Indian Journal of Orthopaedics最新文献

{"title":"Operative Management of Aseptic Humeral Shaft Nonunion: A Retrospective Study from Eastern India.","authors":"John Mukhopadhaya, Janki Sharan Bhadani, Rajeev Ranjan, Shubhanshu Ranjan Kushwaha","doi":"10.1007/s43465-024-01290-5","DOIUrl":"10.1007/s43465-024-01290-5","url":null,"abstract":"<p><p>Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3-5% of all fractures, have nonunion rates of 2-33% in nonoperative and 5-10% in surgical management. This study, the largest case series on operative management of humeral shaft nonunion, examines surgical techniques and outcomes. This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from 2002 to 2020. Cases were from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20-70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathological fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using DASH, VAS, and constant shoulder score scores at a minimum follow-up of 24 months. The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Union was achieved in 21 weeks on average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful complication management to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and one case of transient radial nerve palsy. Absolute stability using a plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiological and functional outcome.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1793-1805"},"PeriodicalIF":1.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813199","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":"Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series.","authors":"Jaswinder Singh, Hitesh Shah, K Venkatadass, Janki Sharan Bhadani, John Mukhopadhaya","doi":"10.1007/s43465-024-01291-4","DOIUrl":"10.1007/s43465-024-01291-4","url":null,"abstract":"<p><p>Distal femur physeal fractures in children, particularly Hoffa fractures, are rare and prone to complications. This study aims to evaluate the outcomes of surgical intervention in children presenting with delayed intra-articular distal femur physeal fractures. A multicentric retrospective study involved six pediatric patients with delayed presentation of distal femur physeal fractures. Five patients underwent surgical intervention involving osteotomy and anatomical re-fixation of the malunited fragments. One patient opted for conservative management. The age at presentation, time since injury, surgical procedures, and clinical and radiological outcomes were evaluated at the final follow-up. Fixation with lag screws was sufficient in three patients, while two required additional plate stabilization. The mean age of patients was 12.2 years, comprising four boys and two girls. The average delay in presentation was 30.8 months (ranging from 3 months to 8 years). For the surgical group (<i>n</i> = 5), the knee range of motion improved from an average of 16°-66° preoperatively to 6°-128° post-operatively at a mean follow-up of 60 months. The mean limb shortening was 3 cm (range 0.5-5 cm). Two patients required additional procedures for distal femur varus malalignment. The conservatively managed patient showed no improvement in knee movements at the 12-month follow-up, serving as a control. Surgical intervention involving osteotomy and anatomical reduction for malunited intra-articular Salter-Harris-type III and IV fractures of the distal femur in children yields good to excellent outcomes. Limb length discrepancy and malalignment, if present, can be addressed separately. Longer follow-up until skeletal maturity is necessary to evaluate final outcomes in these patients. <b>Level of evidence</b>: Level IV (case series). Therapeutic.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-024-01291-4.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1782-1792"},"PeriodicalIF":1.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813202","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":"Managing Nonunion in Orthopedic Surgery.","authors":"John Mukhopadhaya, Janki Sharan Bhadani, Lalit Maini","doi":"10.1007/s43465-024-01288-z","DOIUrl":"10.1007/s43465-024-01288-z","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1677-1679"},"PeriodicalIF":1.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813178","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":"Beyond Hardware: The Orthoplastic Approach to Managing Infected Nonunions.","authors":"Vikas M Agashe, Janki Sharan Bhadani, Lalit Maini","doi":"10.1007/s43465-024-01289-y","DOIUrl":"10.1007/s43465-024-01289-y","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1777-1781"},"PeriodicalIF":1.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813094","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":"Research Trends in the Management of Scaphoid Non-unions: A Bibliometric Review.","authors":"Manish Raj, Pranav Sharma, Janki Sharan Bhadani, Shukla Mondal","doi":"10.1007/s43465-024-01286-1","DOIUrl":"10.1007/s43465-024-01286-1","url":null,"abstract":"<p><strong>Background: </strong>The scaphoid is the most commonly fractured carpal bone, often going into non-union and secondary complications. Despite this, no explicit guidelines exist for the management of its non-union till date. This study quantitatively analyses the existent research on scaphoid nonunions from 2013 to 2024 using bibliometric methodology.</p><p><strong>Materials and methods: </strong>The Web of Science database was used to search for and extract publications using the keywords 'scaphoid' AND 'nonunion'. Articles were then filtered based on their eligibility, and the metadata of the remaining articles was analysed using bibliometric methodology (R software and VOSviewer application). Performance analysis and science mapping were performed to obtain the metrics for past, present, and future trends in research on scaphoid nonunions.