International Journal of Research in Orthopaedics
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Do parallel pinning offer advantage over crossed pinning for displaced supracondylar humerus fractures in children: a randomized trial
Get PDFBackground: To compare outcomes between cross pinning with lateral pinning for fixation of displaced supracondylar fracture of humerus in children.
Methods: Children (<12 years) with displaced supracondylar fractures of the humerus were randomized to receive either cross pinning (Group 1) or lateral pinning Group 2). Follow-ups were conducted at 3 weeks, 6 weeks, and 3 months. Clinic-radiological union, Baumann angle, loss of reduction, stability of fracture fixation, incidence of complications, and Flynn's score were compared.
Results: The mean age of children in group 1 was 7.2±2.1 and in group 2 was 6.7±2.3, respectively (independent t-test, p=0.259). The mean follow up was 6.4±2.3 and 6.54±2.1 months, respectively (p=0.356). There were no significant differences observed in Baumann's angle, change in Baumann angle, loss of reduction, carrying angle, loss of carrying angle, range of motion in flexion and extension of the elbow, or total loss of range of motion between the two groups. One patient (2.4%) in group 1 had ulnar nerve injury. Based on Flynn's grading, 32 patients (85.7%) in group I and 27 patients (67.5%) in group II achieved excellent results (Figure 2b &c). In group I, 9 patients (31.4%) and in group II, 10 patients (25%) had good results. group I had 1 patient (2.4%) with fair results, while group II had 2 patients (5%) with fair results. One patient (2.5%) in group II had poor results.
Conclusions: Both techniques ensure stable fixation, union, and good functional outcomes, except for iatrogenic ulnar nerve injury with cross pinning.
Patient outcomes following minimally invasive plate osteosynthesis for fractures of the distal tibia
Get PDFBackground: Minimally invasive plate osteosynthesis (MIPO) has become the go-to method for treating fractures of distal tibia because of its several benefits over open procedures. Assessing the radiological and clinical results of participants undergoing MIPO to treat fractures of distal tibia was the main goal of this study.
Methods: The study was prospective-observational. It was conducted at Srirama Chandra Bhanja (S.C.B.) medical college and hospital, Cuttack, India for one year, i.e., from February 2024 to January 2025. This study included fifty-two individuals who had received MIPO for fractures of the distal tibia.
Results: Among all the 52 patients who participated in the study, 33 (63.4%) were men and 19 (36.5%) were women. A mean age of 52.3±6.5 years was found. Most of the patients, i.e., 38 (73.1%) of patients took 20-24 weeks. Six (11.5%) of patients took >24 weeks. And, lastly, 08 (15.4%) of patients took <20 weeks.
Conclusions: According to the study's findings, MIPO for distal tibia fractures produces good radiological and clinical outcomes, with the majority of patients having a strong functional recovery and union within 24 weeks
Functional outcome of postero-medial condyle fractures of proximal tibia treated using posteromedial locking compression plate
Get PDFBackground: Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. They comprise approximately 8% of all fractures among those aged over 55 years. Surgical intervention for tibial plateau fractures is essential to achieve articular congruity, proper joint alignment, mechanical stability and support ligamentous integrity, as well as to enable prompt rehabilitation
Methods: A 12 months prospective study was conducted from July 2023 to June 2024 at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh. The study included 30 patients with Schatzker Type IV, V and VI proximal tibial fractures. Fractures involving the medial condyle were treated using a posteromedial locking compression plate.
Results: The study included participants aged between 23 to 62 years with the mean age being 36 years (22 males and 8 females). Schatzker classification Type IV fractures being the most prevalent (14 cases) followed by Type V fractures (10 cases) and Type VI fractures (6 cases). Right-sided fractures were more common, with 20 cases reported, compared to 10 cases of left-sided injuries. The functional outcome was measured using the Lysholm Knee Score according to age, fracture and gender. It was excellent results in 19 patients, good results in 8 and fair results in 3 at six month follow up.
Conclusions: Fixation of the tibial plateau fractures using locking compression plates allows for early rehabilitation of the patient and has an excellent functional outcome. Restoring stability, articular congruity and alignment ensures long-term joint health and minimizes complications. A well-planned approach to the tibial plateau fracture with importance to the posteromedial fragment has excellent functional outcomes
Clinical and radiological outcome of wide enbloc laminectomy with subaxial lateral mass screw fixation in patients of cervical spondylotic myelopathy with ossification of posterior longitudinal ligament: a prospective observational study
Get PDFBackground: Data evaluating the clinical and radiological outcome of wide enbloc laminectomy with sub-axial lateral mass screw fixation in patients of cervical spondylotic myelopathy with ossification of posterior longitudinal ligament (OPLL) is scanty in the literature.
