International Journal of Research in Orthopaedics
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Bone health from infancy to adolescence: a narrative review of nutritional and lifestyle determinants
Get PDFLifelong bone health is largely determined by the foundation established during childhood and adolescence, when the skeleton undergoes rapid growth and mineralization. This paper explores the critical influence of early-life factors including nutrition, physical activity, hormonal balance and disease states on the development of peak bone mass, a key predictor of osteoporosis and fracture risk in later years. Emphasis is placed on the roles of calcium and vitamin D, the resurgence of nutritional rickets in both developing and developed regions and the decline in physical activity among youth worldwide. This narrative review integrates findings from global studies to highlight the importance of balanced diets, regular weight-bearing exercise and early screening in vulnerable populations. Ultimately, it underscores the need for a comprehensive public health strategy to promote optimal bone development from infancy through adolescence, ensuring skeletal resilience across the lifespan
Functional outcomes of anterior cruciate ligament reconstruction with peroneus longus autograft: a cohort study
Get PDFBackground: Injuries to the anterior cruciate ligament (ACL) are a frequent cause of functional limitation in active individuals. Reconstruction using autografts is the standard surgical approach. While hamstring and bone-patellar tendon-bone (BPTB) grafts are commonly used, each is associated with donor-site morbidity. The peroneus longus tendon (PLT) has emerged as a viable option with biomechanical properties comparable to the native ACL and fewer donor-site complications. Objectives were to assess the functional outcomes of ACL reconstruction with PLT autograft, focusing on knee stability, ankle function, and donor-site morbidity.
Methods: A prospective cohort of 35 patients underwent arthroscopic ACL reconstruction with PLT autograft between July 2019 and August 2021. Functional outcomes were evaluated preoperatively and at 3, 6, and 9 months using international knee documentation committee (IKDC) score, Lysholm score, foot and ankle disability index (FADI), and American orthopaedic foot and ankle society (AOFAS) score. Data were analyzed with Wilcoxon signed-rank test (p<0.05).
Results: Mean IKDC scores rose from 65.8 preoperatively to 92.6 at 9 months (p<0.001). FADI scores showed minimal change, from 99.3 preoperatively to 97.6 at 9 months, with no significant ankle morbidity. The average AOFAS score was 98.4 at 9 months. Ninety-six percent of patients expressed satisfaction with their results, with no neurovascular complications noted.
Conclusions: ACL reconstruction using PLT autograft provides excellent short-term outcomes with minimal donor-site morbidity, supporting its role as a safe and effective alternative to conventional grafts
Functional and radiological outcomes of posterior column tibial plateau fractures treated with column-specific fixation: a prospective study
Get PDFBackground: Posterior column tibial plateau fractures are complex intra-articular injuries. This study aims to evaluate the functional and radiological outcomes of such fractures managed through column-specific open reduction and internal fixation based on CT classification.
Methods: A prospective interventional study on 30 patients with posterior column tibial plateau fractures treated surgically between 2020 and 2022 at Deen Dayal Upadhyay Hospital, New Delhi. Fractures were classified based on CT imaging and approaches selected according to column involvement. Functional and radiological outcomes assessed at 6 months using Rasmussen’s grading systems. Data were analyzed using SPSS v21, with significance set at p<0.05.
Results: Mean age of patients was 40.3±8.94 years, with a male predominance (86.67%). RTA accounted for 90% of injuries. Most common fracture pattern was PM/AM (33.33%), and the posteromedial approach was used in 60% of cases. The mean time to radiological union was 17.13±1.22 weeks. Functional outcomes were excellent in 33.33%, good in 60%, and fair in 6.67% of patients. Radiological outcomes showed excellent results in articular depression (63.33%), condylar widening (80%), and angulation (76.67%). A significant correlation was found between radiological and functional outcomes (p=0.030), but not between fracture classification and outcome (p=0.426). Minimal complications (4 superficial and 1 case of deep infection).
