International Journal of Research in Orthopaedics
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The reduction in the incidence of iatrogenic meralgia paresthetica after hip arthroscopy by preoperative mapping of the nerve
Get PDFBackground: The gold standard for treating femoroacetabular impingement (FAI) is hip arthroscopy. The proximity of neurovascular structures makes them susceptible to injury. Among these, damage to the thigh's lateral cutaneous nerve is frequently sustained during the anterior portal hip arthroscopy procedure. The study's main goal was to determine whether ultrasound mapping of the thigh's lateral cutaneous nerve reduced the risk of injury during anterior portal hip arthroscopy. The secondary goal was to determine how traction time and subsequent traction-related complications-of which pudendal nerve injury is the most concerning-were affected by medially positioning the anterior portal to allow direct access to the anterior part of the labrum.
Methods: The study included 51 patients who underwent hip arthroscopy for femoral osteoplasty and/or acetabuloplasty, as well as anterior labral repair, between August 2022 to November 2024.
Results: The average traction time was 57.1 minutes, with a range of 40 to 85 minutes and an SD of 10.4 minutes. Three patients (5.9%) experienced partial palsy of the lateral cutaneous nerve of the thigh. Following surgery, one patient (2%) experienced complete pudendal nerve palsy, and 8 patients (15.7%) experienced partial palsy.
Conclusions: The present study discusses the safety and potential advantages of mapping the lateral cutaneous nerve of the thigh using ultrasound. It also suggests that this method may help to shorten the duration of traction and minimize complications associated with it
Calcaneum tuberculosis-an uncommon phenomenon: narrative review
Get PDFThe Mycobacterium tuberculosis is the cause of tuberculosis (TB), a dangerous and highly contagious infection that is a major source of morbidity and mortality. One to three percent of cases have osteoarticular TB, and 10% of these cases involve foot and ankle involvement. The bone in the foot most frequently attacked by TB is the calcaneus. There are currently relatively few case series studies and case Report available that describe this uncommon phenomenon. The aim of this narrative review is to find information on the calcaneum tuberculosis-An uncommon phenomenon. We evaluated the medical records of some patients with 4 to 68 years, who had isolated calcaneal tuberculous osteomyelitis. As part of the systematic search, the phrase "calcaneal tuberculosis-an uncommon phenomenon" was created in relation to integrative, along with its synonyms, and the search database was used. The Google search engine was used to manually search PubMed and Google Scholar. The database did not include any further articles. According to the study's conclusions, Mycobacterium tuberculosis is the main cause of TB, a dangerous and communicable infectious illness. Calcaneal tuberculosis is uncommon. A high degree of clinical suspicion, in addition to positive imaging data, GeneXpert findings, and Gram stains, can aid in the diagnosis of TB calcaneus because it is an uncommon illness. To stop the illness from spreading to other bones and joints, early identification is crucial. Patient was treated with antitubercular medication and had a successful operation to correct the abnormalities
The enigma of xanthogranulomatous osteomyelitis: report of a rare case with review of literature
Get PDFXanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory condition histopathologically characterized by foamy macrophages, lymphocytes, plasma cells and fibrosis. It primarily affects organs like gallbladder and kidney but rarely involves bone. To date, only 21 cases of bone XO have been documented. XO mimics neoplastic bone lesions, creating diagnostic challenges necessitating a comprehensive approach that includes a thorough clinical history, detailed radiographic evaluation and definitive histopathologic examination. Hereby, we report a rare case of 25-year-old male presenting with pain, swelling and fever in the left forearm. Imaging revealed features suggestive of osteomyelitis and histopathological examination showed sheets of foamy macrophages, chronic inflammatory cells and fibrosis, thus clinching the diagnosis of XO. Through the case report we wish to highlight the importance of considering XO in the differential diagnosis of bone lesions so to avoid misdiagnosis of malignancy
Result of tensor fascia lata muscle pedicle bone graft in early-stage avascular necrosis of femoral head in adults
Get PDFBackground: The avascular necrosis (AVN) of femoral head in young adults is a disabling condition. The core decompression along with Tensor fascia lata (TFL) Muscle pedicle bone graft (MPBG) fixed with screw at the base of the neck of the femur is a simple, effective, treatment method with excellent to good result in majority of the early cases of AVN.
Methods: In this retrospective study we operated on 32 hips with early or advanced AVN especially in young adults from May 2021 to April 2023, using core decompression along with TFL MPBG fixed with screw at the base of the neck of the femur. The final assessment was done on only those patients who were followed for at least 2 years post operatively using modified Harris hip score (mHHS).
