Indian Journal of Orthopaedics最新文献

Purpose: Several modifications of the direct lateral approach to hip have evolved to improve the functional outcome after hip arthroplasty. We evaluated our modified lateral approach to hip, which involves only 'functional elevation' of abductors and spares vastus lateralis. The anatomical basis of this modified approach is presented along with a literature review.

Materials and methods: We prospectively evaluated uncemented total hip arthroplasty (THA) using our modified lateral approach in 50 consecutive patients. They were assessed for intraoperative joint-stability, component placement accuracy, surgery duration, blood loss, any event of hip dislocation, and functional outcome. They were followed for at least 2 years.

Results: The most common indication was hip arthritis secondary to femoral head osteonecrosis (n = 41). The mean age was 38.5 years. The mean duration of surgery was 68.5 min. None of these cases had demonstrable posterior/ anterior instability. Mean acetabular inclination was 43° (range 40°-50°) and anteversion was 20° (range 15°-25°). The mean femoral anteversion was 13°. Mean deviation of femoral stem axis from femoral shaft axis was 2.4° ± 1.23° in the coronal plane and 4.1° ± 1.74° in the sagittal plane. None of the cases had intraoperative trochanteric avulsion, postoperative prosthetic dislocation, nerve injury, or heterotrophic ossification at 12 months. None of the patients had Trendelenburg gait/ sign at 6-month follow-up. Mean Harris hip score improved from 42 (range 36-45) before surgery to 78.5 (range 72-85) at 6 months (p < 0.05) and 92.5 (range 85-100) at 12 months (p < 0.05) after surgery.

Conclusion: The described 'functional' modification of the lateral approach to the hip enables the surgeon to place components accurately and results in good early functional outcomes.

Background: Significant anterior glenoid bone loss (> 15%) compromises the success of soft-tissue Bankart repair in recurrent shoulder instability. Bone-augmenting procedures-the coracoid-based Latarjet and the anatomic Eden-Hybinette/iliac-crest bone-graft transfer (ICBG)-are the most frequently deployed techniques, yet direct head-to-head evidence remains limited.

Purpose: To compare clinical and radiographic outcomes, complication profiles, and return-to-sport (RTS) rates after Latarjet versus ICBG for bony Bankart lesions.

Methods: A PRISMA-conformant search of PubMed, Embase, Scopus, and Cochrane (inception-April 2025) identified studies reporting outcomes of either procedure with ≥ 2-year follow-up. Two reviewers independently screened articles, extracted data, and graded quality (MINORS/NOS). Primary outcome was recurrent instability; secondary outcomes were complication rate, graft-related issues, osteoarthritis progression, range-of-motion (ROM) loss, patient-reported outcome measures (PROMs), and RTS.

Results: Forty-eight studies (10 comparative, 32 Latarjet-only, 6 ICBG-only) encompassing 5842 shoulders met inclusion. Mean follow-up was 6.2 years. Comparative meta-analysis (4 studies; n = 310) showed no significant difference in recurrent instability (OR 1.72, 95% CI 0.79-3.73; p = 0.17) or overall complications (OR 1.11, 95% CI 0.56-2.23). ICBG had a lower risk of graft resorption (8% vs 22%, p = 0.03) but a higher incidence of donor-site morbidity (12%). Latarjet provided a small but significant external-rotation loss (mean 5.7°) yet enabled faster RTS (7.8 vs 10.4 months). PROM improvement (ASES, WOSI, Rowe) exceeded the minimal clinically important difference for both techniques without inter-group disparities.

Conclusion: Both procedures reliably restore stability in the setting of bony Bankart lesions. Choice should be individualized: Latarjet offers earlier RTS and avoids extra-articular harvest morbidity, whereas ICBG preserves native coracoid anatomy and demonstrates superior graft integration. High-level prospective trials powered for clinical end-points are still required.

Level of evidence: Level III (systematic review of mostly level III-IV studies).

