International Journal of Research in Orthopaedics
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Vitamin D deficiency and risk of postoperative complications in joint arthroplasty: a meta-analysis
Get PDFVitamin D deficiency is prevalent among patients undergoing joint arthroplasty and may influence surgical outcomes. This meta-analysis aimed to evaluate the association between preoperative vitamin D deficiency and postoperative complications following joint arthroplasty. A systematic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science and Scopus from inception to January 2025. Random-effects models were used to calculate pooled odds ratios (ORs) and standardized mean differences (SMDs). Subgroup analyses were performed based on study design, joint type, vitamin D threshold and follow-up duration. Twenty-three studies (8,762 patients) were included. Vitamin D deficiency was significantly associated with increased risk of overall postoperative complications (OR 2.18, 95% CI 1.76-2.69), periprosthetic joint infection (OR 2.83, 95% CI 2.05-3.91), superficial surgical site infection (OR 1.89, 95% CI 1.45-2.47), aseptic loosening (OR 1.76, 95% CI 1.38-2.25), prosthetic dislocation (OR 1.82, 95% CI 1.31-2.53) and revision surgery (OR 2.25, 95% CI 1.72-2.94). Functional outcomes were significantly worse in vitamin D-deficient patients at 6 months and 12 months postoperatively. The association between vitamin D deficiency and complications was strongest with the <10 ng/mL threshold. Preoperative vitamin D deficiency is significantly associated with increased risk of multiple complications and poorer functional outcomes following joint arthroplasty. The risk appears to increase with the severity of deficiency suggesting that vitamin D status represent a modifiable risk factor. Future research should investigate whether preoperative vitamin D supplementation can reduce complication risk and improve outcomes
A prospective comparative study of distal tibia and fibula fractures treated with tibial interlocking nailing with and without fibular plating
Get PDFBackground: Distal both bone leg fractures present significant challenges in orthopedic surgery. The purpose of this study was to evaluate the functional and radiological outcomes of tibial interlocking nailing alone versus interlocking nail with supplementary fibular plating.
Methods: A hospital-based, prospective interventional study was conducted on 72 patients, divided into two groups. Karlstrom-Olerud scoring and radiographic assessment were used to evaluate outcomes. SPSS software will be used for all statistical calculations.
Results: Patients in the interlocking nail with fibular plating group demonstrated improved alignment values in varus/valgus angulation (p=0.00008) and anteroposterior angulation (p=0.00029), also Karlstrom Olerud score was significantly better in fibular plating group at 3 months (p=0.002). There was slightly earlier union time in fibular plating group than patients without fibular plating (14.86 and 15.55 respectively) and also there was higher rate of patients requiring secondary procedures in group without fibular plating (6) compared to group with fibular plating (2).
Conclusion: Patients with fibular plating group demonstrated significantly improved alignment and functional scores, suggesting that supplementary fibular plating enhances stability and reduces malalignment
Assessment of depression, anxiety and quality of life in chronic low back pain patients in rural population
Get PDFBackground: Chronic low back pain (CLBP) being one of the most common musculoskeletal disorders, has a clear impact on the psychological status of the patient; also studies have shown that Quality of Life (QOL) is hampered in CLBP cases. Several studies have been conducted recently on CLBP and its association with depression, anxiety and QOL, however, this study has been majorly surveyed on the urban population; a need was felt to perform a similar survey on the rural population. This stud aimed to assess the depression, anxiety and quality of life in patients with chronic low back pain in rural population.
Methods: Total 60 participants were selected based on inclusion and exclusion criteria from the orthopedic department of Dr. APJ Abdul Kalam College of Physiotherapy. PHQ 9, GAD-7 and WHOQOL-BREF Questionnaires were used in their local language (Marathi). Data was collected on sheet of paper, and a consent form was given to participants.
Results: Results of PHQ-9, and GAD-7 obtained in the study revealed that 54 participants were severely depressed and 6 participants were moderately severe depressed. 50 participants of CLBP have severe anxiety issues, 8 participants have moderate anxiety and only 2 have mild anxiety. QOL was more affected in CLBP patient.
