International Journal of Research in Orthopaedics
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Prevalence of spin reporting bias in hip labrum reconstruction: a qualitative assessment of systematic reviews and meta-analyses
Get PDFHip labral reconstruction is an evolving technique to treat labral pathology. Spin is a recent concept that is defined as a reporting bias that misrepresents research. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding acetabular labral reconstruction. Electronic libraries were queried for meta-analyses and systematic reviews regarding hip labrum reconstruction. The nine most severe types of spin found in abstracts were used as an evaluation tool. Two reviewers each performed a blinded assessment of each article for spin. A third reviewer was used to address any discrepancies between the original reviewers. Other variables evaluated include number of citations, journal impact factor, reported conflicts of interest (COI), adherence to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodologic quality according to a measurement tool to assess systematic reviews (AMSTAR-2). The electronic database search resulted in 1,148 articles, of which 10 met inclusion criteria. Of these 10 articles, 70% (7/10) were found to have at least one form of spin present, 20% (2/10) contained 3 different types of spin, 30% (3/10) contained 2 different types of spin, and 20% (2/10) contained 1 type of spin. The most common type of spin found was type 5, “conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in the primary studies,” which was found in 60% (6/10) of the articles. When assessing AMSTAR-2 score, 90% (9/10) of the articles were found to be ‘low quality’ or ‘critically low quality.’ Spin was present in 70% of the abstracts of meta-analyses and systematic reviews pertaining to hip labrum reconstruction. Recognition of spin is crucial for orthopaedic surgeons. Improved guidelines should be considered to reduce the prevalence of spin in orthopaedic literature
Osteochondroma of the distal tibia with associated varus deformity of ankle
Get PDFOsteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. The most common site is the distal femur followed by the proximal humerus and proximal tibia. It is made up of a bony protrusion that is covered by a cartilage cap. Osteochondroma is asymptomatic and grows away from the nearby joint. It is very common in kids and young adults. Sometimes patient comes in 2nd decade with complaints of pain and swelling. This paper reports a presentation of osteochondroma present over the right distal tibia
Can tip-apex distance and calcar reference tip-apex distance predict lag screw cut-out in elderly patients with trochanteric femoral fractures treated with gamma3 nails
Get PDFBackground: The most common complication of cephalomedullary nail fixation for femoral fractures is lag screw cut-out. The significance of the tip-apex distance (TAD) in predicting lag screw cut-out is still debated. There has been no study conducted on the calcar reference tip-apex distance (CalTAD) regarding its impact on lag screw cut-out. To compare the average TAD and CalTAD between groups with and without lag screw cut-out and to determine the TAD and CalTAD values associated with the highest risk of lag screw cut-out.
Methods: This was a prognostic prediction study utilizing a retrospective cohort of 756 patients with trochanteric femoral fractures treated with Gamma3 nails. This study compared the differences in TAD and CalTAD values between the two groups.
Results: The group without lag screw cut-out had lower TAD and CalTAD values compared to the group with lag screw cut-out (TAD; 20.3±5.3 mm vs. 22.1±5.7 mm; p=0.044); (CalTAD 22.3±4.4 mm vs. 25.2±5.3 mm; p<0.001). The cutoff points of TAD >23 mm and CalTAD >25 mm were associated with the highest risk of lag screw cut-out (TAD: OR, 2.91; 95% CI, 1.47-5.77; p=0.002); (CalTAD: OR, 3.43; 95% CI, 1.73-6.80; p<0.001).