</p><p><strong>Results: </strong>A total of 272 articles were included in the study for bibliometric analysis after screening the initial 501 articles. There has been a rise in the number of articles published yearly, but the overall growth rate still remains negative. Developed nations with economic stronghold dominate in research, with the United States of America (USA) having the most published and cited articles. International collaborations in research were also lead by the USA with majority of its ties with Canada. The <i>Journal of Hand Surgery-American Volume</i> clearly remains the most productive and cited journal on this subject. Keywords analysis shows a shift from arthrodesis and excision towards bone grafting, arthroscopy, and internal fixation, indicating a future research trend towards minimally invasive procedures and evaluating the need for grafting.</p><p><strong>Conclusions: </strong>There is a continually increasing research interest in scaphoid non-unions with a trend towards minimally invasive definitive treatment methods. The research, however, lacks major contributions from the developing world which need to be strengthened. The need for vascularized and non-vascularized grafts is still under evaluation, with an emerging opinion in favour of even graft-less fixation.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1736-1755"},"PeriodicalIF":1.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813203","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":"Mass Spectrometry Characterization of the Human Ankle and Hindfoot Fracture Microenvironment in Young and Aged Subjects.","authors":"John F Dankert, Devan D Mehta, Tori C Rodrick, Evgeny Kanshin, Rown Parola, Beatrix M Ueberheide, Drew R Jones, Kenneth A Egol, Philipp Leucht","doi":"10.1007/s43465-024-01284-3","DOIUrl":"10.1007/s43465-024-01284-3","url":null,"abstract":"<p><strong>Background: </strong>Bone regeneration following a fracture is dependent on multiple factors including skeletal stem cells (SSCs). Recruitment, proliferation, and differentiation of the SSCs is guided by the proteins and metabolites found within the fracture microenvironment. Understanding how intrinsic factors affect the fracture microenvironment has been a topic of ongoing investigation. This study sought to determine whether the levels of select proteins and metabolites within the fracture hematoma would be differentially expressed depending on the age of the patient. We hypothesized that a distinct set of proteins and metabolites found within the fracture hematoma microenvironment would be present at varying levels depending on patient age.</p><p><strong>Methods: </strong>The research study was reviewed and approved by an Institutional Review Board. Hematomas were collected from subjects aged 18 years old or older undergoing surgical intervention for a fracture. Hematoma samples were selected from the biorepository and assigned to one of two fracture groups including young ankle/hindfoot and aged ankle/hindfoot. Protein and metabolite levels within each hematoma were analyzed by liquid chromatography-mass spectrometry.</p><p><strong>Results: </strong>A total of seven hematomas were included in each the young ankle/hindfoot and aged ankle/hindfoot groups. From the global metabolomic analysis, creatine, 2-methylindoline, and acetyl-L-carnitine were identified as being differentially expressed between both groups. An untargeted metabolomic analysis of the two groups identified significant differences in the levels of an additional 66 metabolites. Proteomic analysis identified 34 proteins that were expressed at significantly different levels.</p><p><strong>Conclusions: </strong>The level of metabolites and proteins found within the local fracture environment vary by patient age. Future investigations will focus on identifying a role for these proteins and metabolites in bone homeostasis and fracture healing.</p><p><strong>Level of evidence: </strong>N/A, basic science investigation.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-024-01284-3.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1871-1882"},"PeriodicalIF":1.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813187","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":"Outcomes of Infected Non-unions of Distal Femur Managed with the Masquelet Method and Ilizarov Ring Fixator.","authors":"Aradhana Rathod, Rameshkrishna Krishnamurthy, Deepak Shivanna, Putta Kempa Raju, Prabhu Manandi","doi":"10.1007/s43465-024-01279-0","DOIUrl":"10.1007/s43465-024-01279-0","url":null,"abstract":"<p><strong>Background: </strong>Distal femur infected non-union management is very challenging especially when there is late presentation and after multiple intervention. Various methods have been described and studied in the literature for infected non-union of femur which includes bone transport by fixators (ring fixators/monolateral frames) and by Masquelet method.</p><p><strong>Objectives: </strong>To study the clinical and radiological outcomes and study the effect on quality of life by patient-reported outcomes (EQ5D5L) and VAS (Visual Analog Scale) score in patients of infected non-union of distal femur managed with combination of Masquelet method and Ilizarov ring fixator.</p><p><strong>Patients and methods: </strong>Eleven patients aged between 18 and 60 years, both sexes, presenting with infected non-union of distal femur were considered for the study. Average findings were: time of presentation-56 weeks post-injury, number of previous surgeries-2.1, bone loss after debridement-8.5 cm, pre-operative VAS score-8.4, pre-operative EQ5D5L score-21.4, ISS-55.6, NUSS-56.54. Surgery was performed in two stages. Stage one involved debridement, application of a knee-spanning ring fixator, a vancomycin-loaded poly methyl methacrylate cement spacer, and closure, with corticotomy performed in some patients during this or the second stage.