International Journal of Research in Orthopaedics
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Functional outcome of peritrochanteric fractures femur treated with proximal femoral nail
Get PDFBackground: Peritrochanteric fractures are common injuries, especially in the elderly, with significant impact on health care. The aim of treatment should be prevention of malunion and early mobilization. Taking all the factors into consideration, surgery by internal fixation of the fracture is an ideal choice.
Methods: This study included 40 adult patients with peritrochanteric fractures of the femur who met the inclusion criteria and were treated with a Proximal Femoral Nail at BGS Global Institute of Medical Sciences, Bangalore, from November 2022 to November 2024.
Results: The study included 40 cases, 31 males and 9 females, aged 22–94. The majority of patients (45%) were admitted for slip-and-fall injuries, mostly right-sided fractures. 25 of 40 cases were trochanteric, 15 subtrochanteric. The trochanteric fracture group had 40% Boyd and Griffin type 2, while the subtrochanteric group had 33.3% Seinsheimer type IIIa and 20% type IIb. The average hospital stay was 20.67 days and weight-bearing took 16.5 weeks. Two patients died before the 6-week follow-up and three were lost to follow-up. The remaining 35 fractures were 22 trochanteric and 13 subtrochanteric. 90.9% of trochanteric fractures and 88.57% of subtrochanteric fractures had good to excellent results.
Conclusions: The study concludes that the PFN is an excellent implant for the treatment of peritrochanteric fractures. The terms of a successful outcome include a thorough understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate reduction of the fracture, instrumentation and a good image intensifier
A comparative study of the outcomes of fixation of fractures of distal femoral nailing versus plating
Get PDFBackground: Distal femur fractures have been historically very difficult to treat as they are often comminuted, unstable, more common in elderly or patients having multiple injuries. Hence, we conducted this study to assess the feasibility and the functional outcome of 30 cases of supracondylar fractures of femur, treated with locking compression plates and retrograde intramedullary supracondylar nails.
Methods: All patients of distal femoral fractures were admitted and history was elicited to reveal the mechanism of the injury and the severity of the trauma, site of the incident, circumstances about which the injury occurred, premorbid medical history and preinjury functional status. Post-operatively patients were discharged with advice to continue physiotherapy as advised and to come for follow up after 3 weeks and later 3 months, 6 months,18 months and 24 months.
Results: Among the 30 cases of supracondylar fracture fixed by supracondylar nail 14 had good scores and one was scored as excellent, whereas those fixed by locking compression plate 14 were scored as good and 1 case was scored as fair. There were no intances of surgical wound infections during the immediate postoperative period.
Conclusions: From the observations and results of our study, it can be concluded that the supracondylar nail is more ideal when compared to the distal femoral locking compression plate as it has less operative time, less blood loss, more range of movement, less soft tissue stripping and faster radiological union when compared to the distal femoral locking compression plate
Can height and weight of the patient predict the tibial footprint dimensions of anterior cruciate ligament on MRI: an observational study
Get PDFBackground: Anterior cruciate ligament (ACL) reconstruction techniques are increasingly individualized based on patient-specific anatomy. Preoperative knowledge of ACL dimensions guides surgical planning, particularly regarding single versus double-bundle reconstruction. This study aimed to evaluate ACL tibial footprint dimensions in a South Indian population and investigate their correlation with patient anthropometric measures.
Methods: This retrospective observational study analyzed MRI scans of 78 patients (41 males, 37 females) with intact ACL who presented with knee pain at a tertiary care teaching hospital in South India between January 2023 and April 2025. ACL tibial footprint length and width were measured on MRI. Correlation and regression analyses were performed to investigate relationships between ACL dimensions and patient height, weight, age and gender.
Results: The mean ACL tibial footprint length and width were 13.7±1.8 mm and 11.5±1.4 mm, respectively. Height demonstrated a strong positive correlation with ACL length (r=0.68, p<0.001) and a moderate correlation with ACL width (r=0.52, p<0.001). In multivariable analysis, height remained the strongest independent predictor of ACL length (standardized β=0.53, p<0.001), while weight (β=0.04, p=0.687) and age (β=0.03, p=0.749) showed no significant independent association. For every 1 cm increase in height, ACL length increased by 0.182 mm (95% CI: 0.140-0.224). Gender differences in ACL dimensions were significant but partially attributable to height differences. Overall, 60.3% of participants had ACL length <14 mm, with a significantly higher proportion among females (83.8%) compared to males (39.0%).
