International Journal of Research in Orthopaedics
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A case report of giant cell tumor of the extensor tendon sheath in index finger
Get PDFGiant cell tumor of the tendon sheath (GCTTS) is an uncommon benign soft tissue lesion of uncertain etiology. Although it predominantly involves the hand, occurrences in the ankle and foot have also been reported but remain rare. Patients typically present with a painless, palpable mass that has often been present for an extended duration. While imaging studies and fine-needle aspiration cytology (FNAC) may suggest the diagnosis, definitive confirmation relies on histopathological examination following surgical excision. This report describes a rare case of GCTTS involving the extensor tendon sheath of the right index finger. A 38-year-old male presented with a 4-year history of a gradually enlarging, painless swelling on the dorsal aspect of the right index finger. Clinical examination revealed a well- defined, firm, 4 cm × 1.5 cm mass located over the proximal phalanx. The swelling had a smooth surface, uniform consistency, and was easily mobile in the lateral plane. Radiographic imaging of the hand showed a localized soft tissue shadow without any evidence of bony involvement. Ultrasonography revealed a soft tissue mass, and FNAC was suggestive of GCTTS. The lesion was subsequently excised, and histopathological analysis confirmed the diagnosis by demonstrating characteristic features of GCTTS. Given its indolent course and subtle presentation, GCTTS should be considered in the differential diagnosis of soft tissue swellings in the hand, particularly in adults. FNAC, followed by surgical excision and histopathological evaluation, remains both diagnostic and therapeutic. Ongoing follow-up is recommended due to the potential for local recurrence.
Graft-specific rehabilitation guidelines for anterior cruciate ligament reconstruction
Get PDFAnterior cruciate ligament (ACL) reconstruction is a frequently performed orthopaedic procedure, with rehabilitation playing a pivotal role in patient recovery. The selection of graft type in ACL reconstruction influences biomechanical properties, healing rates and post-surgical complications, necessitating a graft-specific rehabilitation approach. This article presents a comprehensive, phase-based rehabilitation protocol tailored to various ACL grafts, including bone-patellar tendon-bone (BPTB), hamstring tendon, quadriceps tendon, peroneus longus tendon, achilles tendon, allograft and synthetic graft. By integrating evidence-based exercise recommendations, this guideline aims to optimize patient outcomes, minimize complications and facilitate a safe return to functional activities and athletic participation
A case report-management of concomitant acromion fracture with acromioclavicular joint dislocation
Get PDFShoulder injuries which comprises of simultaneous acromion fracture and acromioclavicular dislocations are rare injuries which were usually managed conservatively or sub optimally in previous times. These managements provided functional results with variable satisfaction. But in this era of grand armamentarium of fixation options we are trying a management option for these type of injuries. Here we present the case of 52 year old gentleman who met with a road traffic injury presented with right dominant side injury with pain and inability to move the shoulder. X-ray and CT evaluation done which yielded concomitant acromion fracture and acromioclavicular joint ligamentous dislocation. He was managed by fixation of acromion fracture by 4 holed 3.5 locking reconstruction plate and tightrope endo-button fixation of the acromioclavicular joint. As the said injury is a rare injury, literature references aided in decision making. Systematic approach to the injury along with a planned rehabilitation protocol yielded patient near normal pre injury level status of dominant side shoulder function. More literature must be published with variants of these fractures and varying fixation methods to attain a meta-analysis level for conclusive evidence.
Results of fixation of medial malleolus fractures with closed versus open reduction
Get PDFBackground: Medial malleolus fractures are common ankle injuries with varied treatment approaches, most notably closed and open reduction techniques. Each method presents distinct outcomes and complication profiles. The study aimed to investigate and compare the clinical and radiological outcomes of both techniques in a local context and in comparison, with international literature.
Methods: A prospective-retrospective study was conducted at Aleppo University Hospital, orthopedic surgery Branch, between January 2020 and January 2025. A total of 67 patients with medial malleolar fractures were included. Patients underwent closed or open reduction based on clinical judgment. Data were collected via clinical examination, medical history, radiological, and laboratory investigations. Outcomes and complications were statistically analyzed.
Results: The non-union rate was higher in the open reduction group (7.7%) than in the closed group (2.4%), but this was not statistically significant. However, the mean union time was significantly longer in the closed reduction group (14.6 weeks vs. 11.5 weeks, p=0.041). Complications such as infection, nerve injury, malunion, and joint stiffness were more frequent in the open reduction group. Secondary displacement and Sudeck’s atrophy were more frequent in the closed group, although none of these differences were statistically significant.
