International Journal of Research in Orthopaedics
Not a member yet
2153 research outputs found
Sort by
Clinical and functional outcomes of proximal femoral nailing in proximal femur fractures: a prospective study of 100 cases
Get PDFBackground: Intertrochanteric fractures are common in elderly osteoporotic patients and carry high morbidity and mortality if not treated adequately. Proximal femoral nailing (PFN) has been developed to overcome limitations of extramedullary fixation devices. Objectives were to evaluate functional and radiological outcomes of PFN in proximal femur fractures.
Methods: A prospective study of 100 patients with intertrochanteric femur fractures was conducted between March 2022 and July 2024. Patients were treated with PFN and followed up for 6-18 months. Functional outcome was assessed using the Harris hip score (HHS).
Results: The mean patient age was 648. years (28-95 years). Left-sided fractures (57%) were more common than right (43%). 68% fractures were unstable (Evan’s classification). Average interval from injury to surgery was 42 days, mean operative time 85 minutes. At one-year follow-up, 66% had excellent, 19% good, 10% fair, and 5% poor outcomes (mean HHS: 8882.). Complications occurred in 15% cases. No non-union was observed.
Conclusions: PFN is a reliable fixation method for intertrochanteric fractures, offering stable fixation, early mobilization, and favorable functional outcomes with minimal complications
Clinical and radiological outcomes in treatment of Lichtman stage IIIB Kienböck’s disease by scaphocapitate fusion: hospital based prospective interventional study
Get PDFBackground: This investigation assessed the effectiveness of scaphocapitate (SC) arthrodesis with lunate preservation in treating patients with stage IIIB Kienböck's disease, characterized by neutral ulnar variance. Additionally, the study sought to identify potential differences in treatment outcomes among patients with stage IIIB Kienböck's disease.
Methods: A total of 38 patients with stage IIIB Kienböck's disease underwent scaphocapitate arthrodesis, stabilized using Herbert compression screws. Each participant underwent comprehensive pre- and post-operative evaluations, including assessments of pain (VAS score), range of motion (ROM), grip strength and functional outcomes (DASH score and PRWE score).
Results: The mean follow-up period for all patients was 17.81 months. Bony union was achieved at an average of 14 weeks, with most patients returning to work within 24 weeks. Comparing pre- and post-operative outcomes, significant improvements were observed: VAS scores decreased from 39.34 to 15.53, grip strength increased from 18.03 to 29.47% and the RS angle was corrected from 84.08° to 59.34°.
Conclusions: This study demonstrates that surgical intervention can significantly enhance wrist mobility, increase grip strength and alleviate pain, ultimately facilitating patients' return to a higher level of functional ability and overall well- being.
Surgical drains following arthroplasty: a systematic review and summary of evidence based on available systematic reviews
Get PDFThe use of surgical drains following arthroplasty is an age-old practice, but has declined in popularity in recent times. Various aspects pertaining to their safety and efficacy have been studied in the past, in focused studies and systematic reviews. The present research aimed to review and summarize the high-quality evidence on the subject. A described methodological framework for conducting a “systematic review of systematic reviews” was chosen, and reporting was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Following a search in the PubMed/Medline and PubMed Central indexing databases, a total of 34 systematic reviews with or without meta-analyses were included. Our research unequivocally indicates that routine drain application is not associated with a reduction in the incidence of postoperative hematoma formation or limb swelling, though it unambiguously results in a significant reduction in the incidence of surgical site erythema and ecchymoses, and the need to change wound dressings postoperatively. This benefit, however, comes at the expense of the possibility of increased blood loss, transfusion requirement, and time to functional recovery, as well as the deterrence to a full implementation of the principles of “enhanced recovery after surgery” protocols and day-care surgery. Where drains are deemed inevitable, the practice of intermittent clamping can mitigate the magnitude of blood loss, while autologous re-transfusion drains may reduce blood transfusion requirements
Prevalence and treatment outcomes of incidental dural tears in lumbar spine surgery
Get PDFBackground: Incidental dural tears (IDT) are common in lumbar spine surgery, varying in prevalence due to patient factors, pathology, and surgical techniques. They may cause cerebrospinal fluid leakage, headaches, and delayed recovery. Proper identification and management are essential for favorable outcomes. This study aimed to evaluate the prevalence and treatment outcomes of incidental dural tears.
Methods: This study was conducted at the Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) and Sylhet M.A.G. Osmani Medical College, Sylhet, Bangladesh from January 2023 to December 2024, using purposive sampling. A total of 86 patients undergoing lumbar spine surgery were included, excluding those with infections or malignancies. Incidental dural tears and treatment outcomes were analyzed using SPSS Version 23, with significance set at p<0.05.
