International Journal of Research in Orthopaedics
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Distal tibia physeal fractures and premature growth arrest
Get PDFBackground: Distal tibia children’s physeal fractures can cause growth complications, as premature physeal closure (PPC), which is radiographic growth plate closure compared to unaffected side.
Methods: Retrospective analysis of 243 patients, conducted to assess occurrence of physeal growth arrest. The study aims to identify factors associated with risk of PPC, investigate how common these complications are and to identify factors might predict their occurrence. Data of 243 children with distal tibial physeal fractures were reviewed in multiple military hospitals in Jordan between January 2018 and October 2023.
Results: Average follow-up was 37 weeks. PPC occurred in 29 cases (12.1%). Majority of PPC cases (64%) associated with Salter-Harris II fractures (19 cases), 14% in Salter-Harris III (4), 14% in Salter-Harris IV (4 cases), 8% in triplane fractures (2 cases). No cases of physeal arrest found in Salter-Harris I or Tillaux fractures. Cox multivariate regression analysis revealed statistically significant associations between mechanism of injury and PPC, and between degree of initial displacement and PPC. Each millimeter of initial displacement increased relative risk of PPC by 1.15 (P < 0.01). Although trends suggested possible link between residual displacement after reduction or number of reduction attempts and PPC risk, these correlations were not significant.
Conclusions: Recent studies reported higher PPC following distal tibial physeal fractures compared to this cohort. Significant predictors of PPC included extent of initial fracture displacement and mechanism of injury. While trends noted regarding residual displacement and number of reduction attempts, found not significant in predicting PPC
Pediatric lateral condyle humerus fractures: a comparison of closed reduction with percutaneous pinning and open reduction with internal fixation for displacement over 2 mm
Get PDFBackground: Lateral condylar humerus fractures (LCHFs) with displacement over 2 mm are commonly treated with open reduction and internal fixation (ORIF). However, closed reduction and percutaneous pinning (CRPP) has been proposed as an alternative. Limited research compares these methods for such fractures. This study aimed to evaluate outcomes of CRPP versus ORIF.
Methods: We retrospectively reviewed pediatric patients with LCHFs displaced >2 mm, treated with CRPP or ORIF at five military hospitals between June 2018 and October 2023. Fractures were classified using the Song and Milch systems. We assessed age, sex, fracture characteristics, surgery duration, postoperative care, and complications.
Results: Of 273 patients, 82 had Milch type I and 191 had type II fractures; 78 were Song stage 3, 123 stage 4, and 72 stage 5. CRPP was used in 102 cases, ORIF in 171. Both groups were similar in age, sex, displacement, and immobilization time. CRPP had shorter surgeries and pin durations and did not need a second procedure for pin removal. Most fractures healed without major complications. Common issues included bone spurs, lateral prominences, and reduced carrying angle, but no functional deficits. Aesthetic scarring was more common in ORIF. Elbow function and range of motion were comparable.
Conclusions: CRPP and ORIF both yield good outcomes for pediatric LCHFs with >2 mm displacement. CRPP offers advantages like shorter surgery, no scarring, and avoiding additional procedures
Functional recovery and quality of life after surgical fixation of segmental femoral shaft fractures: a case series from India
Get PDFSegmental femoral shaft fractures, which are often a result of high-energy trauma, pose significant challenges in management and rehabilitation. This case series presents twelve male patients (mean age 40 years, range 28-52) with segmental femoral shaft fractures treated between October 2022 and March 2023 at tertiary care centers in Tamil Nadu, India. Surgical fixation methods included intramedullary interlocking nails (58.3%), locking plates (25%), and other constructs (16.7%), with all patients undergoing open reduction. Functional recovery and quality of life were assessed using WOMAC, EQ-5D-3L, and SMFA scores at 1, 3, and 6 months postoperatively. Significant improvements were observed across all measures, with mean WOMAC scores decreasing from 55.6 (±6.5) to 18.2 (±5.9), EQ-5D-3L scores improving from 0.62 (±0.10) to 0.91 (±0.06), and SMFA dysfunction index decreasing from 41.4 (±5.3) to 12.6 (±3.9) over six months. Radiological union was achieved in 33.3% of cases at 3 months and in all remaining eleven patients (one lost to mortality from associated injuries) by 6 months, with a mean union time of 23.7 weeks. This case series demonstrates that appropriate surgical fixation of segmental femoral shaft fractures can yield favorable functional outcomes and quality of life improvements, with complete radiological union achievable within six months in this challenging fracture pattern
A study on factors affecting the functional outcome in patients with soft tissue sarcoma: experience from a tertiary care centre
Get PDFBackground: Soft tissue sarcoma (STS) patients undergoing surgery may experience reduced functional outcome compared to the general population. The aim of this study is to evaluate the functional outcome and to determine important predictive factors that affect the post-operative functional outcomes in patients who had undergone surgery for STS.