Conclusions: The lag screw cut-out group had higher TAD and CalTAD values. TAD values greater than 23 mm and CalTAD values greater than 25 mm were associated with the highest risk of lag screw cut-out
Fibrodysplasia ossificans progressiva: a comprehensive review
Get PDFFibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder that causes heterotopic ossification of soft tissues, leading to abnormal bone growth in muscles, tendons, and ligaments. First identified in the 17th century, FOP was classified in 1968 and is linked to a mutation in the Activin A receptor type I gene (ACVR1) which affects bone morphogenetic protein (BMP). The autosomal dominant condition FOP has the potential to lead to aberrant bone development. At birth, FOP individuals appear normal, except for characteristic malformations of the great toes. FOP patients develop painful, inflammatory soft tissue swellings during the first decade of life, often precipitated by soft tissue injury. Minor trauma can trigger new flare-ups and leads to progressive heterotopic ossification. Most FOP sufferers are wheelchair-bound by their third decade and needs lifelong assistance with daily living tasks. Bone morphogenetic proteins (BMPs) are bound by the transmembrane kinase receptor ALK2, which is encoded by the (ACVR1/ALK2 gene). FOPs induce heterotopic bone formation in skeletal muscle and can be caused by mutations in the activin A receptor type I (ACVR1) and activin-like kinase 2 (ALK2) gene. Clinical therapy focuses on preventing and controlling inflammation, with ongoing research focusing on specific therapies targeting receptor activity, aberrant pathways, or cellular components influencing bone neo-formation
Statistical analysis of total hip arthroplasty at rural hospital in Maharashtra under MJPJAY: a prospective study
Get PDFBackground: Total hip arthroplasty (THA) is one of the most common orthopedic surgeries globally, particularly in Western countries. In India, its prevalence has increased over the last two decades. However, most data on THA are from Europe and the United States. This study analyzes the clinical and demographic characteristics of patients undergoing uncemented THA at a rural hospital in Maharashtra, India, under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).
Methods: A prospective study was conducted in the Department of Orthopedics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from January 2020 to October 2022. A total of 123 patients (130 hips) who underwent uncemented THA, were included. Patients were categorized by age, gender, and primary indication for surgery. Preoperative evaluations, radiographic analysis, and postoperative follow-ups assessment of pain, range of motion, and complications were done.
Results: The mean age of patients was 40.32±12.53 years, with males (85.36%) outnumbering females (14.64%). Bilateral hip involvement was seen in 56.9% of cases and osteonecrosis of the femoral head was the most common indication (89.23%), with 57.6% idiopathic, 12.3% alcohol-related and 6.1% steroid-induced. The complication rate was 3.8%, with dislocation being the most frequent (2.1%). Revision surgeries performed in 2.1% of cases.
Conclusions: THA under MJPJAY demonstrates comparable clinical outcomes to international standards. Idiopathic osteonecrosis remains the leading cause, with a male predominance. Standardized protocols for the Indian population are needed
Utility of distal palmar flap in the reconstruction of distal thumb injury
Get PDFSelecting the most appropriate technique for thumb reconstruction depends on multiple factors, including level of injury, status of the remaining hand, age, occupation, overall health, and functional demands of the patient. In this study we used distal palmar flap for reconstructing distal tissue loss of thumb in patients. It was noted that such defects could be treated effectively with regional flap i.e. distal palmar flap, which gives good aesthetic outcome and patient satisfaction, Patient satisfaction was found to be better with palmar crease flap for smaller defects than larger defects, however all of the patients graded satisfaction as good (80%) and very good (20%). Distal palmar flap is a good reconstructive method for thumb reconstruction, as it an easier and non-microvascular technique which retains the thumb length, colour, vascularity and appearance of thumb. Thus, can be safely advocated for use as it has no significant complications associated with the technique
Tackling the challenge of 90-day readmissions in hip fracture management: a retrospective study
Get PDFBackground: Hip fracture readmissions within 90 days pose a significant challenge in orthopaedics, burdening healthcare systems and affecting patient outcomes. This study, set against the backdrop of an aging population and rising hip fracture incidences, seeks to analyse the factors contributing to these readmissions and propose viable management strategies.
Methods: Conducted as a single centre study at a hospital which is part of the NHS UK, this retrospective study reviewed 1264 patients treated for neck of femur (NOF) fractures between April 2020 and December 2022. Data on patient demographics, comorbidities, surgical interventions, and readmission reasons were collected and analysed using descriptive statistics and multivariable logistic regression.
Results: The study found a 21.8% readmission rate, with the majority being for non-orthopaedic reasons such as infections and cardiovascular events. Age and comorbidities were significant predictors of readmission, while surgical factors had a less pronounced impact. A year-wise trend showed a peak in readmissions during the COVID-19 pandemic.
