Indian Journal of Orthopaedics最新文献

Background: Managing sports injuries and ensuring effective rehabilitation are crucial for maintaining optimal athletic performance, particularly among young athletes. Lower limb injuries, due to their frequency and impact on mobility, require precise and personalized rehabilitation approaches. Traditional biomechanical analysis methods often fall short in capturing complex temporal and spatial dependencies inherent in human movement data. To address these limitations, this study proposes a novel hybrid deep learning model aimed at improving injury assessment and recovery prediction.

Methods: The proposed framework introduces an Attention-based Random Forest Optimized Convolutional Bidirectional Long Short-Term Memory (A-RF-CBiLSTM) model. Data were collected from four comprehensive datasets: an electromyography dataset, EMG data of limb muscles, a kinematics and EMG dataset during gait-related activities, and the WebAtlas-Human lower limb dataset. Preprocessing involved bandpass filtering, high-frequency noise removal, normalization, and artifact elimination to ensure signal clarity. Feature selection was performed using the Random Forest (RF) algorithm to identify the most relevant inputs for rehabilitation prediction. The selected features were then processed through a Convolutional Block Attention Module (CBAM) to assign adaptive weights based on significance. A depthwise separable Convolutional Neural Network (CNN) was applied for efficient feature extraction. Subsequently, a Bidirectional Long Short-Term Memory (BiLSTM) network captured temporal dependencies in both forward and backward directions. Outputs from the CNN and BiLSTM layers were fused to enhance predictive robustness. Model training was optimized using the Adam optimizer with hyperparameter tuning. Various model performance evaluation tests were conducted to ensure reliability.

Results: The A-RF-CBiLSTM model achieved high performance with 98.87% accuracy, 98.60% precision, 97.34% recall, 97.34% F1 score, and 97.88% specificity. These results confirm its effectiveness in predicting rehabilitation outcomes and identifying lower limb injury patterns.

Conclusion: This study presents a robust and efficient hybrid model that significantly advances the state-of-the-art in biomechanical analysis for sports injury management.

Introduction: The Ponseti method is a globally accepted treatment modality for Clubfoot or Congenital Talipes Equinovarus (CTEV). This study compares the kinematic and kinetic gait patterns in children with unilateral and bilateral idiopathic clubfeet with the age-matched control group.

Methods: 40 children with a mean age of 9.61 ± 3.04 (6-15 years) of which 23 (23 feet) were unilateral and 17 children (34 feet) were bilateral, who had completed 2 years post weaning of splints. Clinical examination included a range of motion of the ankle, static and dynamic deformities, and rotational profile of the hip. 3D Gait analysis was performed with a multi-camera motion capture system.

Results: In unilateral CTEV, there was a significant difference in calf girth and foot size. Ankle dorsiflexion showed a statistically significant difference in mid-swing (p =  < .001) although Initial contact and Loading Response and Terminal Stance were reduced and were not statistically significant for unilateral CTEV. A significant difference in ankle inversion p =  < .001 was noted in mid-swing in Unilateral and Bilateral feet. On comparison to the control participant's normal, kinetic data showed Internal Ankle plantar flexor moments (p =  < .001) to be reduced in the unilateral and bilateral groups. Internal ankle extensor movement was statistically significant in the bilateral group, while in the unilateral group, it was not. Ankle power was statistically reduced in both groups.

Conclusion: Gait analysis shows subtle kinetic and kinematic changes in children with clubfeet, mainly deviations in ankle rockers and reduced ankle power generation which may impact clinical function.

Background: The terrible triad of the elbow posterior dislocation combined with radial head and coronoid process fractures presents significant treatment challenges due to its inherent instability and high complication risk. Early recognition and standardized surgical intervention are critical for restoring function and minimizing disability.

Objectives: To evaluate the functional outcomes, complication rates, and patient satisfaction following standardized surgical treatment for the terrible triad of the elbow.

Methods: This prospective observational study included 18 patients aged 28-55 years who underwent surgery for the terrible triad injury at a tertiary care center. The surgical interventions included radial head fixation or arthroplasty, coronoid process fixation, and lateral ulnar collateral ligament (LUCL) repair. The functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analog Scale (VAS), range of motion (ROM), and American Shoulder and Elbow Surgeons (ASES) scores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months. The statistical analysis was performed using Wilcoxon signed-rank and Spearman correlation tests.

Results: Postoperative MEPS improved significantly from a mean of 41.44 to 90.17 (p < 0.001), and DASH scores decreased from 65.61 to 16.93 (p < 0.001). VAS scores reduced from 7.11 to 2.61, and significant gains were observed in all ROM components. A strong inverse correlation was noted between MEPS and DASH (ρ = -0.998). Complications occurred in two patients (11%), primarily mild stiffness and superficial infection. Overall, 55.5% of patients reported being satisfied or very satisfied with their outcomes, with an average return-to-work time by 3 months.

Conclusion: Standardized surgical protocols for terrible triad injuries of the elbow yield excellent functional recovery, improved mobility, and effective pain control. Early intervention, structured rehabilitation, and careful patient selection are essential for optimizing outcomes and minimizing complications.

