Indian Journal of Orthopaedics最新文献

Objectives: Chronic capitellum-trochlea coronal shear fractures (defined as untreated injuries > 3 weeks) are complex intraarticular fractures of the distal humerus, primarily caused by missed diagnoses of low-energy trauma and typically requiring open reduction and internal fixation (ORIF). These articular fractures are associated with high complication rates, including nonunion and post-traumatic osteoarthritis. This retrospective analysis of ten patients evaluated the clinical efficacy of 3D printing-assisted ORIF in improving surgical precision and functional outcomes (assessed by Mayo Elbow Performance Score, MEPS) for chronic coronal shear fractures involving the humeral trochlea and capitellum.

Methods: This retrospective study included ten patients with chronic coronal shear fractures treated with open reduction and internal fixation between September 2017 and September 2022. 3D-printed anatomical models were generated from CT scans using Medraw software to design patient-specific surgical strategies. Postoperative outcomes were assessed using the Mayo Elbow Performance Score (MEPS) by a blinded evaluator.

Results: Patients ranged in age from 13 to 67 years (40.8 ± 17.2 years). All patients with closed fractures underwent surgery 5-16 weeks after injury (9.3 ± 3.6 weeks). No early postoperative complications, such as wound healing issues, were observed. Follow-up periods ranged from 8 to 12 months (9.7 ± 1.9 months), and bony union times averaged 12.9 ± 4.1 weeks (range, 8-19 weeks). No long-term complications, including instability or fixation loosening, were reported. The mean MEPS was 92.5 ± 8.2, with excellent results in seven cases and good results in three cases.

Conclusions: 3D printing may aid in developing precise, patient-specific surgical plans, potentially improving articular reduction accuracy and minimizing intraoperative challenges in treating chronic coronal shear fractures of the humeral trochlea and capitellum.

Background: Fragility fractures of the femoral neck (NOF) are a growing concern in the "young elderly" (aged 65-84), a group experiencing the intersection of aging and active lifestyles. These fractures occur with minimal trauma due to weakened bones, primarily from osteoporosis. The management of such fractures in this population presents distinct challenges, requiring a balance between rapid recovery and the limitations imposed by aging physiology.

Management: The rising incidence of femoral neck fractures is linked to age-related bone loss and comorbidities like osteoporosis, sarcopenia, and chronic diseases. Women, due to post-menopausal bone loss, are disproportionately affected. Early surgical intervention (internal fixation, hemiarthroplasty, or total hip arthroplasty) is crucial for restoring mobility. Surgical complications such as avascular necrosis, fixation failure, and dislocation remain significant concerns. Rehabilitation involving early mobilization and osteoporosis management is essential for optimal recovery, though the risk of mortality and permanent disability remains elevated.

Conclusion: Fragility fractures in the young elderly require a multidisciplinary approach that combines prompt surgical intervention, targeted rehabilitation, and long-term osteoporosis management. Preventive strategies focused on bone health and fall prevention will be critical in reducing the incidence and improving outcomes for this population.

Background: Patients with isolated patellofemoral osteoarthritis (PF-OA) have limited surgical options when conservative management fails. The emerging robotic-assisted patellofemoral arthroplasty (RA-PFA) technique can help attain precise implant positioning, which may result in satisfactory surgical and functional outcomes for PF-OA patients.

Materials and methods: We retrospectively reviewed routinely collected clinical data of patients who underwent consecutive RA-PFA at a quaternary care center, between January 2018 and October 2022. We describe their preoperative and postoperative clinical profile, their radiological and functional outcomes at the end of a median 54-month follow-up-like patellar tilt (PT), Caton-Deschamps Index (CDI), Visual Analog Scale (VAS), Oxford Knee Score (OKS) and Kujala score (KS). Outcomes were reported as median (range).

Results: We retrospectively analyzed the outcomes of four patients (three females and one male) aged 50-71 years who underwent RA-PFA on six knees (two bilateral). All four patients had an improvement in their postoperative patellar tilt [- 2.5° (- 7° to 8°) to 3.5° (2°-6°)], CDI [0.93 (0.7-1.3) to 0.89 (0.75-0.98)], VAS [7.5 (7-8) to 1 (1-2)], OKS [20.5 (15-24) to 39.5 (36-44)], and Kujala score [53 (48-69) to 79 (76-83)]. None of the patients suffered a postoperative adverse event or needed revision procedures.

Conclusion: As the first report from India, RA-PFA seems to be an effective intervention for isolated PF-OA. However, considering the costs incurred, its superiority over conventional PFA in surgical precision or patient outcomes is yet to be established.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01500-8.

Background and objective: Osteogenesis Imperfecta (OI), an inherited genetic disorder affecting 1 in 20,000 people worldwide, is currently treated with bisphosphonates for moderate and severe forms. Dual-energy X-ray absorptiometry (DXA) is the standard method for assessing the improvement in bone quality in OI but due to the unavailability of DXA in some places, hand radiographs can be used to calculate the second metacarpal index (MCI) to assess the bone quality in many osteoporotic disorders. In this study we evaluated the feasibility of using metacarpal index to assess the bone quality in OI in children.

Methods: We evaluated the MCI values in 37 children aged 1-18 years at baseline (before intervention), and following pamidronate treatment in 18 children with type III or type IV OI.

Results: A decrease in MCI was noted with ageing as anticipated in the OI population, and we also observed an increase in MCI among the younger cohort (under 8 years) receiving pamidronate compared to the older cohort (above 8 years). The change in MCI after pamidronate therapy was monitored, and those who were initiated on pamidronate at a younger age showed more improvement in MCI than those who were started at a later age.

Conclusions: Our study suggests that when DXA measurements are not feasible, MCI can be a potential tool to assess bone quality and evaluate bisphosphonate therapy in the OI population.

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.