Indian Journal of Orthopaedics最新文献

{"title":"Fragility Fracture: 10 Commandments.","authors":"S S Jha","doi":"10.1007/s43465-025-01356-y","DOIUrl":"https://doi.org/10.1007/s43465-025-01356-y","url":null,"abstract":"<p><strong>Background: </strong>Fragility fractures are a major health concern. It is a fracture that occurs from a low-impact event, such as a fall from standing height or less typically due to weakened bones. These fractures are most commonly associated with conditions like osteoporosis, where the bone density is reduced, making the bones more susceptible to get fractured. Fragility fractures often occur in older adults including post-menopausal women and commonly affect areas, such as the hip, spine, and wrist. These fractures reflect the underlying bone fragility, and following first fragility fracture, there is increased risk of getting further fractures. Apart from osteoporosis, the contributing factors have also to be considered like age, gender, nutritional deficiencies, physical activities, and medical conditions like chronic kidney disease. The other risk factors like smoking, and excessive alcohol consumption, and certain medications such as corticosteroids and anti-convulsants like sodium valproate, can overtime result into osteoporosis.</p><p><strong>Methods: </strong>Fragility fractures basically revolve around the terminal management of osteoporosis and many issues have not been over emphasized. Hence, these 10 commandments have been crafted to focus on the areas which can help prevent fragility fractures or combat those cases who come with a history of fragility fractures.</p><p><strong>Results: </strong>The ten commandments have crystallized into various headings, including fragility fracture-the risk factors & DEXA, subnormal turnover bone diseases, microbiota & microbiome, inflammaging including obesity, parathyroid, thyroid & testosterone, dilemmas in the management of osteoporosis in younger adults, vitamin D, calcium & albumin, pharmacologic treatment options, associated medications & alternative therapies, and monitoring. High and low turnover bone disease, dysbiosis in gut, and inflammaging are the highlights including therapy and monitoring.</p><p><strong>Conclusion: </strong>Fragility fracture also known as osteoporotic fracture has significant morbidity and mortality. Management of osteoporosis has been emboldened with the existing basket of both anti-resorptive and anabolic drugs. Safety concerns on long-term use of these drugs are emerging. These ten commandments will help management strategies to concentrate on targeting therapy to persons most \"at risk\" of getting these fractures.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"244-255"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Metals and Alloys in Orthopedics with Their Relevance in Osteoporosis.","authors":"Nirmal Ch Mohapatra, Rajesh Rana, Sisir Kumar Sahoo","doi":"10.1007/s43465-025-01344-2","DOIUrl":"https://doi.org/10.1007/s43465-025-01344-2","url":null,"abstract":"<p><strong>Background: </strong>The evolution of metals and alloys in orthopedics has significantly improved the management of bone-related disorders, particularly osteoporosis, where decreased bone density and fragility complicate implant stability and healing. Traditional materials such as stainless steel and cobalt-chromium alloys provided strength and wear resistance but were associated with challenges like stress shielding and implant loosening.</p><p><strong>Materials and methods: </strong>To address these limitations, titanium alloys emerged as a superior alternative due to their biocompatibility, lightweight nature, and bone-like elasticity, making them suitable for osteoporotic patients. Recent advancements have led to the development of magnesium-based biodegradable implants and nitinol (shape-memory alloy), which enable minimally invasive procedures and provide dynamic support. Additionally, porous and bioactive coatings, such as hydroxyapatite (HA), have been introduced to enhance osseointegration and implant fixation in compromised bone.</p><p><strong>Results: </strong>The integration of pharmacological strategies, such as bisphosphonates and sclerostin antibodies, with advanced implant surfaces has further enhanced bone regeneration. Emerging innovations, including 3D-printed personalized implants and smart alloys capable of adapting to physiological changes, show promise for improved long-term stability and faster recovery in osteoporotic patients.