Results: The prevalence of IDT in lumbar spine surgery was 15.1%. The IDT group consisted of 84.6% males, 23.1% patients aged ≤30 years, and 53.8% with previous spinal surgery. The IDT group had longer operation times (197.4±37.7 minutes), longer hospital stays (10.5±2.1 days), and higher drainage volumes (266.7±28.9 ml). Post-operative complications, including wound infections (23.1%) and headaches (30.8%), were more common in the IDT group.
Conclusions: IDT occur in 15.1% of lumbar spine surgeries. Risk factors include male gender, younger age, and previous spinal surgery. IDT is linked to longer operation times, extended hospital stays, higher drainage volumes, and increased post-operative complications
Precision vs. tradition: evaluating alignment accuracy and functional outcomes in robotic vs. conventional total knee arthroplasty
Get PDFBackground: Total knee arthroplasty (TKA) is the treatment of choice in severe osteoarthritis (OA) knee. Robot-assisted TKA (RA-TKA) promises superior precision and personalized bone resection and alignment, whereas conventional TKA (C-TKA) relies on manual alignment techniques. This randomized controlled trial compares alignment accuracy and short-term functional outcomes between the two modalities.
Methods: 100 patients with bilateral knee OA were randomized to RA-TKA (n=50) or C-TKA (n=50). Postoperative mechanical alignment (hip-knee-ankle (HKA) angle) and functional outcomes (new knee society score (NKSS) and forgotten joint score (FJS)) were assessed at 6 months.
Results: RA-TKA achieved significantly better alignment, with 82% of patients within±3° of the target HKA angle compared to 64% in C-TKA (p<0.01). However, functional outcomes were comparable: KSS (RA-TKA: 205.42±6.52 vs. C-TKA: 205.4±7.94, p=0.989) and FJS (RA-TKA: 88.6±4.07 vs. C-TKA: 88.92±4.16, p=0.662).
Conclusions: RA-TKA offers improved alignment accuracy over C-TKA but does not confer superior short-term functional outcomes. Despite achieving more precise mechanical alignment, no significant differences in key functional scores are observed within six months postoperatively. The potential long-term benefits of this improved alignment, such as increased implant longevity or reduced wear, remain unconfirmed and warrant further investigation in studies with extended follow-up
Radiological and functional assessment of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach: a hospital-based observational study
Get PDFBackground: Tibial shaft fractures are among the most frequently encountered long bone injuries. Due to limited soft tissue coverage and subcutaneous location, the tibia is prone to complications such as non-union, infection and malalignment. The suprapatellar approach for intramedullary nailing has recently gained favour for its potential benefits over the traditional infrapatellar method, reducing anterior knee pain and facilitating easier intraoperative imaging. The aim of this study was to assess the radiological and functional outcome of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach.
Methods: This prospective observational study was conducted in the Department of Orthopaedics, National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh, from March 2022 to March 2023. Total 33 patients with closed tibial shaft fractures were included in the study.
Results: The study included 33 patients (mean age 38.3±11.6 years), predominantly male (69.7%). Right-sided fractures were more common (60.6%). Most injuries (81.8%) were due to motor vehicle accidents. AO type 42A fractures were most frequent (54.5%). Anterior knee pain was minimal, with a mean VAS of 0.5. Radiological union occurred in 90.9% within 21 weeks (mean 17.9±3.5). Complications were rare (12.1%). Most patients achieved a ROM of 130–139°, with fair to good functional outcomes in over 90% of cases.
Conclusions: Suprapatellar nailing offers a reliable and minimally painful solution for managing closed tibial shaft fractures with favourable radiological and functional outcomes
Surgical challenges in total hip replacement after failed proximal femoral osteosynthesis: two case reports
Get PDF
Conversion total hip arthroplasty (THA) after failed proximal femoral osteosynthesis is a technically demanding procedure due to altered anatomy, poor bone quality, retained hardware and risks of intraoperative complications like stem perforation and periprosthetic fractures. A 60 years old hypertensive female presented with pain and limited mobility two years after undergoing proximal femoral nailing for an intertrochanteric fracture. Imaging revealed malunion and avascular necrosis (Ficat and Arlet Stage 4). She underwent hybrid THA, complicated by stem perforation. Revision THA with a long uncemented stem and trochanteric osteotomy was performed. Postoperatively, she developed wound gaping and sterile serous discharge, managed successfully with VAC therapy and debridement. A 44 years old male with prior bilateral subtrochanteric fracture fixation presented with left hip pain and avascular necrosis. Following implant removal, uncemented THA was done but complicated by stem perforation through a prior lag screw hole. Revision THA with corrected trajectory using the same stem was performed. Recovery was uneventful. THA following failed internal fixation carries higher risks than primary THA due to distorted anatomy and implant-related challenges. Intraoperative adaptability, use of long-stem prostheses and meticulous wound management were essential in both cases. Fluoroscopic guidance and preoperative planning helped manage complications effectively. Conversion THA after failed fixation presents significant technical challenges. However, with individualized surgical strategies and diligent perioperative care, satisfactory outcomes can be achieved.