Background: Postoperative orthopedic wounds frequently lead to deep infections, and conventional drainage tubes exhibit inadequate drainage capacity. This study aimed to assess the efficacy of an innovative and improved negative-pressure wound irrigation drainage tube in enhancing infection control and facilitating wound healing.

Methods: Forty New Zealand rabbits were randomly assigned to five groups: A (control), B (abscess model), C (Penrose drain), D (improved negative-pressure wound irrigation drainage tube with drainage), and E (improved negative-pressure wound irrigation drainage tube with drainage and irrigation). A deep wound infection model was established, and its success was assessed using Gram staining and mass spectrometry. Daily weight, temperature, and drainage volume were recorded for each rabbit group. In vitro cellular experiments were performed to assess the biocompatibility of the materials. Histological examinations were conducted on postoperative day 14 to evaluate wound healing.

Results: Bacterial culture demonstrated the consistent presence of primary pathogenic bacteria in all groups, confirming the successful establishment of the model. Following surgery, all rabbit groups showed a consistent increase in body weight with no significant variation (P > 0.05). On day 14, the average skin temperature of Group E was significantly lower than that of the other groups (P < 0.001). The average total drainage volumes on day 14 were 9.03 ± 0.60 ml for Group C and 10.49 ± 0.99 ml for Group D, indicating significantly higher drainage in Group D than in Group C (P < 0.05). In vitro experiments demonstrated that the product had no adverse effect on the viability and proliferation of fibroblast cells. Histological analyses indicated that muscle tissue structure was normal in Group A, exhibited cell loss with inflammatory cell infiltration in Group B, displayed slight abnormalities with mild fibrosis in Group C, showed mild irregularities with a relatively organized arrangement of muscle cells in Group D, and remained essentially normal in Group E.

Conclusion: The improved negative-pressure wound irrigation drainage tube demonstrated distinct advantages over the conventional Penrose silicone drain in controlling inflammation, optimizing wound treatment, and promoting wound healing in deep wound infections.

Introduction: Proximal femoral nails commonly used to treat trochanteric hip fractures in the elderly have different distal fixation options such as interlocking screws and claws. The aim of this study was to compare the failure rate and migration of the fixation construct during the follow-up of screw- and claw-fixed nails in elderly patients with trochanteric hip fractures.

Materials and methods: A retrospective case-control study was conducted including patients aged 65 years or older and treated with a proximal femoral nail between 2018 and 2023. Patients were grouped according to the type of distal locking: screw- and claw-fixed. Demographic data and follow-up radiographs were obtained from hospital records. Follow-up radiographs were analyzed to assess fracture type, treatment failure through lag screw cut-out, and migration of the nail and the lag screw over time. Two types of migration were evaluated; distal migration of the nail in the medullary canal (nail migration distance; NMD) and migration of the lag screw in the femoral head (lag screw migration ratio; LSM).

Results: There were 339 patients with a mean follow-up of 7.2 ± 4.2 months (208 in the screw-fixed group and 131 in the claw-fixed group). The groups were similar in terms of age, sex, fracture type, and stability. While 16 (7.7%) cut-outs were observed in the screw-fixed group, there were 1 (0.8%) in the claw-fixed group (p = 0.004). Mean nail migration was 1.3 ± 2.1 mm for screw-fixed nails and 4.8 ± 5.8 mm for claw-fixed nails (p < 0.001). Lag screw migration ratio was significantly higher in screw-fixed nails (4.2% vs 2%, respectively, p < 0.001).

Conclusions: Claw-fixed nails are significantly more likely to slide in the medullary canal, resulting in a reduced lag screw cut-out compared to screw-fixed nails in elderly patients with trochanteric hip fractures.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01600-5.

[This corrects the article DOI: 10.1007/s43465-025-01545-9.].

Background: Although various surgical techniques are applied in the treatment of Achilles tendon ruptures, the impact of rupture localization, particularly the distance from the insertion point on functional outcomes remains unclear. This study aims to investigate the relationship between rupture level, surgical timing, techniques, and patient-reported outcomes.