</p><p><strong>Results: </strong>The three patients (27.3%) had graft infection and underwent gradual docking after debridement. The results calculated for eight patients (without graft infection 72.7%) are as follows: Average ROM of knee 0 to 29.3degrees, external fixator duration was 48.1 weeks, union time was 27.5 weeks, VAS score was 1.9, immediate post-operative and 6 months frame removal EQ5D5L scores were 13.8 and 10.6, respectively. ASAMI bone score was excellent in five (62.5%), good in two (25%), and fair in one (12.5%). ASAMI functional score was excellent in one (12.5%), good in six (75%), and fair in one (12.5%).</p><p><strong>Conclusion: </strong>Masquelet method with stabilization using Ilizarov ring fixator with or without lengthening can give promising results in patients with less infection severity score. Patients with high score should be managed by only fixators (ring/monolateral).</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-024-01279-0.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1815-1826"},"PeriodicalIF":1.1,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813201","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":"Technology Update in Management of Multi-Ligament Knee Injuries.","authors":"Sujith Sidharthan, Rajarshi Bhattacharya","doi":"10.1007/s43465-024-01281-6","DOIUrl":"10.1007/s43465-024-01281-6","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-ligament knee injuries present in various combinations of structures around the knee joint, with or without involvement of neurovascular structures, posing significant challenges to the treating physician and therapists. Accurate diagnosis with appropriate surgical intervention and comprehensive rehabilitation to restore function and stability is, therefore, paramount. This article looks at the recent advancements in technology that are aiding in the management of these injuries.</p><p><strong>Method: </strong>An extensive search of literature was done in PubMed, SCOPUS, and Google Scholar on this topic and the necessary information was derived from the relevant articles for this review. The progress made in the field of diagnosis, surgical management, rehabilitation and patient education tools were explored.</p><p><strong>Discussion: </strong>A wide variety of diagnostic tools exists that are providing a more accurate evaluation of multi-ligament knee injuries both pre-operatively and post operatively. Advances in technology and techniques have aided in transforming their surgical management to a more minimally invasive approach. Patient-specific instrumentation, computer navigation and robotic-assisted surgery are in various stages of development offering enhanced precision and accuracy during ligament reconstruction procedures along with developments in digital technology and artificial intelligence.</p><p><strong>Conclusion: </strong>Advancements in technology have transformed the management of multi-ligament knee injuries, offering new tools and techniques that enhance diagnostic accuracy, surgical precision, and rehabilitation effectiveness. Artificial intelligence and its utility have widened the horizons, while at the same time bringing in the need for regulations necessary to monitor and develop these technologies.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 11","pages":"1537-1547"},"PeriodicalIF":1.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619315","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":"From the Guest Editors: Unraveling the Complexities of Multiligament Knee Injuries-A Global Endeavor.","authors":"Srinivas B S Kambhampati, Prahalad Kumar Singhi, Rajagopalakrishnan Ramakanth","doi":"10.1007/s43465-024-01282-5","DOIUrl":"https://doi.org/10.1007/s43465-024-01282-5","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 11","pages":"1507-1508"},"PeriodicalIF":1.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619310","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":"A Unique Variant of Intra-Prosthetic Dislocation in Dual Mobility Articulation Total Hip Arthroplasty-Displacement of Metal Liner.","authors":"Sumant Chacko Verghese, Jayteja Killampalli, Amir-Reza Jenabzadeh, Vijay Vardhan Killampalli","doi":"10.1007/s43465-024-01276-3","DOIUrl":"10.1007/s43465-024-01276-3","url":null,"abstract":"<p><p>Total hip arthroplasty stands as a milestone in surgical success for alleviating hip arthritis-related pain and enhancing patients' quality of life. While complications persist, advancements like dual-mobility articulation aims to mitigate risks. This manuscript presents an unprecedented unique complication in a 60-year-old woman with a revision dual mobility THA. The metal liner displaced from its original position causing impingement at the medial aspect of the femoral neck and deformation of the acetabular shell. Radiographic evidence revealed the displaced liner cutting into the femoral neck. This unusual complication prompted a re-revision, revealing severe damage to the acetabular cup and femoral neck. While intra-prosthetic dislocations in dual-mobility articulations are recognized, this case deviates from conventional types, emphasizing the need for ongoing vigilance in prosthesis design and patient follow-up. This case report highlights a new variant of intra-prosthetic dislocations to the existing literature on dual-mobility THA complications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"58 12","pages":"1883-1887"},"PeriodicalIF":1.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813057","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}