Methods: Authors retrospectively analysed patients who had undergone surgery between January 2016 to November 2023, in our institution and assessed for post-operative functional outcomes, at the end of 6 months and one year. To evaluate the functional outcomes, Musculoskeletal Tumor Society Score (MSTS) was used. Established predictive factors like age, size of the tumor and time since surgery were analysed with Multivariate regression analysis.
Results: In the study, a total of 51 patients were assessed with median age of 50 yrs. Age (MSTS score–80 versus 74, p=0.01), size of the tumor (MSTS score–79 versus 74, p=0.03). Time since surgery (significant linear association between functional scores at the end of 6 months and one year, p value=0.0004) were identified as significant predictive factors. Patients who are younger than 40 years, tumor less than 10 cm have better functional outcomes.
Conclusion: Functional outcomes in patients who underwent surgery for STS, improve with time. Patients can be reassured that final functional outcome will be better than early post-operative outcome. Age of the patient, size of the tumor and time since surgery were the most consistent and significant determinants of functional outcome
A study of factors which influence the outcome in fracture dislocations of proximal humerus treated by open reduction and internal fixation with philos plate
Get PDFManagement of proximal humerus fracture dislocation is challenging owing to the possibility of multiple complications including avascular necrosis. Literature remains controversial regarding the mode of management Osteosynthesis vs arthroplasty and the pros and cons of one over the other, particularly in elderly age groups. This is a case series include 20 patients admitted with proximal humerus fracture dislocation and were treated with open reduction internal fixation with proximal humerus internal locking osteosynthesis systems (PHILOS) plate. Post operatively, serial X-rays were taken at post-operative day 1, 1 month, 6 months and at 1 year to assess the union. Clinically patients were assessed with constant Murley score at the end of 1 year. The mean constant-Murley score at the end of 1 year was found to be 70.8 with 86 being the highest and 42 being the least and it has a strong negative correlation with increasing age. 5% of the patients developed avascular necrosis and remaining 95% united well. The result also shows that the chances of occurrence of AVN humeral head is proportional to the duration of surgery since injury. We conclude that osteosynthesis for proximal humerus fracture dislocation gives good outcome including the elderly patients. Early fixation, anatomic reduction, meticulous placement of implant and minimal soft tissue stripping and adherence to appropriate and regular rehabilitation program can give better functional outcome irrespective of the age of the patient. The learning curve with the implant chosen and surgeon’s skill play a major role in the final outcome
Functional outcome of varus derotation osteotomy in late presenting Perthes disease: a case series
Get PDFLate-onset Perthes disease, particularly in children older than nine years, is known to have a more aggressive course and a less favorable prognosis, often progressing to osteoarthritis by the fourth decade of life if left untreated. While younger children are usually managed conservatively, and those aged 6-9 years may benefit from surgical intervention, the optimal treatment strategy for children aged 8 years and above remains controversial. This case series evaluates the clinical and radiological outcomes of varus derotation osteotomy (VDRO) in 12 children (10 males, 2 females) with a mean age of 9.4 years, treated at the Department of Orthopaedics, Government Medical College, Kota, between 2020 and 2025. All patients were classified as stage IB, IIA, or IIB based on the modified Elizabethtown classification and presented with restricted hip abduction and internal rotation. Hip pain was reported in 58.33% of cases, and 75% had a limp. VDRO was performed approximately three weeks after diagnosis. Five patients (41.67%) were older than 10 years at presentation. Outcomes were assessed at an average follow-up of 3.4 years. Radiological evaluation included the caput index (CI), epiphyseal quotient (EQ), and articulotrochanteric distance, while clinical assessment used range of motion and the Harris Hip Score. Significant improvements were observed in CI (p=0.000) and EQ (mean postoperative value 0.606; p=0.0000). Favorable results were seen in all patients with stage IB and IIA disease, and in 50% of those with stage IIB. VDRO appears to be an effective option for late-presenting Perthes disease in this age group
Short-term results of synovectomy and total knee arthroplasty in patients with diffuse-type pigmented villonodular synovitis
Get PDFBackground: Diffuse-type pigmented villonodular synovitis (D-PVNS) is a rare, benign proliferative condition that affects the knee joint, often leading to subchondral bone erosion, cyst formation, and ultimately secondary osteoarthritis. This study aimed to assess the short-term clinical outcomes of synovectomy combined with total knee arthroplasty (TKA) in patients diagnosed with D-PVNS.
Methods: This study was conducted in the department of orthopaedics at government medical college, Kota, between 2020 and 2025, 28 patients with histopathologically confirmed D-PVNS of the knee underwent synovectomy followed by TKA. Clinical and operative data were recorded perioperatively and throughout follow-up to evaluate surgical effectiveness.