Methods: This retrospective study analyzed 32 patients (30 males, 2 females; median age 45 years, IQR (Interquartile Range): 35-55) who underwent surgical repair for acute Achilles tendon rupture between January 2021 and December 2023. Patients were classified based on rupture location (proximal > 6 cm vs. distal ≤ 6 cm from calcaneal insertion), surgical timing(early ≤ 7 days vs. delayed > 7 days), and technique (open vs. percutaneous). Primary outcomes included Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores at minimum 6-month follow-up. Second- ary outcomes included return to activity, complications, and patient satisfaction.

Results: Complete rupture location data was available for 17 patients. Patients with distal ruptures showed numerically higher functional scores compared to proximal ruptures (ATRS: 88.1 ± 7.5 vs. 80.4 ± 11.2, p = 0.117; AOFAS: 93.5 ± 4.0 vs. 86.7 ± 7.8, p = 0.089), though these differences did not reach statistical significance. The observed effect size was moderate to large (Cohen's d = 0.808 for ATRS, d = 1.067 for AOFAS). Overall functional outcomes were favorable with median ATRS score of 87 (IQR: 80-92) and AOFAS score of 92 (IQR: 88-96). Clinical success rates indicated that 78.1% of patients achieved good or satisfactory results (ATRS ≥ 80 points) and 90.6% achieved AOFAS scores ≥ 85. No differences were observed between open and percutaneous repair techniques (ATRS: 84.2 ± 10.1 vs. 86.5 ± 9.2, p = 0.57). Early surgery (≤ 7 days) showed a trend toward higher scores compared to delayed surgery (ATRS: 86.0 ± 9.5 vs. 80.2 ± 11.8, p = 0.31), though this difference was not statistic- ally significant. No major complications or re-ruptures occurred during follow-up.

Conclusion: Distal Achilles tendon ruptures may be associated with higher functional outcomes, though larger studies are needed to confirm this finding. Both open and percutaneous repair tech- niques appear to provide satisfactory results. Early surgical intervention within 7 days may be benefi- cial, though the evidence suggests rather than confirms this advantage. These findings could be con- sidered in location-specific treatment planning and suggest that contemporary surgical approaches may be effective for Achilles tendon rupture repair.

Background: This study aimed to evaluate how orthopedic surgeon's professional experience affects implant selection in the surgical treatment of geriatric unstable intertrochanteric femur fractures.

Methods: Plain radiographs of 107 patients aged ≥ 75 years with AO type 31 A2.2 or A2.3 fractures, Singh index ≤ 3, and cumulative ambulation score ≥ 5 were assessed by orthopedic surgeons with varying levels of experience. Surgeons chose between proximal femoral nail (PFN), dynamic hip screw (DHS), and hip arthroplasty (total or hemi) for each case. Participants were grouped by experience: junior (≤ 5 years), middle (6-10 years), and senior (≥ 11 years), each with 9 surgeons. Preferences across groups were statistically compared.

Results: All observers chose PFN or hemiarthroplasty (HA), while none preferred DHS or total arthroplasty. Junior surgeons predominantly preferred PFN. As experience increased, preference shifted toward HA. Senior surgeons overwhelmingly chose HA, while middle-experienced surgeons preferred PFN and HA at close rates.

Conclusion: Implant selection is shaped not only by fracture type but also by the surgeon's clinical experience. Surgeons with greater experience more frequently choose arthroplasty, likely due to greater technical ability, complication management skills, and awareness of long-term outcomes.

Background: Plantar fasciitis is the most common cause of heel pain in adults, and while most cases respond to conservative treatment, a subset of patients require surgical intervention. Endoscopic plantar fascia release (EPFR) is preferred for its minimally invasive nature and favorable outcomes. However, the cost of disposable instrumentation presents a barrier in low-resource settings. This study aims to evaluate the clinical effectiveness and safety of endoscopic plantar fascia release using reusable, affordable, autoclavable instruments developed as a cost-conscious alternative to disposable kits.