</p><p><strong>Conclusion: </strong>The continuous development of orthopedic materials has paved the way for more effective treatments for osteoporosis, addressing key challenges such as implant stability, stress shielding, and bone regeneration. Innovations in bioactive coatings, biodegradable metals, and personalized implants represent the future of orthopedic care, offering improved outcomes for patients with compromised bone health. However, continuous research is essential to optimize these technologies for broader clinical applications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"271-279"},"PeriodicalIF":1.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"S S Jha","doi":"10.1007/s43465-025-01353-1","DOIUrl":"https://doi.org/10.1007/s43465-025-01353-1","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"243"},"PeriodicalIF":1.1,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Macroscopic Soft Tissue Injury (Modified MASTI) Classification for Bone and Soft Tissue Integrity in Cruciate Retaining Total Knee Arthroplasty.","authors":"Ravikumar Mukartihal, Rajdeep Das, Sharan Shivaraj Patil, Vikram G K Bhat, S Chandan, Ratnakar Vecham, A V Gurava Reddy, Adarsh Annapareddy","doi":"10.1007/s43465-025-01343-3","DOIUrl":"https://doi.org/10.1007/s43465-025-01343-3","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to develop a 'modified macroscopic soft tissue injury (MASTI) classification' for cruciate retaining (CR) total knee arthroplasty (TKA), and compare the iatrogenic injury of robotic-arm assisted (RA) TKA and conventional jig-based (CJ) TKA using it.</p><p><strong>Methods: </strong>100 symptomatic knee osteoarthritis patients were chosen of which fifty received RA TKA, whereas fifty received CJ TKA. Posterior cruciate ligament (PCL), soft tissue envelope and bone resection surfaces were assessed during operation and scores allotted for each. The overall score was then graded to form the classification.</p><p><strong>Results: </strong>The classification had a high inter-observer reliability. RA TKA patients had significantly better PCL scores, soft tissue injury scores, bony injury scores, and modified MASTI grades, and had decreased chances and extent of soft tissue release for coronal balancing. Lesser degree of constitutional varus and sagittal plane deformity, and lower BMI have been found to be associated with better soft tissue preservation and better-modified MASTI grades.</p><p><strong>Conclusion: </strong>The 'modified MASTI classification' is a validated and reliable system to serve as a universal tool and platform for recording and grading iatrogenic bone and soft tissue injury during CR TKA. Using this classification, RA TKA is found to be less invasive and inflicts lesser extent of iatrogenic injuries when compared to CJ TKA. This classification can also be used as a parameter for evaluating the outcome of bone and soft tissue injuries and soft tissue releases to short- and long-term functional outcomes of patients, complications and longevity of implants.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-025-01343-3.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"414-425"},"PeriodicalIF":1.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Tibia Fractures in Osteoporosis.","authors":"Ravi Sauhta, Dheeraj Makkar","doi":"10.1007/s43465-025-01337-1","DOIUrl":"https://doi.org/10.1007/s43465-025-01337-1","url":null,"abstract":"<p><strong>Background: </strong>Tibial plateau fractures are frequently observed in elderly patients, often resulting from low-energy trauma. The treatment of tibial plateau fractures in this population is further complicated by factors such as osteoporosis, osteoarthritis, and other medical comorbidities.</p><p><strong>Objective: </strong>This article provides a comprehensive review of the different treatment strategies for proximal tibial fractures in the elderly. A variety of internal and external fixation techniques, medical management as well as acute arthroplasty, are discussed as potential approaches for achieving optimal reconstruction and functional recovery.</p><p><strong>What is already known: </strong>Existing literature emphasizes that osteoporotic bones, characterized by reduced bone density and compromised structural integrity, pose significant challenges to fracture fixation. These factors often diminish the efficacy of fixation devices in proximal tibial fractures, leading to an increased likelihood of fixation failure.</p><p><strong>Gap in literature: </strong>While the high failure rates associated with osteoporotic bone fixation are wellrecognized, there is a notable lack of comprehensive studies that integrate biomechanical, biological, and technological advancements to improve fixation outcomes, in proximal tibial fractures. This article aims to address this gap by reviewing current diagnostic approaches and exploring innovative strategies involving advanced materials and regenerative technologies designed to enhance fixation success.