Clinical profile and surgical outcomes of displaced supracondylar humeral fractures in children
Get PDFBackground: Supracondylar humeral fractures are the most common elbow injuries in children, frequently resulting from low-energy trauma such as falls on an outstretched hand. Displaced fractures often require surgical intervention due to risks of neurovascular compromise and functional impairment. Understanding patient demographics, fracture types and treatment outcomes is essential for optimizing care. The aim of this study was to assess the clinical profile and surgical outcomes of displaced supracondylar humeral fractures in children.
Methods: This cross-sectional observational study was conducted at the Department of Orthopaedics, Shaheed Ziaur Rahman Medical College Hospital and Ibn Sina Diagnostic Centre, Bogura, Bangladesh from February 2025 to July 2025. Total 64 pediatric patients diagnosed with displaced supracondylar humeral fractures were enrolled in the study.
Results: In this study, mean (±SD) age was 9.2±3.5 years and majority patients (65.6%) were male. Most injuries were sustained from falls on an outstretched hand (84.4%) and 62.5% were classified as Gartland type III fractures. Closed reduction with percutaneous pinning (CRPP) was performed in 81.3% of cases, while 18.7% underwent open reduction. According to Flynn’s criteria, 59.4% achieved excellent outcomes, 28.1% good, 9.4% fair and 3.1% poor. Complications were minimal, with only 15.6% experiencing issues such as pin tract infections, nerve palsy or malunion.
Conclusions: Displaced supracondylar humeral fractures in children can be effectively managed with timely surgical intervention, particularly using CRPP. Most patients regain excellent to good elbow function, with a low rate of complications, reinforcing the safety and efficacy of current surgical protocols
Unmasking the curve: is growth hormone therapy a silent contributor to pediatric scoliosis: a systematic review
Get PDFGrowth hormone (GH) therapy is used to promote growth in pediatric short stature conditions, including idiopathic short stature (ISS), growth hormone deficiency (GHD), and Turner syndrome. Concerns have arisen regarding potential associations between GH treatment and the development or progression of scoliosis, particularly when used off-label in ISS. A systematic review following PRISMA guidelines was conducted and registered in PROSPERO (CRD420251069349). Searches were performed across PubMed, Scopus, Embase, and Web of Science through July 2025. Studies evaluating scoliosis onset or progression during GH therapy in children were included. Data extracted encompassed GH dosage, treatment duration, patient demographics, scoliosis incidence, Cobb angle progression, and orthopedic outcomes. Quality assessments were performed using the Newcastle‑Ottawa Scale, Cochrane Risk of Bias, and AMSTAR‑2 tools. Studies involving over 3,000 children were analyzed. Scoliosis incidence ranged from 3% to 22%, with higher risk among boys, those experiencing rapid growth velocity, and syndromic conditions like Turner and Prader–Willi. Ziv‑Baran et al reported a hazard ratio of 2.12 (95% CI: 1.75–2.57; p<0.001) for scoliosis in GH-treated versus controls. Evidence from clinical and animal studies suggests that GH stimulates asymmetric vertebral growth via the GH/IGF‑1 axis. Although most scoliotic curves were mild and non-surgical, regular orthopedic surveillance was recommended. GH therapy in children, particularly for off-label ISS use, may increase risk for scoliosis onset or progression in at-risk subgroups. While overall orthopedic risk is low, early identification of predisposed patients and periodic radiographic monitoring-especially during rapid growth phases-is essential to ensure safe and individualized GH treatment
Pipkin fracture dislocation with ipsilateral lateral collateral ligament and medial collateral ligament avulsion injury-a rare case report
Get PDFPipkin fractures are complex femoral head fractures typically associated with posterior hip dislocation. Concomitant injuries of the knee ligaments, especially involving both the medial collateral ligament (MCL) and lateral collateral ligament (LCL), are exceedingly rare. Early diagnosis and coordinated management are critical to preserving joint function and preventing long-term complications such as osteonecrosis or instability. We report an unusual case of a high-energy trauma resulting in a Pipkin type II fracture-dislocation with ipsilateral LCL and MCL avulsion injuries