Methods: This prospective case series included 24 patients with intractable plantar fasciitis who underwent EPFR using reusable instruments between April 2019 and March 2024. Patients were assessed preoperatively and at 12 months postoperatively using the AOFAS Hindfoot Score and the VAS for pain. Data were analyzed using paired t tests with significance set at p < 0.05.

Results: The mean preoperative AOFAS score improved from 59.2 ± 3.8 to 84.4 ± 6.0 postoperatively (p < .001), and the mean VAS score decreased from 8.1 ± 1.7 to 2.4 ± 0.5 (p < .001). Pain relief was reported by 91.7% of patients. No major complications were observed.

Conclusion: Endoscopic plantar fascia release using reusable instruments is a safe and effective surgical option, providing significant pain relief and functional improvement. The use of reusable instruments offers a practical and potentially more affordable alternative in resource-limited settings.Level of evidence: IV.

Background: Orthopaedic implant-related infections (OIRIs) are a major clinical challenge, contributing to increased morbidity, prolonged hospitalisation, and higher healthcare costs. This study investigated the prevalence of biofilm-associated genes (icaA, icaD) in Staphylococcus spp., antimicrobial resistance patterns, and the relationship between implant material, infection rates, and treatment outcomes.

Methods: This was a cross-sectional study of 200 clinical samples from patients with suspected OIRIs. Pathogens were identified using MALDI-TOF MS, and antimicrobial susceptibility was tested according to CLSI 2023 guidelines. Biofilm formation was assessed by a modified microtiter plate assay, and icaA, icaD, and mecA genes were detected by PCR. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between implant material, biofilm genes, and infection risk.

Results: The mean patient age was 37.99 ± 18.17 years, with males comprising 74%. Fractures were the leading cause of OIRIs (72.5%), predominantly affecting the lower limb (62.5%). Staphylococcus epidermidis (30.2%) and Escherichia coli (15.1%) were the most frequent isolates, with 98% of infections being monomicrobial. Methicillin resistance was common, with 57% of MRSA and 45% of MRSE producing strong biofilms. The icaD gene was significantly associated with biofilm formation (79% in MRSA, 45% in MRSE), whereas icaA showed no such link. Steel implants had the highest infection rate (41.5%), though analysis indicated surgical and patient factors as primary drivers. MDR Gram-negative bacteria displayed high resistance to cephalosporins and fluoroquinolones, with carbapenems and colistin remaining effective.

Conclusions: OIRIs are strongly influenced by biofilm formation and methicillin resistance. Management should prioritize biofilm-targeted therapies, precision antibiotic use, and implant surface innovations to reduce infection risk and improve outcomes.

Background: Figure-of-eight bandages (F8B) and arm slings are common treatments for midshaft clavicle fractures (MCF), yet the optimal approach remains uncertain due to conflicting evidence. This meta-analysis compared their effectiveness in adult patients.

Methods: A literature search of PubMed, Scopus, Cochrane, and Google Scholar was conducted through July 2025. Four RCTs and two retrospective studies involving 688 adults were included. Assessed outcomes included pain (VAS), Constant score, union time, clavicle shortening, nonunion, dissatisfaction, and other complications.

Results: Pain levels were comparable between groups at 1 and 3 weeks (p = 0.07 and 0.42). Constant score at 3 years was significantly higher in the F8B group (p = 0.01), but the MD of - 1.69 is below the threshold for clinical relevance. Similarly, although F8B was associated with significantly less clavicle shortening (p = 0.02), the difference of 0.80 mm is likely within the margin of measurement error and not clinically meaningful. Healing time showed no significant difference (p = 0.70). Patient dissatisfaction and nonunion rates were lower in the F8B group but not statistically significant (p = 0.11 and p = 0.33). F8B demonstrated a significantly lower risk of pooled complications including malunion, displacement, and skin discomfort (p = 0.007).

Conclusion: F8B may offer modest advantages in alignment and function, but current evidence does not justify its routine use over slings. Further high-quality, patient-centered studies are needed to guide individualized care.