Methods: This is a prospective observational study aimed to know the clinical and radiological outcome of wide enbloc cervical laminectomy with sub-axial lateral mass screw fixation in patients of cervical spondylotic myelopathy associated with OPLL. A total of sixty patients were included in our study who underwent wide enbloc cervical laminectomy and sub axial lateral mass screw fixation and were followed up to 1 year postoperatively. Modified Japanese orthopedic association (MJOA) score was used for functional outcome calculation, which was done at 1 month, 3 months, 6 months and 1 year postoperatively. We used C2-C7 Cobb’s angle as parameter of cervical alignment on lateral radiograph of cervical spine, modified Singh’s grading was used to asses cord compression on cervical spine MRI.
Results: There was significant improvement in MJOA score from preoperative (12.2) to one year postoperative (15.7). The mean improvement in MJOA was 3.5 points. The average neurological recovery rate was 60.34%. Overall, 90% patients showed improvement in MJOA score. Cervical alignment is maintained from preoperative 15 degree to postoperative 14.3 degree. The average decrease in cobb’s angle was 0.7 degree and cord compression value improved from preoperative 2.7 to postoperative 0.4 according to modified Singh’s grade.
Conclusions: Wide enbloc cervical laminectomy with sub-axial lateral mass screw fixation is a safe and effective treatment of multilevel cervical spondylotic myelopathy associated with OPLL providing a good functional outcome, maintaining adequate cervical alignment postoperatively
Subungual glomus tumor: a clinical case and a review of the literature
Get PDFGlomus tumors are rare vascular lesions, located in the dermis, very difficult to diagnose. A 55 years old female patient with pain at first finger of her right hand, which eradiated to the forearm, with several years of evolution. The pain was worst with local compression and cold exposure. The magnetic resonance imaging was compatible with a subungual glomus tumor. Surgical resection of the lesion by a lateral approach was done. The histopathological analysis confirmed the diagnosis and the patient complaints disappeared after the procedure. The surgical treatment is usually curative and the lateral approach, although not the most commonly used, could be a good alternative.
The role of multidisciplinary care in managing sarcoma in low- and middle-income countries: a focus on treatment outcomes
Get PDFSarcomas are a heterogeneous group of rare malignancies requiring complex and individualized management strategies. In high-income settings, multidisciplinary care (MDC) has been shown to improve diagnostic accuracy, optimize treatment planning, and enhance patient outcomes. However, the role and implementation of MDC in managing sarcoma within low- and middle-income countries (LMICs) remain underexplored. This paper critically examines the impact of multidisciplinary care models on treatment outcomes for sarcoma patients in LMICs, highlighting current practices, barriers, and opportunities for improvement. Drawing on data from peer-reviewed literature, institutional reports, and global cancer care guidelines, we analyze how team-based approaches involving surgical oncologists, radiation oncologists, medical oncologists, radiologists, pathologists, and supportive care specialists influence early diagnosis, resection margins, recurrence rates, and survival outcomes. Findings indicate that while MDC improves adherence to evidence-based guidelines and fosters coordinated care, its effectiveness in LMICs is limited by workforce shortages, infrastructural deficits, and fragmented health systems. Nevertheless, innovative approaches such as virtual tumor boards, regional centers of excellence, and task-shifting models show promise in bridging gaps. Case studies from selected LMICs demonstrate that even in resource-constrained settings, structured multidisciplinary interventions can lead to earlier diagnosis, improved surgical planning, reduced treatment delays, and better quality of life (QoL). We conclude that scaling up MDC for sarcoma care in LMICs requires sustained investment in health system strengthening, interprofessional training, and policy support. Emphasizing locally adaptable MDC frameworks could significantly enhance sarcoma outcomes and contribute to closing the global cancer care gap
Outcome of femoral shaft fracture in paediatric age group with titanium elastic nail
Get PDFBackground: Femoral shaft fractures are among the most serious and disruptive injuries in children, not only physically but also emotionally—for both the child and their family. Traditionally, such fractures were treated with conservative methods like traction and casting. However, with evolving medical practices and increasing emphasis on early mobility, surgical options like titanium elastic nailing system (TENS) have become more popular, especially in older children.
Methods: This prospective study was conducted at Government Medical College, Kota, between December 2022 and November 2023, involving 30 children aged 4 to 14 years with femoral shaft fractures treated using TENS. We evaluated healing time, complication rates, functional outcomes, and overall effectiveness of this technique.
Results: Most fractures (96%) were managed successfully with closed reduction. The average time to fracture union was 8 weeks, and most children could bear full weight by that time. By 12 weeks, nearly 90% regained full range of knee movement. Minor complications like skin irritation and superficial infection occurred in a few cases but were easily managed. Importantly, no child developed severe complications such as delayed union, non-union, or avascular necrosis.
Conclusions: Using Flynn's criteria, 87% of children had excellent outcomes, while the rest had satisfactory results. No poor outcomes were observed. Our findings suggest that TENS is a safe, minimally invasive, and highly effective method for treating femoral shaft fractures in children, allowing quicker recovery, early mobility, and a return to normal life with minimal complications.