Conclusions: This study concludes that there is high incidence of depression and anxiety in CLBP patients and have reduced QOL. Therefore, psychological counseling should be integral part of conventional CLBP treatment
Analysis of misdiagnosis and malpractice in orthopaedic traumatology: retrospective observational study of 13 cases in a teaching university hospital
Get PDFOrthopedics surgery has been a topic in medical malpractice for more than 130 years. The main type errors are diagnostic, treatment, communication, evaluation, environmental or system-related problems. These medical errors arouse more and more interest among our populations and degrade the doctor-patient relationship to the point of seeing more and more legal overtones. This case series presents thirteen patients with major clinical consequence resulting from a misdiagnosis or malpractice. The average age of the patients was 43.5 years. 92% of medical errors were linked to an initial admission to the emergency department. Traumatic injuries were most frequent (84,61%), including 10 cases of fractures and 1 case of dislocation. Cases of misdiagnosis were less frequent than malpractice but had serious consequences, with 1 death and 3 major amputations. Unrecognized vascular injuries remained the most common cause. The causes of malpractice are numerous. The most common main mistakes had occurred outside of operating rooms (89%) and were due to orthopaedic treatment in 67% of cases. We noted 3 cases of death related with general complications (thrombo-embolism, traumatic choc). This case series demonstrates that medical errors can be dramatic for the patients and family. Graduate medical education reform should focus on strengthening these aspects of training which can be an important factor for decreasing this phenomenon
A randomized controlled study comparing the efficacy of ultrasound guided intra articular-triamcinolone vs platelet rich plasma in active phase (stage 1) of adhesive capsulitis (frozen shoulder)
Get PDFBackground: Adhesive capsulitis is a common cause of shoulder pain and restricted movement. Various treatment options exist, ranging from analgesics and steroid injections to biologics like platelet-rich plasma (PRP). PRP offers potential healing benefits with minimal immunological risk. Given conflicting evidence for existing therapies and the growing use of PRP, comparing PRP with steroid injections is warranted.
Methods: A randomized, single-blinded controlled trial included 84 patients aged 30–70 years with adhesive capsulitis. Participants were randomized into Group A (triamcinolone 80 mg) and Group B (2 ml autologous PRP). Outcome measures included Visual Analogue Scale (VAS), range of motion (ROM), Shoulder Pain and Disability Index (SPADI), and Constant-Murley Score (CMS), assessed at baseline, 3 months, and 6 months. Statistical analysis employed Chi-square/Fisher’s exact test and Student’s t-tests.
Results: Patients receiving PRP showed significantly greater improvements in VAS, SPADI, CMS, and ROM compared to those receiving steroid injections at both 3- and 6-month follow-ups (p<0.001). Transient side effects such as nausea, vomiting, and hypotension were more frequent in the PRP group but lacked statistical significance. Recurrence and lack of treatment response were higher in the steroid group.
Conclusion: PRP is more effective than triamcinolone in short-term pain relief and functional recovery among adhesive capsulitis patients, with minimal adverse effects. Larger multi-centric studies with longer follow-up are recommended to evaluate its long-term benefits and comparative efficacy with other treatments
Modern prescribing practices and perspectives among Indian Orthopaedicians on Denosumab in osteoporosis: a cross-sectional survey
Get PDFBackground: Denosumab reduces vertebral, hip and nonvertebral fracture risk by improving bone mineral density (BMD) in Osteoporosis. This survey aimed to understand the prescribing patterns and perspectives of Denosumab Indian Orthopaedic practice.
Methods: This cross-sectional survey was conducted among Indian Orthopaedicians for insights on Denosumab prescription patterns, patient profile, treatment duration, adherence, safety and efficacy. Data were analysed descriptively by cross-tabulation.
Results: Among 91 Orthopaedicians prescribing Denosumab for Osteoporosis (T-score<-2.5), 63.74% prescribed for fragility fractures, 60.44% to prevent recurrent fractures and 57.14% in patients without fragility fractures. Denosumab was preferred considering better patient compliance (56.04%), safety (54.95%), efficacy (51.65%) and dosing frequency (49.45%). Patient adherence for up to three years was reported by 79.13%. Teriparatide was the most common drug prescribed in combination (55%) or sequential manner (60% pre and 30.43% post-denosumab). Calcium and Vitamin D were supplemented by 94.51% of doctors. Denosumab drug holiday was not recommended by 62.64%. Approximately 52.7% and 66.7% of doctors reported 10% and 20% BMD increases after 12 and 12-24 months of therapy, respectively. Highest improvements were reported in the lumbar spine and hip. Myalgia (60.44%) and musculoskeletal pain (26.37%) were the most common side effects. Among all, 82.4% prescribed Denosumab in elderly osteoporotic patients with co-morbidities like diabetes (85.33%), cardiovascular disorders (62.67%), renal (54.67%) and hepatic impairment (21.33%).
Conclusions: Our findings underscore the significance of Denosumab in Osteoporosis with insights into the prescribing patterns of Indian Orthopaedicians. It highlights the need for strategies to improve patient adherence for optimizing therapeutic outcomes.
