Indian Journal of Orthopaedics最新文献

Background: Acromioclavicular joint dislocation is a common shoulder injury, with chronic high-grade cases often requiring surgical intervention to restore stability. While reconstruction techniques are the standard approach for managing chronic dislocations, the role of hardware augmentation remains controversial. This systematic review compares the clinical outcomes of reconstruction alone versus hardware-augmented reconstruction in patients with chronic high-grade acromioclavicular joint dislocation.

Methods: We searched Cochrane Library, EMBASE, and Pubmed databases using the keywords "acromioclavicular joint," "dislocation," and "surgery" according to the MeSH index for English-language studies. We performed a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: Two authors independently reviewed 915 articles. 36 met the inclusion criteria, comprising 1013 patients who underwent reconstruction surgery and 57 patients who underwent reconstruction with hardware-augmented reconstruction surgery. The reconstruction group demonstrated higher Constant-Murley (88.2 vs. 85.6) and Subjective Shoulder Value scores (84.1 vs. 70) compared to the combination group. However, the combination group had a superior American Shoulder and Elbow Surgeons score (93 vs. 82). The complication rate was higher in the reconstruction group (16% vs. 12%). In comparison, the combination technique had a lower revision rate (4.5% vs. 5.86%).

Conclusion: This study compared treatment outcomes between reconstruction alone and hardware-augmented reconstruction, and it revealed that reconstruction alone is superior in functional outcomes. However, reconstruction augmented with a hardware-augmented reconstruction approach is superior in terms of lower complications and revision rates.

Background: Intertrochanteric (IT) fractures in the elderly are a major orthopaedic challenge due to osteoporotic bone quality, implant anchorage difficulties, and associated comorbidities. These factors contribute to nearly one-third mortality within a year of injury, representing a significant global health and economic burden.

Methods: Historically, stable IT fractures were treated with surface implants such as dynamic hip screws (DHS), whilst intramedullary (IM) implants like proximal femoral nails (PFN) were reserved for unstable patterns. Evidence from 1999 to 2010, including Cochrane reviews, supported this practice. However, recent studies and updated Cochrane data advocate intramedullary fixation for both stable and unstable fractures. The authors draw from their extensive experience on intertrochanteric fracture management, ten important principles on fixing intertrochanteric fractures using PFN.

Results: Current evidence supports the use of intramedullary implants as the preferred method for intertrochanteric fracture fixation. The authors concur with this trend and share practical tips to improve outcomes using PFN. Emphasis is placed on achieving optimal fracture reduction, which directly correlates with surgical success. Once adequate reduction is attained, a variety of intramedullary devices can effectively maintain alignment. These principles are presented as ten commandments in this article.

Conclusion: Intramedullary fixation, particularly with proximal femoral or trochanteric fixation nail (TFN) utilising a dual screw system, is recommended for both stable and unstable intertrochanteric fractures in the elderly. Despite the availability of single screw systems favoured for their ease of use, the authors maintain preference for the two-screw design due to enhanced stability. Surgical expertise in achieving and maintaining reduction remains paramount to successful outcomes.

Introduction: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a key patient-reported outcome measure designed to evaluate pain, stiffness, and physical function in knee osteoarthritis. Translating WOMAC into Kannada language would improve health care and research among Kannada-speaking patients. Hence, the study aimed to translate WOMAC into Kannada version of WOMAC (K-WOMAC) and test its psychometric properties.

Methods: WOMAC was translated into K-WOMAC using the standard Beaton guidelines, which involved forward and backward translations, a pre-final version review, an expert committee evaluation, and final administration. Fifty individuals with knee osteoarthritis (IKOA) were recruited to evaluate the scale's reliability and validity. Validation assessments included content validity, construct validity with varimax rotation, concurrent validity with Numerical Pain Rating Scale (NPRS), intra-rater and test-retest reliability, Bland and Altman method, standard error of measurement (SEM) and minimal detectable change (MDC), and floor and ceiling effects of K-WOMAC.

Results: Scale-level content validity index (S-CVI/Ave) of K-WOMAC is 0.97. The exploratory factors yielded 5 factors with 24 items of cumulative variance contribution rate of 78.7%. Concurrent validity of K-WOMAC with NPRS is ρ (rho) = 0.73; p < 0.001. The intra-rater and test-retest reliability of K-WOMAC are ICC = 0.87 and ICC = 0.65 respectively. Bland and Altman graph confirmed the level of agreement between the sessions. Standard error measurement (SEM) and minimum detectable change (MDC) are observed to be 9.9 and 25, respectively. However, there is no floor and ceiling effect in K-WOMAC.

Conclusion: English version of WOMAC is translated into Kannada language, K-WOMAC with acceptable psychometric properties.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01502-6.

Introduction: An open knee dislocation (OKD) is a severe injury associated with significant intra- and extra-articular injuries. Given the lack of consensus with existing literature, this study aims to systematically review the associated injuries, diagnostic and treatment approaches for OKDs.

