (PT) provided superior pain relief, functional improvement, and higher treatment satisfaction after 24 weeks compared to PT alone. The IA-PRP group also showed better VAS scores and reduced acetaminophen use, indicating more effective pain management.</p> <p><strong>Conclusions:</strong> In AC, IA-PRP injections showed greater pain relief and improved shoulder mobility compared to PT alone after 12 weeks. PRP's effectiveness highlights its potential, especially when corticosteroids are unsuitable, though longer-term studies are needed to confirm these results.</p> Tanmay A. Avhad, Sahil Lombar, Neeraj Kalra Copyright (c) 2024 International Journal of Research in Orthopaedics Mon, 10 Jun 2024 00:00:00 +0530 From incision to outcomes: a comparative dive into the functional outcomes of arthroscopic all-inside and outside in meniscal repair techniques <p><strong>Background:</strong> Meniscal repair has been associated with superior outcomes, including enhanced knee function, increased activity levels, reduced osteoarthritis progression, cost savings, and improved long-term functional outcome scores compared to partial meniscectomy. This study aimed to evaluate and compare the functional outcomes of meniscal repairs performed using the outside-in and all-inside techniques, utilizing the International Knee Documentation Committee (IKDC), Tegner Lysholm (TL) scores and comparing our results with previous studies.</p> <p><strong>Methods:</strong> This prospective study included 53 patients with traumatic meniscal tears and associated ligamentous injuries that underwent arthroscopic meniscal repair. Details of investigations were recorded, and knee functional assessment was performed using the 2000 IKDC score and TL scores.</p> <p><strong>Results:</strong> The mean age of the patients was 28±8.41 years, with 41 (77.36%) males and 12 (22.64%) females. At the final follow-up of 1 year, the IKDC scores in the all-inside group and outside in group were 93.26±4.45 and 94.31±2.63. The TL scores in the all-inside and outside in groups were 95.33±2.45 and 96±1.00. No statistically significant difference was noted between the two groups (p value &gt;0.005).</p> <p><strong>Conclusions:</strong> Meniscal repairs in the two groups in our series demonstrated favourable clinical outcomes, as evidenced by significant improvements in IKDC score with averages increasing from 25.31 to 93.26 and from 25.91 to 94.31 in all-inside and outside-in groups respectively. The TL sores showed an improvement from 21.07 to 95.33 and from22.43 to 96.00 in all-inside and outside-in groups respectively. In conclusion, short-term results of traumatic meniscal tears with repair are promising, leading to significant improvements in knee function irrespective of concomitant injuries and the type of repair.</p> Ashu Malhotra, Shekhar Srivastav, Harjoban Singh, Biswarup Sen Copyright (c) 2024 International Journal of Research in Orthopaedics Wed, 26 Jun 2024 00:00:00 +0530 Comparison of clinical and functional outcomes in patients operated with standard offset stem versus high offset stem in total hip replacement: a retrospective study <p><strong>Background:</strong> Femoral offset restoration in total hip replacement is crucial for normal anatomy and reduced joint forces, with potential implications for implant longevity and complications. This study compares standard and high offset stem total hip replacement outcomes for better restoration of native offset, also to improve understanding of clinical and functional outcomes particularly regarding implant selection in total hip replacements.</p> <p><strong>Methods: </strong>The study will include 40 patients who underwent THR, divided into standard offset and high offset stem groups. Preoperative data, including history and clinical examination, was collected. Post-operative recovery, satisfaction, and pain levels will be assessed through serial follow-ups at 6, 12, and 18 weeks, along with clinical improvement measured by Harris hip score. Analysis at 18 weeks will evaluate the outcomes of standard vs. high offset stem surgeries.</p> <p><strong>Results: </strong>Group A exhibited significantly higher proportions of patients with a Harris hip score &gt;90 (excellent) compared to Group B (70% vs. 25%) and significantly lower proportions with scores indicating poor, fair, and good outcomes (&lt;70: 0% vs. 10%, 70-79: 5% vs. 15%, 80-89: 25% vs. 50%, respectively; p=0.02).</p> <p><strong>Conclusions: </strong>This study confirms that increasing femoral offset with high-offset stems improves functional outcomes and biomechanics in total hip arthroplasty, emphasizing the need for patient-specific anatomical consideration.</p> Tanmay A. Avhad, Siddharth Gunay, Ketan Naik, Zafar Syed, Arif Chaudhary Copyright (c) 2024 International Journal of Research in Orthopaedics Thu, 30 May 2024 00:00:00 +0530