Conclusions: The findings emphasize the complexity of managing NOF fractures and the importance of a comprehensive, multidisciplinary approach to care. Targeted interventions, including orthogeriatric co-management and falls assessment, are recommended to mitigate readmission risks and enhance patient care, though further research is needed for more definitive strategies
A comparative study of intraarticular versus subacromial corticosteroid injection in the treatment of frozen shoulder
Get PDFBackground: Frozen shoulder or adhesive capsulitis, is a condition characterized by pain and restricted movement of the shoulder joint. Corticosteroid injections are commonly used to alleviate symptoms, but the optimal injection site remains debated. This comparative study aims to evaluate the efficacy of intraarticular versus subacromial corticosteroid injections in treating frozen shoulder.
Methods: This prospective, randomized controlled study was conducted over 12 months, from November 2022 to October 2023, at Bangalore Medical College and Research Institute, Bangalore. A total of 60 patients diagnosed with adhesive capsulitis were enrolled and randomized into two groups: 30 patients in the intraarticular (IA) injection group and 30 patients in the subacromial (SA) injection group. Patients were randomly assigned to either the IA group or the SA group. The IA group received a 40 mg injection of Triamcinolone Hexacetonide with 4 ml of 2% lidocaine into the glenohumeral joint. SPSS (Version 25.0) was used for analysis.
Results: Patients in the intraarticular group demonstrated significantly lower pain scores compared to those in the subacromial group at the 4th, 8th and 12th weeks (p<0.05). The intraarticular group consistently achieved higher Constant Shoulder Scores at 4, 8 and 12 weeks, suggesting a more effective recovery in shoulder function compared to the subacromial group.
Conclusion: This study demonstrates that intraarticular corticosteroid injections are more effective than subacromial injections in treating patients with frozen shoulders, particularly in terms of pain relief and functional improvement
From numbness to diagnosis: a case of median nerve schwannoma
Get PDFSchwannomas are a common entity, but upper limb schwannomas are rarely encountered. Even in hand, ulnar nerve schwannomas are more commonly reported than median nerve schwannomas. Hence, we present a case report of median nerve schwannoma in a 54-year-old woman. She presented with a benign swelling of 3 cm associated with numbness and pain. On examination, Tinels sign was positive. MRI revealed a well-defined swelling that was hypointense on T1 and hyperintense on T2 STIR images. The swelling was marginally excised, and histopathology revealed the presence of Antoni A and B cells, consistent with Schwannoma. The patient was completely asymptomatic at 1-month follow-up. This case report stands as a testament to how early diagnosis and treatment can help in alleviating the physical as well as psychological stress in such patients
Musculoskeletal simulation for patient transfer using hand load measurement device
Get PDFBackground: Unsuitable posture in patient transfer motion causes lower back pain (LBP) among caregivers. The suitable postures to reducing lumbar loads during patient transfer are investigated by musculoskeletal simulation. However, existing musculoskeletal simulation cannot accurately predict lumbar loads because the existing musculoskeletal models are generated by only motion data. Thus, this study aimed to propose and evaluate an accurate musculoskeletal model using hand load data obtained from a hand load measurement device.
Methods: Motion and hand load data for the musculoskeletal model were measured during patient transfer by an inertial measurement unit (IMU)-based motion capture system and hand load measurement device. The existing model without using hand load data and the proposed model using hand load data predicted the activity of the erector spinae muscles and the compressive force of L4-L5. The correlation of erector spinae muscle activity was compared between the predicted and ground truth (surface electromyography) values. Furthermore, predicted compressive forces of L4-L5 were compared with reference value reported by previous study related to in vivo intradiscal pressures measurement.
Results: The proposed model could predict erector spinae muscle activity with a correlation that was significantly greater than that of the existing model (p<0.05). Furthermore, the proposed model could predict compressive forces of L4-L5 with approximate values close to in vivo intradiscal pressures measurement.
Conclusions: Proposed musculoskeletal model may more accurately predict lumbar loads during patient transfer than the existing model. Proposed musculoskeletal model will be applied to explore suitable postures for preventing LBP