Methods: Three databases (PubMed, Embase, Scopus) were searched in accordance with Preferred Reporting for Systematic Reviews and Meta-analysis (PRISMA) guidelines in April 2025. Studies involving case(s) of OKD with details of demographic, diagnostic and/or management approach were included.

Results: The search strategy yielded 20 studies (five case studies and 15 case reports), with a mean MINOR score of 9.9. Across all studies, there were 87 patients with a mean age of 38.5 (range 18-70) years. Male proportion was 73% and mechanism of action was high-energy trauma in all cases. The severity of ligamentous injury amongst 20 cases that were reported across 13 studies as classified by the Schenck Knee Dislocation (KD) classification was: 20% (4/20) KD-I, 10% (2/20) KD-II, 30% (6/20) KD-III and 40% (8/20) KD-IV. The proportion with associated meniscal injury, fracture, vascular compromise, neurological deficit, and post-injury infection was 67% (12/18), 60% (25/42), 31% (27/87), 39% (12/41) and 28% (22/78) respectively. An average of 1.58 debridements (range 1-11) was performed, with external fixation performed in 62% (23/37) cases after initial debridement. Outcomes remain heterogenous when compared against various factors.

Conclusion: OKD represents a severe injury associated with KDIII-IV ligamentous injuries. Prompt and thorough initial debridement plays a critical role in mitigating the risk of subsequent infection. Outcomes are variable due to heterogeneity in presentation. Additional studies are necessary to determine the optimal management approach.

Study design: Systematic review; Level of evidence, 4.

Background: The erector spinae (ES), one of the paraspinal muscles, is important in invasive procedures performed on the lumbar spine. There are a few data on magnetic resonance imaging (MRI) of this muscle and interspinous gap (ISG). This study aimed to measure bilateral ES thickness at L4-5 and L5-S1 levels, and ISG at L4-5 level in lumbar MRI.

Methods: Between May 2020 and 2021, patients who presented with complaints of low back pain and underwent lumbar MRI with the preliminary diagnosis of piriformis syndrome were retrospectively scanned. This syndrome was chosen to ideally evaluate paraspinal muscle dimensions in a population without disc herniation. A total of 408 cases (225 males and 183 females) without disc herniation were identified, and ES muscles (REST, LEST, and AEST) and ISG measurements were performed via picture archiving and communication systems (PACS).

Results: At the L4-5 level, mean REST was 40.11 ± 4.46 mm, mean LEST was 39.83 ± 4.57 mm and AEST was 39.97 ± 4.51 mm. There was no statistical difference according to gender and age (p > 0.05). Similarly, for L5-S1, mean REST was 36.93 ± 4.61 mm, mean LEST was 36.66 ± 4.68 mm, AEST was 36.79 ± 4.64 mm, and there was no statistical significance according to gender and age (p > 0.05). Total ISG was mean 4.11 ± 0.69 mm and there was no significance according to gender or age (p > 0.05).

Conclusion: The identification and thickness measurement of paraspinal muscles are important in lumbar surgical interventions. For the first time, ES muscle thickness and ISG were evaluated in routine lumbar MRI scans, and valuable data that could contribute to the literature were obtained only with the use of PACS.

Purpose: To elucidate the implications of restoring larger percentage of native ACL tibial insertion area on the functional outcomes and stability of the knee joint after arthroscopic ACL reconstruction.

Methods: Prospective study of 201 patients with clinical and radiological signs of ACL insufficiency, while individuals with multi-ligamentous injuries, concomitant intra-articular fractures, and revision ACL cases were excluded. Intraoperatively arthroscopic ruler was used to measure the native footprint dimensions and the percentage of native ACL footprint area restored was calculated. The patients were divided into two groups depending upon the percentage of native ACL tibial footprint area restored. Group A patients had > 70% area restored and group B < 70% area was restored. Pre- and postoperatively, patients were assessed using KT1000, Lysholm score, and IKDC score.

Results: At 1 year follow-up, mean IKDC scores at 12 months for group A and group B were 89.28 ± 4.74 and 79.22 ± 4.98, respectively (p value < 0.05). The mean Lysholm scores at 12 months for Group A and B were 93.68 ± 2.71 and 88.02 ± 2.8, respectively (p value < 0.05). The mean KT1000 scores at 12 months for group A (> 70% footprint area restored) and group B (≤ 70% footprint area restored) were 0.37 ± 0.66 and 0.39 ± 0.53, respectively.

Conclusions: The functional outcomes in terms of IKDC and Lysholm scores were better, while there was no objective difference in the knee laxity when the ACL reconstruction procedure was able to restore more than 70% of the native ACL tibial footprint size.