Results: The mean age of the patients was 29.2 years. The mean duration of surgery was 129 minutes. The mHHS score was found to be excellent in 12, good in 15, Fair in 3 and poor in 2 patients. The correlation was found between AVN & mHHS. Those with early AVN had better mHHS compared to advanced one, whereas a few with advanced AVN had the tendency to progress to further advanced stage of AVN.
Conclusions: The core decompression along with TFL MPBG fixed with screw in the neck of the femur is a simple, effective and reproducible treatment modality with excellent to good results in early AVN in majority of young adults
Role of physiotherapy in relieving osteoarthritis knee pain using Lysholm score
Get PDFBackground: Knee osteoarthritis (OA) is a prevalent condition that significantly impacts quality of life. While pharmacological interventions are commonly used, non-pharmacological approaches like physiotherapy have gained increasing recognition. In this study, the Lysholm Knee Scoring Scale was used to assess how well physiotherapy worked in reducing knee pain and enhancing functional results for people with OA knee.
Methods: A randomized controlled trial from 1st February 2023 to 31st July 2023 at Department of Orthopaedics, Padmashree Dr. D.Y. Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India was conducted with 500 participants diagnosed with knee OA. Participants were randomly assigned to either the physiotherapy group (n=250) or the control group (n=250). The physiotherapy group received a 12-week standardized program consisting of exercise therapy, manual therapy and education. The control group received standard care. The primary outcome was the Lysholm Knee Scoring Scale, assessed at baseline, 12 weeks (post-intervention) and 24 weeks (follow-up). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion, muscle strength and quality of life.
Results: At baseline, the groups were comparable in terms of age, gender, body mass index and clinical characteristics. The physiotherapy group demonstrated significantly greater improvements in the Lysholm Knee Scoring Scale compared to the control group at 12 weeks (mean difference: 10.2, 95% CI: 7.4, 13.0; p<0.001) and 24 weeks (mean difference: 12.2, 95% CI: 9.2, 15.2; p<0.001). Similar patterns were observed for secondary outcomes, with the physiotherapy group showing significant improvements in WOMAC pain and function, knee range of motion, quadriceps strength and quality of life (all p<0.001).
Conclusions: This study provides evidence that physiotherapy interventions, including exercise therapy, manual therapy and education, are effective in relieving knee pain and improving functional outcomes in individuals with knee osteoarthritis, as measured by the Lysholm Knee Scoring Scale and other relevant clinical measures
Reviving mobility: conversion arthroplasty as a solution for failed proximal femur fixation
Get PDFProximal femur fractures are very common both in young and old age group and are usually managed surgically. In case of failed fixations, young patients are managed with subsequent attempts of osteosynthesis to achieve union and maintain integrity of femoral head. However, in case of elderly patients, arthroplasty of hip joint may be considered keeping in mind the poor bone quality, loss of bone or injury to the articular cartilage. This study is aimed to assess the outcomes and consequences of conversion arthroplasty following unsuccessful fixation of intertrochanteric fractures. We report 3 cases of proximal femur fixation, who were initially managed with intramedullary nailing subsequent to trauma. But patients post operatively developed complications like implant failure, non-unions and post traumatic arthritis of hip for which conversion arthroplasty was done as a rescue procedure following failed fixation
Flap-sparing approach to pediatric hand wound management with acellular dermal matrix, skin grafting and vacuum-assisted closure: a case report
Get PDFSevere pediatric hand injuries with exposed tendons and vessels have traditionally been managed using flap coverage. Flap surgeries in young children can be technically demanding, associated with donor site morbidity. Emerging evidence supports alternative reconstructive strategies using dermal substitutes and advanced wound therapies. We report a case of a 3-years-old male with a 3×2 cm anterolateral hand laceration exposing thenar muscles, tendons and vessels following road traffic trauma. Initial primary closure failed. The wound was managed with debridement, application of vacuum-assisted closure (VAC) therapy, placement of an acellular dermal matrix (ADM), split-thickness skin grafting (STSG) and VAC reapplication. Functional and aesthetic outcomes were documented. The wound healed with complete graft take and without the need for flap coverage. The patient regained full hand function with satisfactory cosmetic appearance. No complications such as infection, graft loss or contracture were noted at 1 month follow-up. The ADM facilitated neodermis formation over exposed tendons, allowing successful skin grafting. ADM combined with STSG and VAC therapy provided an effective alternative to flap surgery for pediatric hand wounds with exposed structures. This method can simplify management, reduce morbidity and preserve excellent functional outcomes in young patients