Incidental finding of an accessory pronator during anterior transposition of the ulnar nerve with anterior interosseous nerve supercharge transfer: a case report
Get PDFThe anterior transposition of the ulnar nerve with anterior interosseous nerve (AIN) supercharge transfer is a well-established procedure for improving motor recovery in severe ulnar neuropathy. Anatomical variations in the forearm musculature, such as the presence of an accessory pronator muscle, can have surgical and clinical implications. A 54-year-old female with cubital tunnel syndrome presented with progressive ulnar nerve dysfunction, including intrinsic muscle weakness and sensory deficits. She underwent anterior transposition of the ulnar nerve with AIN supercharge transfer. During the procedure, an unexpected accessory pronator muscle was identified between the pronator quadratus (PQ) and flexor digitorum profundus (FDP). The AIN innervated the muscle and was carefully dissected to facilitate nerve transfer. Postoperatively, the patient demonstrated improved intrinsic muscle strength without complications. Accessory muscles in the forearm are rare but may contribute to nerve compression syndromes or impact surgical approaches. This case highlights the importance of recognizing such anatomical variations to optimize surgical technique and avoid iatrogenic injury. Awareness of accessory pronators is crucial in upper limb nerve surgeries to ensure successful nerve transfer and prevent intraoperative complications.
Morphometric analysis of scaphoid: influence of screw design and surgical approach in scaphoid fracture fixation: a study in Indian population
Get PDFScaphoid fractures are among the most frequent carpal bone injuries, and screw fixation has become the treatment of choice. The stability of fixation is maximized when the screw is centrally placed and of maximum possible length. In this case series, we examined scaphoid morphometry in the Indian population and assessed the influence of sex, surgical approach, and screw design on achievable screw length. The study was performed on ten computed tomography (CT) scans of normal wrists, including five men and five women. Three-dimensional reconstructions were created, and the central longitudinal axis of the scaphoid was defined. Virtual headless compression screws from five commercially available designs were positioned along this axis. The scaphoid length measured along its central axis was greater in men (mean 27.52 mm, standard error of the mean 0.70 mm) than in women (mean 23.32 mm, standard error of the mean 0.61 mm). Longer screws could be inserted through a volar approach (male mean 25.28 mm, standard error of the mean 0.84 mm; female mean 20.92 mm, standard error of the mean 0.91 mm) compared with a dorsal approach (male mean 24.84 mm, standard error of the mean 0.94 mm; female mean 20.48 mm, standard error of the mean 1.00 mm), irrespective of screw design. This case series highlights sex-related differences in scaphoid size and suggests that the volar approach permits the placement of longer screws. Screw design continues to play a crucial role in determining fixation options
Cross-sectional descriptive study of characteristics of infants with congenital talipes equino varus requiring and not requiring tendo-Achilles tenotomy post Ponseti casting
Get PDFBackground: Congenital talipes equinovarus (CTEV) is a common musculoskeletal anomaly with prevalence ranging from 0.4-7.0 per 1000 live births. The Ponseti method has revolutionized CTEV management, though percutaneous Achilles tenotomy requirements vary across populations. Objective was to evaluate characteristics of infants with CTEV requiring and not requiring tendoachilles tenotomy following Ponseti casting at an Indian tertiary care center.
Methods: A prospective and retrospective cross-sectional study was conducted over 24 months (January 2022-December 2024) involving 44 children with idiopathic CTEV aged <12 months. All patients were treated using standardized Ponseti method with serial casting. Pirani scoring system assessed deformity severity. Statistical analysis compared patients requiring versus not requiring tenotomy using appropriate tests.
Results: The study included 35 males (79.55%) and 9 females (20.45%) with mean age 2.70±2.47 months. Bilateral involvement occurred in 50% of cases. Mean Pirani score improved significantly from 5.55±0.70 to 0.28±0.61 (p<0.001). Ten children (22.73%) required percutaneous Achilles tenotomy while 34 (77.27%) achieved correction through casting alone. Patients requiring tenotomy had significantly higher mean age at presentation (3.5±3.27 vs 2.47±2.19 months, p=0.001), higher initial Pirani scores (5.80±0.63 vs 5.47±0.71, p<0.001), and required more casts (4.5±1.65 vs 3.85±1.33, p<0.001).
Conclusions: The Ponseti method achieved 100% initial correction with relatively low tenotomy requirements (22.73%). Older age at presentation, higher initial Pirani scores, and increased casting requirements significantly predict tenotomy need. Early treatment initiation optimizes outcomes in CTEV management
Right recurrent patellar dislocation treated surgically via the Campbell method: an illustrative case report
Get PDFRecurrent patellar dislocation is a disabling condition, particularly prevalent among adolescents and young adults, often caused by anatomical abnormalities such as trochlear dysplasia or prior trauma. Surgical intervention, including the Campbell technique, is indicated when conservative management fails. A 24 years old male with recurrent right patellar dislocation and trochlear dysplasia (Dejour type B) underwent proximal realignment via the Campbell technique. The procedure involved creating a medial capsular flap, reinforcing it with Fiber wire sutures and repositioning it to stabilize the patella. Postoperative immobilization and rehabilitation were implemented. Surgical stabilization using the Campbell technique is a viable option for recurrent patellar dislocation, offering excellent functional outcomes in anatomically predisposed patients. Comprehensive evaluation and tailored surgical planning remain essential for optimal results