Background: Valgus-impacted femoral neck fractures (FNFs) are considered stable fractures in clinical practice. The main surgery approach is closed reduction and internal fixation, particularly in situ fixation. However, several complications commonly occur in healed valgus-impacted FNFs after in situ fixation, such as femoral neck shortening and anterior femoroacetabular impingement, leading to poor functional outcomes. Various closed reduction techniques for valgus-impacted FNFs have been described; however, these methods often involve invasive procedures that carry the risk of vascular damage and infection.

Method: Here we present a straightforward non-invasive reduction technique for valgus-impacted FNFs that is easy to perform and effective. This technique achieves reduction through leverage principles without the need for surgical instruments.

Result and conclusion: This approach effectively provides anatomical reduction and may reduce the frequency of complications associated with valgus-impacted FNFs.

Background: For patients with advanced knee arthritis, general knee arthroplasty (TKA) is a commonly used technique to relieve aches and restore function. Although medial-pivot (MP) and post-stabilized (PS) implants are the various maximum widely used prosthetic designs, there is still confrontation over their relative efficacy and effect on affected person results.

Aim: This examines the goal to systematically compare the medical and functional consequences of medial-pivot (MP) and Post-stabilized (PS) knee implants in sufferers undergoing general knee arthroplasty (TKA).

Methods: The strategy for this systematic overview involved an in-depth literature search of the usage of databases, including PubMed, CINAHL, Embase, and the Cochrane Library, adhering to PRISMA recommendations. An overall of ten studies have been protected on this SRMA.

Results: A total of ten studies were included in this analysis. Different variables were analyzed quantitatively for this study which includes WOMAC scores, KSS scores, OKS scores, and range of motion. The results of this meta-analysis showed that the tolerability of both of these methods was the same and no significant difference was observed between both groups. Data were extracted and a forest plot was made. The total effect was found to be 0.15 (-0.05, 0.35).

Conclusions: We conclude that, although the medial-pivot (MP) prosthesis exhibits some advantages in knee kinematics and patient satisfaction, there is no statistically significant overall clinical superiority when compared to the Post Stabilized (PS) knee implants in total knee arthroplasty (TKA). This is based on a systematic review and meta-analysis. When it comes to reducing pain, enhancing range of motion, attaining radiographic alignment, and handling complications, both MP and PS prostheses are equally effective. This gives medical professionals practical choices that can be tailored to the specific surgical preferences and needs of each patient.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01496-1.

This editorial entitled "Advancing Osteoporosis Care through Surgical Innovations" for "Osteoporosis-Surgical Care" Special Issue 2, is slated to be published in the August Abstract following the publication of comprehensive medical management of osteoporosis, the "Osteoporosis-Surgical Care" Issue 1. The remaining articles are scheduled to be published in "Osteoporosis-Surgical Care: Issue 2. The article focuses on various novel surgical techniques in different locations of fragility fractures. These articles are expected to inspire orthopaedic surgeons to adopt these innovative approaches.

Background: Despite growing gender parity among medical graduates globally, orthopedic surgery remains one of the most male-dominated specialties. Structural barriers, cultural perceptions, and limited mentorship opportunities contribute to the underrepresentation of women. In Türkiye, comprehensive data on the experiences of female orthopedic surgeons have been lacking.

Objective: This study explored the professional, educational, and social experiences of female orthopedic surgeons and residents in Türkiye through a nationwide e-survey, aiming to identify challenges, needs, and expectations.

Methods: An exploratory-descriptive, cross-sectional e-survey was conducted among members of the Women Orthopedists Working Group (Advocacy, Research, Empowerment, and Alliance Network for Women in Orthopedics-ARENA) under the Turkish Society of Orthopedics and Traumatology (TSOT). The survey included Likert-scale, multiple-choice, and open-ended questions covering demographics, career progression, work-life balance, mentorship, discrimination, and future goals. Thematic analysis was conducted following Braun and Clarke's six-phase framework to interpret qualitative data.

Results: Of 61 eligible participants, 59 responded (response rate: 96.7%). The findings revealed high professional commitment among respondents, with 88.2% selecting orthopedics as their first-choice specialty and 74.6% willing to recommend it to other women. However, 81.6% experienced gender-based bias, citing discrimination, exclusion, and limited credibility and the burden of representation. Only 7.0% respondents frequently presented at national congresses, with time constraints (40.4%) and lack of mentorship (23.1%) as key barriers to academic productivity. Work-life balance was a major concern, with reduced family time and high stress. Despite these challenges, many highlighted strengths such as resilience, meticulousness, empathy, and communication skills. Key future needs included mentorship (48.2%), leadership training (21.4%), and scholarships (19.6%).

Conclusion: Female orthopedic surgeons in Türkiye face significant gender-specific challenges, particularly related to bias, professional visibility, and work-life balance. Despite these obstacles, they demonstrate resilience and strong professional identity. The findings highlight the need for multilayered strategy integrating institutional reform, expanded mentorship networks, education, and cultural transformation to enhance gender equity and professional development in orthopedics.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01503-5.