</p><p><strong>Conclusion: </strong>The management of proximal tibial fractures in the elderly requires a nuanced approach that integrates surgical intervention with medical management. A tailored treatment plan, based on specific fracture characteristics and overall health, is critical to optimizing postoperative functional outcomes. This article emphasizes the importance of a comprehensive, individualized treatment strategy to improve recovery and quality of life for elderly patients suffering from tibial plateau fractures.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"326-345"},"PeriodicalIF":1.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoporotic Distal Femur Fractures: An Overview.","authors":"Vivek Trikha, Arvind Kumar","doi":"10.1007/s43465-025-01345-1","DOIUrl":"https://doi.org/10.1007/s43465-025-01345-1","url":null,"abstract":"<p><strong>Background: </strong>Distal femur fractures in geriatric patients present a significant challenge due to age-related factors, including osteoporosis, comorbidities, and diminished functional reserve. These injuries have high morbidity and require nuanced management strategies to optimize outcomes. In the current chapter, we have reviewed the challenges associated with these intricate injuries and the potential solutions for their favorable outcomes.</p><p><strong>Method: </strong>We reviewed the published literature on epidemiology, pathophysiology, clinical presentation, and current treatment modalities for distal femur fractures in the elderly population, with a focus on advances in surgical techniques, rehabilitation strategies, and outcomes.</p><p><strong>Discussion: </strong>Operative treatment remains the mainstay, tailored to fracture patterns, patient comorbidities, and bone quality. Locking plates offer strong fixation in osteoporotic bone, while intramedullary nails, especially the newer generation ones, provide better biomechanical stability for unstable fracture types. Total knee replacement and distal femur replacement is a viable option in severe cases with comminution or poor bone quality.</p><p><strong>Conclusion: </strong>Distal femur fractures in the elderly are complex injuries with high morbidity and mortality. Early surgical intervention, optimized postoperative care, and a focus on addressing osteoporosis are key to improving outcomes and minimizing the long-term impact of these fractures on the vulnerable population. Favorable fracture healing can be achieved with plates, nails and their combinations as long as they are judiciously used.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"311-325"},"PeriodicalIF":1.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Elderly Elbow Fractures.","authors":"Ravi Gupta, Anil Kapoor","doi":"10.1007/s43465-024-01331-z","DOIUrl":"https://doi.org/10.1007/s43465-024-01331-z","url":null,"abstract":"<p><strong>Background: </strong>Elbow fractures are common in elderly patients with osteoporotic bones, typically resulting from falls on the elbow. Common fracture types include distal humerus, olecranon, and radial head fractures. Occasionally, a combination of these fractures occurs, creating complex injuries such as terrible triad injuries. Accurate evaluation using X-rays and CT scans is essential for optimal treatment planning. Careful preoperative planning, including the decision between non-operative and operative treatment and selecting appropriate surgical implants, is critical for achieving successful outcomes.</p><p><strong>Objective: </strong>This chapter focuses on common elbow fractures in elderly patients and explores the available treatment options. Given the lack of clear consensus on managing elbow fractures in osteoporotic bones, we address the associated complications and highlight various treatment approaches.</p><p><strong>Current knowledge: </strong>Numerous treatment methods have been proposed for osteoporotic elbow fractures, including various fixation techniques, arthroplasty, and excisions. Despite the availability of multiple treatment options, no method has emerged as superior. Each method has distinct advantages and disadvantages. This chapter aims to compile and compare these options, outlining their respective pros and cons.</p><p><strong>Conclusions: </strong>Elbow fractures in osteoporotic bones present significant challenges for surgeons. Although elderly patients with osteoporotic bones generally have lower functional demands compared to younger individuals, they still require adequate, pain-free elbow function for daily activities. Advances in surgical techniques and implant technology have expanded treatment options for these fractures. Achieving successful outcomes requires selecting the appropriate implant, meticulous preoperative planning, and expert surgical execution tailored to the specific fracture characteristics.