Results: There were no intraoperative complications. The mean operative time was 73.4 minutes (range: 47-115 minutes), and the average estimated blood loss was 223.9 mL (range: 50-600 mL). Patients were followed up for an average of 58.7 months (range: 36-84 months). Range of motion improved from a mean of 86.1°±11.3° preoperatively (range: 60°-100°) to 107°±11.4° postoperatively (range: 90°-130°). The average knee society clinical score increased from 38.9±9.5 to 84.4±6.1, while the functional score improved from 48.9±13.1 to 84.6±6.1 (p<0.05). Postoperative radiographs revealed no signs of prosthesis loosening, dislocation, or periprosthetic fracture.
Conclusions: Synovectomy combined with total knee replacement offers favorable short-term outcomes in managing D-PVNS of the knee, with significant improvements in joint function and stability and no major complications observed during follow-up
Unusual combination of Bado type I Monteggia lesion and ipsilateral humerus lateral condyle fracture with intercondylar extension in an adult following high velocity trauma: a case report
Get PDFMonteggia fracture dislocation is a rare injury pattern which accounts for less than 2% of all forearm fractures (in both adults and children) and accounts for 0.7% of all elbow fractures and dislocations in adults. The present case involves a 22-year-old male with Bado type I Monteggia fracture dislocation with ipsilateral lateral condyle humerus fracture with intercondylar extension with no distal neurovascular deficits which is the first case to be reported in literature to the best of our knowledge. A successful outcome was achieved due to early diagnosis, anatomical reduction, stable internal fixation and early mobilization. This case report aims to highlight this rare presentation and in adding data to literature for describing this injury pattern in Bado type I equivalents. These injuries require a comprehensive clinical and radiological evaluation for diagnosis as well as management
Anterior cruciate ligament allografts and low-dose gamma irradiation: a systematic review
Get PDFAnterior cruciate ligament (ACL) rupture is a common injury requiring surgical reconstruction in active patients. Autografts are considered the gold standard due to superior early biomechanical performance, but allografts offer advantages such as reduced operative time and elimination of donor-site morbidity. Irradiation is the primary sterilisation method; however, high doses impair mechanical integrity. Low-dose irradiation has been proposed to preserve graft strength while ensuring sterility. A systematic review was performed using EMBASE, PubMed and Scopus, supplemented with backward snowballing. Cohort and randomised studies comparing low-dose irradiated allografts to autografts in vivo were included. Primary outcomes were graft failure/revision rates, knee laxity (KT-1000/2000, Lachman, pivot shift) and patient-reported measures (IKDC, Lysholm). Eight studies comprising over 10,000 patients were included. Autografts demonstrated lower graft failure rates in younger (<22 years) patients, with revision rates of 10.1% for allografts vs. 2.9% for autografts. In older cohorts, outcomes were largely equivalent. Arthrometric testing showed greater knee laxity with allografts, but this did not consistently translate into differences in patient-reported outcomes. Return-to-sport was faster with autografts, reflecting earlier graft incorporation, while long-term outcomes converged once allografts remodelled. Autografts remain the graft of choice for younger, high-demand patients due to superior early stability and lower revision rates. Low-dose irradiated allografts may represent a viable alternative in older or less active populations. High-quality, prospective studies with standardised protocols are required to clarify long-term efficacy and guide graft selection
Radiation safety in orthopaedic surgery: educational guidelines for surgeons using X-rays and C-arm fluoroscopy
Get PDFOrthopaedic surgeries frequently rely on intraoperative imaging, particularly X-rays and C-arm fluoroscopy, to enhance procedural accuracy. However, these modalities expose surgeons and operating theatre personnel to ionizing radiation, leading to both immediate and long-term health risks. Despite the availability of protective measures and the ALARA (As low as reasonably achievable) principle, adherence to radiation safety in orthopaedics remains suboptimal. This review highlights radiation hazards in orthopaedic practice and presents practical, evidence-based strategies for minimizing occupational risk. A comprehensive literature review was performed, focusing on intraoperative radiation exposure in orthopaedics, its biological effects, and preventive measures. International radiological safety guidelines, surgical protocols, and recent orthopaedic studies were analyzed, with emphasis on practical recommendations for operative settings. Ionizing radiation can cause deterministic effects (cataracts, skin injury) and stochastic effects (malignancy, infertility, genetic mutation). Key strategies to reduce exposure include minimizing fluoroscopy time, increasing distance from the source, using shielding devices, adopting pulsed fluoroscopy, and optimizing C-arm positioning. Pregnant staff require additional precautions such as double dosimetry and modified work schedules. Despite the availability of personal protective equipment (PPE), lack of structured education and poor compliance remain major challenges. Radiation exposure during orthopaedic procedures is a preventable occupational hazard. Strict enforcement of safety protocols, adequate PPE, routine training, and institutional monitoring are essential to protect surgeons and operating teams