International Journal of Research in Orthopaedics
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Resident involvement in upper extremity fracture fixation impacts surgical time and hospital stay
Get PDFBackground: The purpose of this study was to evaluate the impact of resident post graduate year (PGY) on surgical outcomes and operative time for upper extremity fracture fixation ad associated complications.
Methods: Using the American college of surgeons’ national surgical quality improvement program (NSQIP) database, we conducted a query for all upper extremity fracture cases using current procedural terminology (CPT) codes outlined by the ACGME requirements for orthopaedic resident education. A total of 2,853 patients met inclusion criteria based on our initial query. Surgical complications and operative times were analyzed based on resident participation and PGY level. Linear regression models were used to assess the impact of resident training level on case duration and patient time in the OR.
Results: Average total operative duration was significantly longer in cases with residents compared to cases without (average operative duration was 86.57 without a resident compared to 116.21 with resident(s), p<0.001). As PGY year increased, operative case duration also increased. Calculations of change in operative duration per PGY year. Proximal humerus fractures 9.975-minute increase per year (p=0.042); Humeral Shaft Fractures 9.933-minute increase per year (p=0.023); elbow 7.558-minute increase (p=0.011); distal radius 2.969-minute increase per year (p=0.038). Resident involvement was also associated with an increased risk for intraoperative transfusions (p=0.019) but not with any other surgical complications.
Conclusions: For upper extremity fractures, there was a predictable increase in total operative time as PGY year increased. Resident involvement led to increased operative duration and patient time in the operating room
Letter to the editor: integrative approach to knee osteoarthritis management
Get PDFThe study provides compelling evidence supporting the synergistic benefit of combining physiotherapy with pharmacologic therapy for managing knee osteoarthritis (OA). The authors have appropriately highlighted that monotherapies-whether pharmacologic or rehabilitative-may offer limited benefit in comparison to a structured dual-modality approach
Functional outcome of the sinus tarsi approach in the treatment of intraarticular calcaneal fractures
Get PDFBackground: Intraarticular calcaneal fracture is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in thirty patients, all of which were managed by sinus tarsi approach an average follow-up period of 18 months. Though open reduction is prevailing, this technique also gives favorable outcome.
Methods: Thirty patients with intraarticular calcaneal fracture were managed by dorsal tarsi approach using between March 2023 to November 2025 were included in this series. All cases were treated with closed reduction. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted.
Results: Of the Thirty patients in the study, twenty-two were males and eight were females. The mean age was 40.4 years (range 18 to 65 years). Eighteen out of thirty patients (60%) had the dominant side fractured). The mean fracture union (radiological) time was 8 weeks (range: 6-12 weeks) and clinical union time was 8.5 weeks week. However, ankle function was excellent in 30 cases (100%).
Conclusions: This study confirmed a high overall rate of union and excellent functional outcomes sinus tarsi approach for a intraarticular calcaneal fractures give good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time-consuming method intraarticular calcaneal fracture. When the surgeon is experienced in the technique
Functional outcomes of acromioclavicular joint dislocation repair using the double Endobutton technique: a retrospective study
Get PDFBackground: A range of surgical techniques has been proposed for acromioclavicular (AC) joint dislocations. Traditional methods, including hardware fixation and non-anatomical reconstructions, are often associated with complications and high failure rates. Recent advancements focus on anatomical reconstruction of the coracoclavicular (CC) ligaments to improve outcomes. This study evaluates the clinical and radiological results of the double Endobutton technique, which reconstructs the trapezoid and conoid ligaments separately, in acute complete AC joint dislocations.
Methods: A retrospective study was conducted at government medical college, Kota, from December 2022 to December 2024, involving 40 patients with Rockwood type III to V injuries. Reconstruction was performed using double Endobuttons, Mersilene tape, and 5 Ethibond sutures through a vertical strap incision. The cohort comprised 18 type V, 6 type IV, and 5 type III injuries; 12 right-sided and 28 left-sided.
Results: Outcomes were assessed using the Constant score and disabilities of the arm, shoulder and hand (DASH) questionnaire at 6, 12, and 24 weeks postoperatively, along with radiological evaluations via Zanca and bilateral AP stress views. At final follow-up (mean: 12 months; range: 8-14), 36 patients had excellent outcomes, 2 had good, and 2 had fair results. The mean Constant score was 96 (range: 80-100) and the mean DASH score was 5.3 (range: 1-11).