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"358-367"},"PeriodicalIF":1.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Considerations in Osteoporotic Fracture Fixation.","authors":"Ritabh Kumar","doi":"10.1007/s43465-024-01332-y","DOIUrl":"https://doi.org/10.1007/s43465-024-01332-y","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic Fractures (OF) present formidable but predictable challenges in fixation. With ageing the bone mineral density is reduced and the internal micro-architecture is disrupted. This increases fracture risk and makes implant hold tenuous. Newer implant technology has helped improve fracture fixation but the risks of early mechanical failure remain tangible.</p><p><strong>Purpose: </strong>After fracture reduction and fixation, the surgeon remains apprehensive regarding rehabilitation. The concerns are higher in the lower limb where non-weight bearing is not possible. Understanding basic mechanics and translating that knowledge to fracture surgery helps provide secure surgical stability to enable full weight bearing assisted mobilization.</p><p><strong>Conclusion: </strong>Applying the logic of mechanics to living biological tissue will help the surgeon better understand the unique mechanical requirements of the fractured bone. Judicious surgical technique and careful combination of implants balancing the mechanical and biological needs of the ageing broken bone will help it heal. Integrating technology and surgical technique with the established principles of osteosynthesis will help improve functional outcomes in OF.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"256-270"},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopedic or Surgical Treatment in Gartland Type II Supracondylar Humerus Fractures: A Systematic Review.","authors":"Andreas Rehm, Rebecca J Worley, Hatem Osman, Katerina Hatzantoni, Luke Granger, Elizabeth Ashby","doi":"10.1007/s43465-025-01340-6","DOIUrl":"https://doi.org/10.1007/s43465-025-01340-6","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"450-451"},"PeriodicalIF":1.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological and Pharmacological Enhancement of Regeneration in Chronic Spinal Cord Injury.","authors":"P S John, Ann Maria John, Jobin Mathew, Vidhu Joshy","doi":"10.1007/s43465-024-01328-8","DOIUrl":"https://doi.org/10.1007/s43465-024-01328-8","url":null,"abstract":"<p><strong>Study design: </strong>Prospective, randomized, single-blind, comparative study.</p><p><strong>Primary objective: </strong>To compare the efficacy of multiple bone marrow implantations and co-administration of citicoline to multiple bone marrow implantations alone in the treatment of chronic Spinal Cord Injury (SCI).</p><p><strong>Setting: </strong>The study was conducted at Fathima Matha Physiotherapy and Rehabilitation Center in Kottayam, India.</p><p><strong>Methods: </strong>Twenty-three participants with chronic traumatic SCI, classified as American Spinal Injury Association Impairment Scale (AIS) A, B, or C, were recruited and randomized into two groups. The first group (BMCT group) received multiple intrathecal implantations of autologous non-manipulated bone marrow aspirate along with oral citicoline (Cytidine Diphosphate Choline). The second group (BM group) received only multiple intrathecal bone marrow implantations. Patients were assessed at baseline and followed up every three months for 24 months.</p><p><strong>Results: </strong>Comprehensive evaluation upon completion of the treatment demonstrated statistically significant improvements in AIS, Spinal Cord Independence Measure (SCIM) score, Walking Index for Spinal Cord Injury (WISCI) score and modified Ashworth score in the BMCT group compared to the BM group. The BMCT group demonstrated statistically significant improvement in motor and sensory scores also. Fractional Anisotropy (FA) values of Diffusion Tensor Imaging (DTI) recorded statistically significant improvement in both the groups after treatment. The Diffusion Tensor Tractography (DTT) recorded considerable improvement only in the BMCT group.</p><p><strong>Conclusions: </strong>This study observed statistically significant functional and neurological recovery in the BMCT group. The statistically significant increase in FA values recorded in both groups and the post-treatment improvements in DTT and MRI in the BMCT group are imaging evidences of spinal cord regeneration.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-024-01328-8.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"438-449"},"PeriodicalIF":1.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}