Optimization of surgical fixation in cervical spine fractures using advanced imaging techniques: a systematic review of functional and neurological outcomes
Get PDFCervical spine fractures are high-stakes injuries with substantial risks of permanent neurological damage and disability. Traditional imaging methods, including plain radiographs and fluoroscopy, are limited by low sensitivity and spatial resolution. This systematic review assesses the impact of advanced imaging specifically preoperative MRI, CT and intraoperative navigation systems on surgical fixation accuracy and patient outcomes. In methodology, we followed PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Scopus and Web of Science from 2010 to 2024. Eligible studies included adult patients with cervical spine trauma undergoing surgical fixation with reported outcomes in screw accuracy, neurological recovery (ASIA scores) or functional status (JOA, NDI, SF-36). Data were synthesized and quality assessed using the Newcastle-Ottawa Scale. In results, eleven studies (n=1,220 patients) met inclusion criteria. Intraoperative CT-based navigation consistently improved screw accuracy (up to 98.1%), reduced malposition and operative times and minimized radiation to staff. MRI influenced surgical decision-making in elderly and neurologically impaired patients, particularly by identifying occult cord compression and reducing surgical delay. Select studies reported functional gains, including ODI improvements from 67.1% to 25.6% and VAS pain reduction from 8.2 to 2.2. Advanced imaging modalities significantly enhance surgical precision and contribute to improved patient safety and recovery in cervical spine trauma. Their integration into surgical planning supports evidence-based, patient-centered care, especially in high-risk or anatomically complex cases
A novel technique to treat osteoporotic proximal humeral fractures with diaphyseal extension
Get PDFBackground: Recent reports of failure of proximal humeral locked plate (PHILOS) in treating comminnuted proximal humeral fractures (PHF) with diaphyseal extension (DE) prompted attempts to either augment or add more fixation which is challenged with the proximity to important neurovascular structures.
Methods: Between February 2020 and May 2024, 29 patients with comminuted fractures of PHF-DE were treated at El-Hadra University Hospital with the addition of either a small locked dynamic compression plate (sLDCP) or a small locked reconstruction plate (sLRP) to the standard PHILOS plate, using the trans-deltoid approach.
Results: The average follow-up (FU) period was about 19.5 months. The average age of the patients was approximately 62.6 years. Most of the patients (72.4%) were females. All patients healed their bones without needing additional procedures like bone grafts. The average healing time was just over six months. The mean visual analogue scoring system (VAS) was 8.2. At the end of the FU, there was no significant change in the neck shaft angle (p=0.7). At the end of the FU, the average Constant-Murley shoulder score was noted as 86.6, the mean Simple Shoulder Score was 79.3%, and the average score for the shoulder rating at the University of California Los Angeles (UCLA) was 31.1. No iatrogenic neurovascular fractures occurred during the study.
Conclusions: Performing double plating on PHF-DE is safe. It does not increase the risk of shoulder impingement, harm to the blood supply of the humeral head, or nerve injuries caused by treatment
A second chance: analyzing trends and outcomes for reapplicants in orthopaedic surgery
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Background: The increasing number of applicants for orthopaedic surgery residency programs, paired with a static number of available positions, has resulted in many candidates being unmatched. This study explored trends and factors associated with successful reapplication outcomes for unmatched orthopaedic surgery applicants.
Methods: This mixed-methods study was conducted between June 2024 and January 2025. Inclusion criteria for qualitative data were unmatched orthopaedic surgery applicants who subsequently matched and participated in interviews. Exclusion criteria included those who did not reapply or did not complete the interview process. Data were obtained from the Orthopaedic Residency Information Network (ORIN) and included demographics of current residents, attending faculty, and residency program characteristics. Gender of program leaders was verified through LinkedIn and program websites. Spearman correlation and ANOVA were used for analysis, with significant variables further examined through multiple regression. Qualitative insights were collected through interviews with previously unmatched applicants who matched on subsequent attempts.
Results: Analysis revealed no statistically significant associations between traditional metrics (e.g., USMLE scores, demographics) and matching outcomes (p>0.05). Qualitative data highlighted that engagement in research and clinical experiences, as well as meaningful mentorship, significantly impacted reapplication success.
Conclusions: Despite the lack of significant predictors from traditional metrics, proactive measures taken during the year off were crucial for unmatched applicants. Candidates should focus on strategic activities to enhance their competitiveness in future applications