Conclusions: While both open and closed reduction techniques are effective in managing medial malleolus fractures, open reduction is associated with a higher rate of complications despite shorter union time. Closed reduction may be preferable in selected patients due to its favorable complication profile. These findings align with international data, although variations exist depending on study settings and sample characteristics.
Patient-generated health communication: a novel readability analysis of online reviews in orthopaedic surgery
Get PDFBackground: Health literacy plays a critical role in patient outcomes, treatment adherence, and care satisfaction. Leading national health organizations and institutions recommend that health communication materials be written at or below the sixth-grade reading level to maximize accessibility. However, the appropriateness of this standard for digitally engaged patient populations remains unclear. This study examined the readability of patient-written online reviews of orthopaedic surgeons to explore whether higher readability levels may still support effective patient communication.
Methods: Orthopaedic surgeons were randomly selected from the American Association of Hip and Knee Surgeons (AAHKS) directory. The most recent online patient review (minimum 50 words) for each surgeon was retrieved from Healthgrades.com, along with the surgeon’s star rating and reviewer’s ZIP code. Readability was assessed using validated tools, including the Flesch-Kincaid grade level (FKGL). Statistical analyses were performed to explore the relationships between readability scores and surgeon rating, geographic region, and household income.
Results: A total of 114 reviews and ratings were analyzed. The mean FKGL was 7.46 (SD 2.49; median: 7.24), significantly above the sixth-grade recommendation (t (114) =6.251, p<0.001). No significant associations were found between the readability level and star rating (p=0.976), region (p=0.697), or median income (p=0.720).
Conclusions: These results suggest that patients actively participating in online health communication exhibit higher literacy levels than the current guidelines assume. This suggests that health communication materials can be crafted at a higher readability level, potentially enhancing message clarity, engagement, and educational value without reducing patient comprehension
Comparison of platelet-rich plasma versus corticosteroid injection for adhesive capsulitis: a randomised controlled trial
Get PDFBackground: Adhesive capsulitis is characterized by pain and progressive restriction of shoulder range of motion. Corticosteroid injections are routinely used for short‑term pain relief, whereas platelet‑rich plasma (PRP) contains bioactive growth factors that may promote longer‑lasting recovery. Evidence comparing these treatments is conflicting and optimal therapy is still unclear. Objectives of the study were to compare the efficacy and safety of a single ultrasound‑guided intra‑articular PRP injection versus a corticosteroid injection for pain relief, functional recovery and range of motion (ROM) in adults with primary adhesive capsulitis.
Methods: In this prospective randomised trial, 40 adults (mean age ~54 years) with idiopathic adhesive capsulitis were randomly allocated to receive either a 4 ml autologous PRP injection or 40 mg of triamcinolone acetonide under ultrasound guidance. A computer‑generated random sequence and sealed opaque envelopes ensured allocation concealment; patients and outcome assessors were blinded. Baseline evaluations included visual analogue scale (VAS) pain scores, Constant–Murley score (CMS), shoulder pain and disability index (SPADI), and passive ROM in forward flexion, abduction, external and internal rotation measured by goniometer. Follow‑ups were performed at 6 weeks, 3 months and 6 months. The primary outcome was change in VAS at 6 months; secondary outcomes included CMS, SPADI, ROM, patient satisfaction (Likert scale) and adverse events. Data were analysed with independent t‑tests and χ² tests using statistical package for the social sciences (SPSS) v26 with p<0.05 considered statistically significant.
Results: Baseline characteristics were comparable between groups. At 6 months, patients in the PRP group demonstrated greater reductions in VAS scores (1.7±0.7 versus 3.1±0.9; p<0.001), higher CMS (80±5 versus 65±6; p<0.001) and lower SPADI scores (20±6 versus 35±7; p<0.001) compared with the corticosteroid group. Gains in forward flexion (150±10° versus 130±12°; p<0.001), abduction (140±9° versus 120±10°; p<0.001), external rotation (60±5° versus 50±6°; p<0.001) and internal rotation (70±6° versus 55±7°; p<0.001) were also significantly larger with PRP. Clinically meaningful pain reduction was observed in 88% of PRP recipients compared with 48% of those receiving corticosteroid injections. Functional improvement and ROM gains occurred in 82% and 80% of PRP patients but in only 48% and 2% of corticosteroid recipients, respectively. High satisfaction (Likert ≥4) was reported by 70% of PRP‑treated patients versus 40 % in the steroid group. No serious adverse events occurred.