Conclusions: Height is a strong predictor of ACL tibial footprint dimensions in South Indian patients, explaining 46% of the variability in ACL footprint length. Patient height could serve as a simple clinical predictor of ACL footprint dimensions when advanced imaging is not readily available, potentially guiding surgical decision-making regarding reconstruction technique
Distal humerus fractures caused during amateur arm wrestling-a case report and literature review
Get PDFArm wrestling is a popular game played worldwide due to its basic nature and though many sports injuries can be associated with arm wrestling, humeral shaft fractures are the most common in adults. These injuries are more common in amateur arm wrestlers due to improper technique and lack of experience. This generates an axial torque on the humerus with shoulder stabilized and elbow fixed in flexion, which can lead to humeral fractures. We present such a case of 21-year-old young man presenting to our department of orthopaedics, GMC Kota with complaints of pain, swelling and deformity in right arm following an arm-wrestling match. We planned for operative intervention by open reduction and internal fixation with locking compression plate (LCP) based on the patient's choice and preference after explaining consent and all treatment modalities. Good union and post op recovery was achieved.
Clinical practice trends and therapeutic preferences in osteoarthritis management: a cross-sectional survey of orthopaedic surgeons in India
Get PDFBackground: Osteoarthritis (OA) is a leading cause of disability worldwide and presents a growing challenge, particularly in India’s aging population. Despite its burden, there is a limited data exist on how OA is managed in real-world clinical settings across India. This study assessed the prescribing patterns and therapeutic preferences of orthopaedic surgeons in India, focusing on pharmacological interventions, intra-articular therapies, and the utilization of adjunctive treatments such as collagen and nutritional supplements.
Methods: A total of 250 orthopaedic surgeons across India participated in this cross-sectional survey carried out by the Indian Orthopaedic Rheumatology Association (IORA). The 32-item questionnaire created by orthopaedic surgeons explored clinical observations, treatment preferences, comorbidity challenges, and attitudes toward nutraceutical use in OA management.
Results: Most clinicians reported a high OA burden in their practice, with symptom onset frequently observed as early as 30–45 years. Obesity and poor nutritional status were identified as common complicating factors. Lifestyle modification was the preferred initial approach, followed by acetaminophen as the first-line pharmacologic agent, especially in elderly patients or those with comorbidities. Topical NSAIDs were favoured for their efficacy and safety profile. A growing role for undenatured collagen type II (UC-II, Lonza) was evident, with 55.2% of respondents prescribing it routinely, particularly in mild-to-moderate OA. Over 75% supported its early initiation, and nearly half considered it for preventive use in high-risk individuals.
Conclusions: Indian orthopaedic surgeons are increasingly adopting a holistic, multimodal approach for osteoarthritis management, balancing early intervention with safety. The growing use of UC-II and nutritional supplements highlights a preventive shift in clinical practice
Proximal femoral nail versus dynamic hip screw in treatment of intertrochanteric fractures: a systematic review
Get PDFIntertrochanteric femoral fractures are common in the elderly and typically require internal fixation. This systematic review compared the clinical and radiological outcomes of the proximal femoral nail (PFN) and the dynamic hip screw (DHS) by analyzing 25 studies published between 2000 and 2024 across PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. Key parameters included operative time, intraoperative blood loss, complication and reoperation rates, union time, and functional outcomes measured by the Harris hip score (HHS). Pooled evidence showed that PFN offers significant advantages in unstable fractures (AO/OTA 31-A2 and A3), demonstrating shorter operative time, reduced blood loss, lower implant-failure and reoperation rates, faster radiological union, and higher HHS at 3- and 6-month follow-up compared with DHS. DHS produced comparable results in stable fracture patterns (AO/OTA 31-A1) but was associated with higher mechanical complications in complex cases. Although PFN requires greater technical expertise and carries a small risk of iatrogenic femoral shaft fracture, its intramedullary design provides biomechanical superiority that supports early mobilization and improved functional recovery, especially in elderly osteoporotic patients. Surgical decision-making should therefore consider fracture stability, patient comorbidities, and surgeon experience to optimize outcomes
Cervical trauma imaging reinvented: the expanding role of ultrasound