Conclusion: CT-based classification and column-specific fixation of posterior tibial plateau fractures provides favorable functional and radiological outcomes with minimal complications. Accurate reduction and stable fixation tailored to fracture morphology are key to optimal recovery
Comparative analysis of the functional outcome of absorbable and non-absorbable suture material used in management of acute Achilles tendon rupture
Get PDFBackground: Achilles tendon rupture is one of the most common tendon injuries in the adult population. The injury commonly occurs in middle-aged adults. Patients with acute rupture often present with sudden onset of pain at the site of injury and experience difficulty with ankle plantar flexion compared to the normal side. In most cases, patients report a sensation similar to being kicked in the lower leg. Achilles tendon rupture causes significant pain and disability. This study assessed the comparative analysis and functional outcomes of acute Achilles tendon rupture managed by polydioxanone (PDS) (absorbable) suture and polyester (non-absorbable) suture. We prospectively studied acute Achilles tendon rupture in patients over a 1 and ½ year period and reviewed functional outcomes and complications.
Methods: Forty-nine patients with acute Achilles tendon rupture were included, with a minimum follow-up period of six months. We used the Boyden score to assess outcomes and complications between the two groups repaired by and polyester (Ethibond), respectively.
Results: In our study, all 26 patients (100%) in the PDS (absorbable) group had good or excellent results based on the Boyden clinical assessment, whereas only 13 patients in the polyester repair group had good or excellent results.
Conclusions: Patients treated with the non-absorbable polyester (Ethibond) suture material for repair had a higher incidence of infection and foreign body granulomas. Surgical repair with the absorbable suture PDS is superior to polyester, as it results in significantly lower postoperative wound complications and higher patient Boyden scores. However, studies with larger sample sizes are recommended
Functional outcome of cauda equina syndrome treated by decompression and transforaminal lumbar interbody fusion in 11 cases: a case series
Get PDFThe unspecific description and definition of Cauda Equina syndrome (CES) in literature gives rise to a quantum of doubts regarding its decision making and management in clinical practice. Prospective analysis of 11 cases of CES, between Jan 2015 and Sep 2017, who had been treated with Decompression and Transforaminal Lumbar Interbody Fusion, was done. The varied presentations were studied and the following parameters were assessed in the evaluation of the functional outcome of each patient: Pain (assessed by the VAS-Visual Analogue Scale), Motor status (assessed by the MRC grading), Bladder recovery (graded as per Gleave and Macfarlane) and the Oswestry Disability Index. Our analysis of the results supported the following points: Increased duration of symptoms had a negative effect on the ODI at 3 months and 1 year, the denser the neurological deficit, the worse was the ODI score at 3 months and 1 year; age>60 years had a negative effect on the ODI score at 3 months and 1 year, time to surgery since presentation had no significant effect on the overall functional outcome and ODI at 1 year, the mean VAS (Visual Analogue Scale) was drastically low at the end of 1 year with most of the patients almost free of back pain at the end of 1 year, bladder recovery was also related to the duration of symptoms and the age of the patient, as increasing age and longer duration of the deficits had a negative impact on the bladder recovery ultimately
Surgical intervention for peripheral plexiform schwannoma of the sciatic nerve: a pediatric case study
Get PDFPlexiform Schwannoma, or neurilemmomas, is a rare and benign manifestation of peripheral nerve sheath tumors. The tumor mostly arises from the gradual growth of Schwann cells. These nerve tumors occur in several sites, with the most prevalent being the head, or neck, or even upper extremities. This tumor predominantly manifests in individuals aged 30 to 40 years and is seen equally in both sexes, with these tumors generally measuring less than 2 cm in size. A 14-year-old boy was referred to Oriana Specialty Hospital, Sharjah, UAE, with a one-year history of vague pain in the middle third posterior aspect of the right thigh accompanied by mild tenderness but no peripheral neurological deficit. Magnetic resonance imaging (MRI) of the right thigh revealed a lesion, and a true-cut biopsy confirmed the diagnosis of a peripheral plexiform Schwannoma arising from the sciatic nerve. On 29 December 2024, a surgical excision of the right thigh sciatic nerve Schwannoma was carried out. A posterior midline thigh incision was made, and the procedure was done with advanced techniques, including the use of a microscope and intraoperative nerve stimulator, to ensure precise tumor dissection from the sciatic nerve. The entire Schwannoma, measuring 24×5.5 cm, was successfully excised. There were excellent recoveries post operatively with no neurological deficits or complications of surgery. He was mobilized with full weight-bearing three hours after the surgery and discharged the next day on oral medications. This particular case testifies to the complete excision of a tumor through proper surgery techniques, preserving the neurological function, with promising outcomes for similar cases
Clinical outcome of Bankart repair with remplissage for recurrent shoulder dislocation with less than 20% glenoid bone loss
Get PDFBackground: The goal was to assess the functional result and recurrence rate of anterior shoulder instability after arthroscopic Bankart’s surgery with Remplissage.