Background: Osteoarthritis (OA) knee joint is a prevalent degenerative disease, affecting the elderly population. Telerehabilitation (TR) services are now used as an adjuvant in modern physical therapy practice because of their feasibility in evaluating, treating, and remote monitoring of musculoskeletal disorders. The digital TR application may serve as an alternative handy tool for those with limited healthcare access. There is a need to evaluate the influence of digital mobile applications in improving pain and functional outcome measures in osteoarthritis knee.

Materials and method: Thirty OA knee participants were assessed in-person and recruited based on the inclusion and exclusion criteria of the study. Participants were introduced to the CasaMed novel mobile application for the delivery of exercise-based intervention for 6 weeks. Participants were assessed at baseline and after 6th week of completion of the virtual care exercise-based program using the mobile application with numerical pain rating scale (NPRS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale. Paired t test was performed to analyze the changes in outcome measures.

Results: The results of the present study showed statistically significant reduction in pain (< 0.001) and improvement in functional outcome measures, WOMAC scale (0.002) in patients with OA knee (p < 0.005).

Conclusion: We have identified a potential digital platform- CasaMed, a novel mobile application that provides a virtual exercise program. Based on this study, we can conclude that the mobile application-based exercise program, shows a positive effect on providing TR at home for exercise delivery using a video-assisted virtual exercise program in patients with OA knee.

Background: The use of bone allograft in Orthopaedics is a novel practice but the detailed information about the indications and outcomes is yet to be reported in Nigeria.

Objective: To highlight the non-oncological indications and early outcomes of the uses of irradiated frozen bone allografts for orthopaedic procedures in Nigeria.

Materials and methods: This was a prospective study of patients who had bone allograft implanted between 1st September 2020 and 31st August 2022 for various non-oncological orthopaedic conditions at our tertiary center. The donors were selected based on American Association of Tissue Bank (AATB) guidelines. The bone allografts were prepared, irradiated, and stored in a freezer at - 80 °C. Ethical clearance was obtained from the institutional ethics committee and written informed consent was signed by patients. They all had implantation of banked femoral head allograft. The details on demographics, indications, and early outcomes were documented in a questionnaire and analyzed with SPSS software version 20.

Results: A total of 28 patients with follow-up results were included in the study. The follow-up duration was a minimum of 1 year. The male-to-female ratio was 2.5: 1 with mean age of 51.0 ± 9.8 years. The indications were acetabular reconstruction in complex primary and revision total hip replacement (67.9%), non-union fractures (14.3%), tibial plateau fractures (10.7%), and spinal fusion surgery (7.1%). Most of the grafts were implanted as structural grafts (57.9%) while others were used as either morselized (26.3%) or composite grafts (15.8%). The mean incorporation time of 6.2 ± 0.7 months was recorded. Most of the patients (92.9%) had satisfactory osteo-integration of the graft (Oswestry's ≥ 2). There was no incidence of infection in this early report.

Conclusion: The use of deep frozen and irradiated bone allografts in the management of non-oncological orthopaedic conditions is a new development in Nigeria. This preliminary report is encouraging and we hope to arrive at a definite conclusion after a long-term follow-up.

Objective: To evaluate the efficacy and safety of duloxetine in treatment of osteoarthritis compared with placebo.

Method: We conducted a comprehensive search for pertinent randomized controlled trials (RCTs) across multiple databases, including PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Google scholar. These selected RCTs aimed to assess the effectiveness and safety of duloxetine versus a placebo in the management of osteoarthritis (OA). We computed the mean difference (MD) for continuous outcome measures and calculated the risk ratio (RR) for dichotomous outcome measures.

Results: Data from 10 RCT including 2294 participants comparing duloxetine and placebo were pooled. Duloxetine showed improvement in BPI-S (Brief Pain Inventory-Severity)MD =  - 0.66; 95% CI, [- 0.75, - 0.57], BPI-I (Brief Pain Inventory-Interference)MD =  - 0.59; 95% CI [- 0.66, - 0.52], WOMAC (Western Ontario and McMaster Universities Arthritis Index) pain sub scale scores SMD =  - 2.56; 95% CI, [- 4.24, - 0.89] P = 0.003; physical function MD =  - 4.59; 95% CI, [- 5.83, - 3.34] P < 0.00001; SF 36 (Short Form) Physical function MD = 1.56; 95% CI, [0.14, 2.97] P = 0.03 and patients global impressions scores SMD =  - 0.47; 95% CI, [- 0.62, - 0.32]. Duloxetine resulted in higher number of treatment emergent adverse events RR = 1.34; 95% CI, [1.12,1.61] P = 0.002; and discontinuations RR = 2.54; 95%, CI, [1.89, 3.42] P < 0.00001. However duloxetine was no different from placebo in improving stiffness and in terms of incidence of serious adverse effects.

Conclusion: Duloxetine demonstrates effectiveness in addressing chronic pain and mitigating the decline in physical function associated with knee osteoarthritis (OA), while maintaining a reasonable level of tolerable adverse events. However, it does not offer a distinct advantage in alleviating joint stiffness.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01372-y.

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.