Outcome of treatment of unstable intertrochanteric fractures using proximal femoral nail augmented with trochanteric stabilization plate
Get PDFBackground: Unstable intertrochanteric fractures remain a major challenge in the elderly population, often associated with high morbidity and complications. Proximal femoral nail (PFN) fixation provides stable internal fixation, while the addition of a trochanteric stabilization plate (TSP) is expected to enhance lateral wall support, reducing implant failure and improving outcomes.
Methods: This prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka and a private clinic, from July 2024 to March 2025. Thirty patients with unstable intertrochanteric fractures underwent fixation with PFN augmented by TSP. Demographic data, operative details, perioperative complications, radiological outcomes and functional results were recorded. Patients were followed up for six months and functional outcomes were assessed using the Harris hip score (HHS).
Results: The mean age was 60.3±11.5 years, with males comprising 60% of patients. AO/OTA type 31-A2 fractures were the most common (63.3%). Mean operative time was 78±12 minutes, with minimal intraoperative complications. Radiological union occurred at a mean of 15.8±2.4 weeks. Implant-related complications were infrequent, with cut-out and back-out noted in 3.3% each. Early complications included superficial surgical site infection (3.3%) and deep vein thrombosis/pulmonary embolism (3.3%). Functional outcomes improved steadily, with the mean HHS rising from 42.3±6.1 at discharge to 88.2±6.7 at 6 months, indicating satisfactory hip function recovery.
Conclusions: PFN augmented with TSP appears to be an effective fixation strategy for unstable intertrochanteric fractures, ensuring reliable fracture union, low complication rates and favorable functional outcomes
A study on functional outcome of cemented bipolar hemiarthroplasty and proximal femoral nailing for intertrochanteric fractures of femur in elderly patients 60-90 years
Get PDFBackground: Intertrochanteric fractures are common in elderly patients, often resulting from low-energy falls and exacerbated by osteoporosis. Procedures like bipolar hemiarthroplasty (BHA) and proximal femoral nailing (PFN) present unique benefits and challenges. The aim of the study was to compare the functional outcome of intertrochanteric fracture treated with proximal femoral nail and cemented bipolar hemiarthroplasty.
Methods: A longitudinal observational study was conducted among patients with complaint of an intertrochanteric fracture between March 2021 and August 2022. A total of 24 patients were selected based on particular inclusion and exclusion criteria and divided into two groups of 12. After the respective procedure, patients were monitored for a duration of 5 months, both preoperatively and postoperatively at 1, 3, and 5 months. The collected data included demographic data, clinical data as well as Harris hip score which was then entered into excel sheets and then analyzed using EZR version 1.54 software.
Results: The present study included 24 patients of which 37.5% were males and 62.5% were females with a mean age of 78.17±9.13 years. The mean blood loss observed was 203.75±65.99 ml, mean surgery time was 96.42±26.02 minutes, and mean number of days needed to bear full weight was 28.21±20.42 days. Of the fracture patterns, 31-A2 was the most common encountered (54.2%). The mean amount of blood loss among participants in the PFN group was 152.50±24.17 ml and in the bipolar group the mean blood loss was 255±52.83 with this difference being statistically significant (p<0.05).
Conclusions: This study found significant intraoperative blood loss differences between PFN and CBH in older intertrochanteric fracture patients. The statistically significant reduction in blood loss makes PFN a safer surgery for this sensitive group
A comparative analysis between the proximal femoral nail and dynamic hip screw in the management of unstable trochanter fracture of the femur
Get PDFBackground: Trochanteric fractures are a growing public health concern, particularly as the population ages. This study aims to assess recovery and functional outcomes following treatment of trochanteric femoral fractures using either PFN or DHS. The aim of this study was to compare the effectiveness of proximal femoral nail (PFN) and dynamic hip screw (DHS) in managing unstable trochanteric fractures of the femur.
Methods: This quasi-experimental study at the emergency and outpatient department of the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka (July 2005-June 2007), included 30 patients with unstable trochanteric fractures, treated with proximal femoral nail (n=14) or dynamic hip screw (n=16). Surgeries were performed under spinal anesthesia, and outcomes, including union rate, complications, and functional results, were assessed and analyzed using SPSS (p<0.05).
Results: Out of the 33 patients initially included, 2 died and 1 were lost to follow-up, leaving 14 patients in the PFN group and 16 in the DHS group. The mean operation time was significantly longer for PFN (117.4 minutes) compared to DHS (72.3 minutes). A higher percentage of DHS patients required blood transfusions. Follow-up results showed that PFN patients experienced less pain, better hip movement, and higher Harris hip scores, with statistical significance in pain relief and functional outcomes.
Conclusions: The proximal femoral nail (PFN) is an effective treatment for unstable trochanteric femoral fractures, offering biomechanical stability, early weight-bearing, and a lower risk of wound infection compared to traditional methods