Methods: This was a prospective study on 30 patients who were operated with arthroscopic Bankart’s repair between April 2022 to March 2024. Pre-op scores and regular follow-up scores were taken using ROWE score, ASES score and Quick DASH for minimum duration of 6 months post-op to assess functional outcome.
Results: Mean VAS score improved from pre-op value of 7.2 to post-op value of 1.8 at the end of 6 months follow-up. Mean ROWE score improved from pre-op value of 24.6 to post-op value of 91.1 at the end of 6 months follow-up. Mean Quick DASH score improved from pre-op value of 44 to post-op value of 11.4 at the end of 6 months follow-up.
Conclusions: We conclude that the arthroscopic Bankart repair with Remplissage surgery is a beneficial and efficient remedy for anterior shoulder instability. Identifying and choosing the right patient is still crucial to the repair’s effectiveness
Failure rate after primary anterior cruciate ligament reconstructions
Get PDFBackground: One of the most common sport injuries is anterior cruciate ligament injury, making anterior cruciate ligament reconstruction (ACL) a very common orthopaedics procedure. Arthroscopic anterior cruciate ligament reconstruction can be performed using auto-graft from different sources like, bone patellar tendon graft, hamstring tendons (semitendinosus with or without gracilis) or peroneus longus tendon.
Methods: A retrospective study of total 230 patients operated from June 2017 until December 2020. All of then underwent primary arthroscopic anterior cruciate ligament (ACL) reconstructions using hamstring tendons auto-graft. The others underwent revision ACL; their primary surgery was done in other hospital.
Results: Statistically, total rate of complications after primary ACL reconstructions, which was defined as the need for revision surgery, was five patients (2.17%) for home revision was done using contra lateral hamstring graft.
Conclusions: A failure rate of 2.17 percent over the reported period of three years falls within reported rates in literature
Symptomatic hamulus-pisiform coalition in a 53-year-old woman with a flexor carpi ulnaris pain
Get PDFHamulus-pisiform coalition is a rare form of carpal bone fusion that is usually asymptomatic but can occasionally cause chronic wrist pain and ulnar neuropathy. We present the case of a 53-year-old woman with persistent ulnar-sided wrist pain lasting over a year despite multiple corticosteroid injections and physiotherapy. Imaging confirmed a complete osseous fusion between the pisiform and hamulus of the hamate bone, accompanied by moderate chronic enthesopathy of the flexor carpi ulnaris tendon. Due to ongoing symptoms and failure of conservative management, surgical excision of the coalition was performed. Three weeks postoperatively, the patient experienced complete pain relief and full recovery of wrist range of motion. This case emphasizes the importance of considering hamulus-pisiform coalition as a possible diagnosis in patients presenting unexplained ulnar-sided wrist pain nonresponding to conservative treatment
Irreducible ankle fracture dislocation: a case report of posterior tibial tendon entrapment
Get PDFAnkle fracture-dislocations are complex injuries that often involve displaced bones and significant soft tissue damage. In rare instances, the posterior tibial tendon can become incarcerated in the tibiofibular space, complicating standard reduction techniques. We present the case of a 61-year-old man who, eight weeks after a traffic accident, exhibited a Gustillo-Anderson IIIA open fracture-dislocation of the right ankle. Initial treatment involved wound debridement, external fixation, and fibular osteosynthesis. However, postoperative radiographs revealed persistent anterolateral displacement of the talus and widening of the medial clear space, necessitating further investigation. During definitive tibial fixation, the posterior tibial tendon, which had initially been missed, was found to be trapped between the tibia and fibula. Using an anteromedial approach, the tendon was successfully repositioned behind the medial malleolus. The patient experienced an uneventful recovery, achieving full ankle function and strength by 12 weeks, with stable fracture healing confirmed on radiographs. This case underscores the critical importance of early recognition of posterior tibial tendon entrapment in ankle fracture-dislocations, as delayed diagnosis can result in severe long-term complications.