Conclusions: The double endobutton technique offers favorable clinical and radiological outcomes, with effective anatomical reduction and functional restoration in most patients. It is a safe and reliable option for treating complete AC joint dislocations
A rare case of Monteggia fracture dislocation with distal radius epiphyseal injury in a 12-year-old male: case report and review of literature
Get PDFMonteggia fracture dislocation is a fracture of proximal ulna with dislocation of radial head. Its association with ipsilateral distal radius fracture is very rare and only ten cases have been reported in the English literature. Authors report a case of a 12 years old male, who sustained Monteggia fracture with ipsilateral distal radius epiphyseal injury following a fall while playing cricket. He was managed conservatively at a local centre elsewhere. As the fracture was found to be displaced, surgical fixation was done at our hospital. At 3 months follow up, the fracture was found to have united and the child had a good functional range of motion. Early diagnosis and one stage surgical management can lead to a satisfactory outcome even in these complex fracture dislocations
Case report of isolated lesser trochanter avulsion fracture
Get PDFAn isolated lesser trochanter avulsion fracture is a rare injury. It is of two types, true fracture which occurs only in adults or as epiphyseal separation which are found in adolescent population. It is caused by a sudden forceful eccentric contraction of the iliopsoas in an attempt to accelerate or decelerate the body. In this case report, 15 year old male football player presented with acute onset of pain while playing football, associated with difficulty in walking. On X ray, it was lesser trochanter avulsion fracture which was fixed with cortical screw with washer+ fibre wire+5 mm suture anchor. the outcome was good. The patient reverted to his obvious activities with normal range of movement. The minimal invasive surgical management have better outcome with faster healing, early mobilization, good range of hip movement
Inpatient temporal trends in open and minimally invasive sacroiliac joint fusions
Get PDFBackground: Lower back pain is a leading cause of disability worldwide, with sacroiliac joint dysfunction implicated in 15-30% of chronic cases. For this a sacroiliac joint fusion (SIJF) may be performed using either open or minimally invasive surgery (MIS) techniques. Prior to the introduction of unique ICD-PCS codes in 2015, there was limited data on the surgical variables for the different techniques. This study aims to evaluate open and MIS inpatient case trends from 2016-2020.
Methods: A retrospective analysis of the national inpatient sample database from 2016 to 2020 was conducted. Patients were identified using ICD-10 PCS codes for open and MIS SIJF procedures. Temporal trends and geographic distribution were analyzed, with demographic and procedural data compared using statistical tests including Mann-Kendall, t-tests, and Chi-square.
Results: Among 38,660 inpatient SIJF procedures, 34,590 were open and 3,890 were MIS. The procedures were primarily performed on females, identifying as white, Medicare payers and in urban teaching hospitals (p<0.001). No significant temporal trends in procedural volume were observed for open (p=0.807) or MIS (p=0.462) SIJF from 2016-2020. However, regional analysis revealed majority of the procedures taking place in the Southern region of the United States (p<0.001).
Conclusions: Inpatient SIJF volumes remained stable from 2016-2020, with most procedures performed in the South. These findings align with the increasing shift toward outpatient MIS SIJF, as inpatient volumes did not rise despite greater MIS adoption. Future studies should examine outpatient trends to further characterize this shift
Comparative analysis of proximal humerus internal locking system plating and external fixation in proximal humerus fracture management: a prospective study on functional outcomes
Get PDFBackground: The management of proximal humerus fractures presents challenges due to their intricate anatomy and varied fracture patterns in NEER’S type 3,4. This prospective study aimed to compare functional outcomes between proximal humerus internal locking system (PHILOS) plating and external fixation ((UMEX).
Methods: Fifteen patients in each group, classified as NEER type 3 and 4 fractures were included. Patient demographics showed no significant age or gender differences between the groups. Patients’ selection was randomized.