Get PDFCervical spine trauma represents a critical emergency requiring prompt and accurate imaging to guide management and prevent irreversible neurological damage. While computed tomography (CT) is considered the diagnostic gold standard, ultrasonography (US) has emerged as a viable alternative or adjunct, particularly in environments where CT is unavailable or in populations vulnerable to ionizing radiation, such as children. This systematic review aimed to evaluate the diagnostic accuracy, clinical utility, and limitations of ultrasound in the acute assessment of cervical spine injuries. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science through July 2025. Studies were selected based on pre-defined inclusion criteria, focusing on original clinical investigations reporting the use of ultrasound in acute cervical trauma. Data were extracted regarding sample size, US modality, diagnostic metrics (sensitivity, specificity, predictive values), and clinical outcomes. Quality assessment was conducted using the QUADAS-2 tool. A total of 30 studies were included. Results demonstrated that point-of-care ultrasound (POCUS) offers high specificity (up to 98%) and moderate sensitivity in identifying cervical fractures and spinal misalignment. Color Doppler imaging proved effective in detecting vascular injuries such as vertebral artery dissection or thrombosis. Intraoperative ultrasound enhanced surgical precision, and pediatric applications showed promise for minimizing radiation exposure. However, limitations included operator dependence, reduced visualization of deep or posterior structures, and variability in training protocols. In conclusion, ultrasound is a promising, rapid, and radiation-free modality for selected cases of cervical spine trauma, particularly in pediatric or resource-limited settings, though it should complement rather than replace advanced imaging
Functional outcomes after titanium elastic nailing of mid-shaft clavicle fractures in a rural tribal cohort of Western Maharashtra
Get PDFBackground: Mid-shaft clavicle fractures are common injuries, often affecting young active individuals. Although plating has traditionally been used for displaced fractures, Titanium Elastic Nailing (TENS) offers a minimally invasive alternative with potential advantages of faster recovery, cosmesis, and ease of implant removal. Limited evidence exists on outcomes in rural tribal populations, where occupational demands and access to rehabilitation may differ from urban cohorts.
Methods: This prospective observational study was conducted at a tertiary care teaching hospital in Western Maharashtra from January 2023 to June 2024. Thirty adult patients (mean age 34 years; 76.6% male) with displaced mid-shaft clavicle fractures underwent intramedullary fixation with TENS. Patients with open, medial, or lateral third fractures were excluded. Functional outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analogue Scale (VAS) for pain at baseline and scheduled follow-ups. Radiological union and complications were recorded.
Results: Ninety percent of patients achieved radiological union by one month, increasing to 96.7% by three months. The mean union time was 12.2 weeks. At final follow-up, the mean CMS was 96.2, mean DASH score was 2.3, and mean VAS score improved from 7.1 preoperatively to 1.2. Complications were minor, including superficial infection (n=2), nail migration (n=2), skin irritation (n=3), and hypertrophic scarring (n=1). No nonunion, implant failure, or deep infection occurred.
Conclusions: TENS is an effective and safe option for displaced mid-shaft clavicle fractures in rural tribal patients, providing excellent functional outcomes, reliable union, and minimal complications. Its minimally invasive nature makes it particularly suitable for resource-limited settings
Prospective evaluation of functional outcome in anterior cruciate ligament reconstruction with peroneus longus graft: a hospital-based study
Get PDFBackground: Anterior cruciate ligament (ACL) reconstruction using the peroneus longus tendon (PLT) graft is emerging as a viable alternative to traditional autografts, offering comparable strength and reduced donor site morbidity. This study evaluates the functional outcomes and complications of ACL reconstruction using this PLT graft.
Methods: A hospital-based prospective study was conducted on 50 patients with isolated ACL tears. Outcomes, including Lysholm, IKDC, Tegner activity, and modified Cincinnati scores, were assessed preoperatively and postoperatively at 6 and 12 months. Visual analog scale (VAS), range of motion (ROM), and complications were also recorded. Statistical significance was set at p<0.05.
Results: Significant improvements were observed in Lysholm (46.2±10.3 to 89.4±6.7), IKDC (38.1±9.7 to 85.2±5.9), and modified Cincinnati (37.5±8.2 to 85.3±5.1) scores (p<0.001). ROM increased from 115°±15° to 140°±5°, and pain (VAS) decreased from 7.4±1.2 to 1.5±0.7. Complications were minimal, with a 2% graft failure rate and mild donor site morbidity.
Conclusions: ACL reconstruction with the peroneus longus graft provides excellent functional outcomes and minimal complications, making it a reliable alternative to conventional autografts.
A current concept review of 9 year old boy with hemophilic arthropathy
Get PDFThe knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor VIII or IX and thus this manuscript seeks to present a current perspective of the role of the orthopedist, physiotherapist and pathologist in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this rigorous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, Synoviorthesis is the optimal to ameliorate bleeding, judicious physiotherapy to prevent chronic joint disease