Conclusions: A single intra‑articular PRP injection provided superior and sustained improvements in pain, shoulder function and ROM compared with corticosteroid injection at 6 months, with a higher proportion of satisfied patients and no significant safety concerns. PRP may therefore be considered an effective longer‑term option for managing adhesive capsulitis - whereas corticosteroids provide only short‑term relief
Management of a rare fifth metatarsal exostosis with pseudoarthrosis in a 29-year-old male
Get PDFExostoses of the fifth metatarsal are uncommon, and their association with pseudoarthrosis is exceptionally rare. Such lesions can lead to chronic pain and functional impairment, often delaying diagnosis. Authors report the case of a 29-year-old male with longstanding lateral foot pain unresponsive to conservative treatment. Radiographic evaluation revealed a fifth metatarsal exostosis with pseudoarthrosis. Surgical excision and debridement were performed, with preoperative evaluation and planning aided by 3D bone models to better define the lesion and optimize the approach. Postoperatively, the patient experienced significant improvement in pain and function, achieving full return to normal activities and work. This case highlights the need to consider unusual bony pathologies in patients with persistent lateral foot pain.
Medial patellofemoral ligament reconstruction after patellar instability: a systematic review of when and for whom to operate
Get PDFRecurrent patellar dislocation is a common condition in adolescents and young adults, often associated with significant functional limitations. The medial patellofemoral ligament is the primary passive stabilizer against lateral patellar displacement, and its insufficiency plays a central role in instability. While surgical reconstruction has become the mainstay treatment for recurrent cases, the optimal indications and patient selection remain subjects of ongoing debate. This systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Databases were searched for studies evaluating medial patellofemoral ligament reconstruction, with inclusion criteria focused on surgical indications, patient characteristics, clinical outcomes, and postoperative complications. Data on redislocation rates, functional scores, surgical techniques, and return-to-sport outcomes were extracted and qualitatively synthesized. Across the included studies, medial patellofemoral ligament reconstruction demonstrated consistent success in reducing redislocation rates to below 5% in appropriately selected patients. Mean postoperative Kujala scores ranged from 85 to 92, with similar improvements in Lysholm and Tegner scales. Isolated reconstruction was preferred in patients with mild anatomical abnormalities, while combined procedures (such as tibial tubercle osteotomy or trochleoplasty) were indicated in cases with elevated tibial tubercle–trochlear groove distance or high-grade trochlear dysplasia. Pediatric populations benefited from physeal-sparing techniques. Reported complication rates ranged from 2% to 7%. This review confirms the effectiveness of medial patellofemoral ligament reconstruction in managing recurrent patellar instability. Patient selection based on anatomical parameters and surgical precision are critical to successful outcomes. The procedure yields high functional recovery and return-to-sport rates with a low incidence of complications
Intra-articular migration of the tibial bone plug during anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: a case series
Get PDFBone-patellar tendon-bone (BPTB) autografts are a preferred choice for anterior cruciate ligament (ACL) reconstruction due to their potential for reliable bone-to-bone healing. However, technical errors can lead to significant complications. This report presents a series of three cases where the tibial bone plug of a BPTB autograft migrated into the intra-articular space. Postoperative analysis identified that proximal displacement of femoral bone plug, divergence of the interference screw during femoral screw fixation was the primary cause. This led to proximal migration of the graft, increase of tension, and subsequent displacement of the tibial bone plug. These cases underscore the critical importance of meticulous surgical technique, particularly in ensuring accurate screw placement to prevent graft migration
Primary ligament repair in unstable elbow dislocations: a case report
Get PDFThe second most commonly affected joint, when it comes to joint dislocations, is the elbow joint. These injuries can usually be treated non surgically, but the complexity of the injury can increase chronic pain and instability requiring surgical intervention. There isn’t enough evidence-based recommendation on the ideal treatment approach in acute elbow dislocations, hence, we bring forth a case report on the same. A 54-year-old male presented with a left elbow dislocation from a road traffic accident experiencing a fall on an outstretched hand and elbow. The patient complained of pain and restricted movements of the left elbow, scoring a 7 out of 10 on the Visual Analogue Scale. Examination confirmed restricted movement and tenderness along with paraesthesia in the region of the left ulnar nerve supply. Vascular integrity was maintained distal to the injury. Imaging showed closed postero-lateral elbow dislocation. Closed reduction under anesthesia was performed which revealed joint instability, leading to the soft tissue surgical repair along with complete elbow reduction. A medial approach for repair of medial ligament and lateral approach for repair of lateral ligament complex and anterior capsule repair was undertaken. Four-week follow-up revealed to have restored range of motion at the elbow joint with significant improvements in joint stability. An ideal treatment approach to elbow dislocations has yet to be decided upon based on the literature. However, common consensus dictates that simple elbow dislocations with joint instabilities warrant surgical intervention to prevent chronic joint instabilities and recurrent dislocations