Results: Functional assessment using disabilities of the arm, shoulder, and hand (DASH) scores revealed superior outcomes in the external fixator group at 6 weeks (55.54±6.50 vs. 50.50±6.10), 3 months (66.91±5.34 vs. 61.67±7.08), and 6 months (77.83±2.79 vs. 65.29±5.15), with significant differences observed (p=6 weeks: 0.0370, 3 months: 0.0299, 6 months: <0.0001). Similarly, visual analogue score (VAS) scores demonstrated lower postoperative pain levels in the external fixator group at 6 weeks (2.85±1.21 vs. 4.14±1.10) and 6 months (0.33±0.52 vs. 1.00±0.58), with significant differences noted (p=0.0049 and p=0.0024). Furthermore, regarding range of motion, the external fixator group consistently outperformed the PHILOS group across all measured shoulder movements at 3 and 6 months, showing significant differences (abduction: p=0.0127, extension: p<0.0001, external rotation: p=0.0004, internal rotation: p=0.0002, flexion: p<0.0001).
Conclusions: These findings underscore the potential superiority of external fixation in achieving better clinical outcomes, lower pain levels, and improved range of motion compared to PHILOS plating in proximal humerus fracture management
Vancomycin in anterior cruciate ligament graft preparation; does it really reduce infection rate?
Get PDFBackground: The aim of our study is to evaluate how the incidence of septic arthritis or postoperative infection is affected by the use of vancomycin in preparation of grafts during anterior cruciate ligament (ACL) reconstruction.
Methods: This is a retrospective comparative study conducted between two groups, first group operated in the period from August 2017 to August 2018, second group operated in the period from December 2022 to December 2023. It focuses on the incidence of post-operative infection rate in ACL reconstruction surgeries. All patients who had ACL reconstruction were included, all surgeries were performed by a single surgeon at the same hospital with the same set up and consumables. Infection was defined as a return to the operating room for irrigation and debridement within 90 days after surgery.
Results: Total of 130 patients were included in the study, first group (vancomycin group) or second group (non-vancomycin group) no patients suffered from postoperative deep infection, neither on the immediate post operative follow up, nor at the end of their final follow up. Comparing the two groups, more revision anterior cruciate reconstructions included in the second group, yet no single case of infection took place in any of the two groups.
Conclusions: In conclusion we found no difference between adding vancomycin to the graft or not adding it, as both groups showed no infection.
Is robotic-arm-assisted total knee arthroplasty less traumatic? A meta-analysis
Get PDFObjective was to identify inflammatory responses that predict postoperative total knee arthroplasty (TKA) outcome. The robotic TKA has resulted decreased tissue trauma. This review aims to determine the level 1 evidence of inflammatory responses following robotic and conventional jig-based TKA as inflammatory markers provide an objective method for assessing the invasiveness of the surgery. A systematic search according to the guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) of the existing literature was performed on the electronic databases PubMed, Scopus and Ovid until the 1st of June 2023. Inclusion criteria were randomized controlled trials (RCTs), written in the English language and published in the last ten years, focusing on studies that evaluated the influence of inflammatory markers (O) on robotic TKA (I) and conventional jig based (C) TKA in end-stage knee osteoarthritis patients (P) were included in the study. The inverse variance method analyzed continuous outcomes as standard mean difference (SMD), random effect model and 95% confidence intervals (CI). In total, among the 557 articles, four studies were included. One hundred sixty-five patients were included, and various inflammatory markers and patient-reported outcome measures were analysed. This meta-analysis showed that R-TKA showed a decreased inflammatory response compared to C-TKA [interleukin (IL)-6 (Std. mean diff. {IV, random, 95 CI}=-1.22 {-1.78, -0.66}, C reactive protein (CRP) (-1.07 {-2.01, -0.13}, erythrocyte sedimentation rate (ESR)=-0.65 {-1.17,-0.12} with a significant p<0.05] with no significant changes in terms of patient-reported outcome measures Western Ontario and McMaster universities osteoarthritis index (WOMAC)=-0.25 {-0.59,0.09}, knee society score (KSS)=0.18 {-0.34, 0.70}, and functional outcome range of motion (ROM)=-0.22 {-0.62, 0.17} with a p>0.05. Robotic-arm-assisted TKA has decreased early postoperative inflammatory response. High powered studies assessing the predictive value of metabolic and inflammatory factors pre and post-surgery and the already evidenced risk factors with follow-up greater than one year after TKA are warranted