Indian Journal of Orthopaedics最新文献

{"title":"Shifting Perspectives in Shoulder Instability: The Emerging Role of the Coronal Glenoid Tilt Angle and 3D Assessment.","authors":"Abdul-Ilah Hachem, Hady Ezzeddine","doi":"10.1007/s43465-026-01896-x","DOIUrl":"10.1007/s43465-026-01896-x","url":null,"abstract":"<p><strong>Background: </strong>Anterior glenohumeral instability is a multifactorial condition heavily influenced by the baseline bony architecture of the shoulder joint. Historically, surgical stratification has relied on defect-based models, prioritizing the measurement of acquired volumetric bone loss. However, recent literature underscores the critical role of inborn congenital morphology.</p><p><strong>Aim/objectives: </strong>This commentary contextualizes the recent study by Sundar et al., which introduces the Coronal Glenoid Tilt Angle (GTA) as a novel, independent risk factor for instability measured via 3D-CT.</p><p><strong>Discussion: </strong>We highlight the clinical bottleneck that exists between advanced 3D spatial profiling and our current surgical algorithms.</p><p><strong>Conclusion: </strong>Ultimately, we advocate for the development of a comprehensive, multidomain instability score that synthesizes a patient's clinical profile, acquired volumetric defects, and intrinsic congenital restraints to better guide personalized interventions, ranging from isolated arthroscopic soft-tissue repairs to robust bone-block stabilizations.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 8","pages":"1917-1919"},"PeriodicalIF":1.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678228","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":"Radiological and Functional Outcomes of Joshi External Stabilization System (JESS) in Proximal Tibia Fractures: A Case Series.","authors":"Siddhartha Sinha, Sandeep Kumar, Arvind Kumar, Saket Bandil, Owais Ahmed Qureshi, Javed Jameel","doi":"10.1007/s43465-026-01887-y","DOIUrl":"https://doi.org/10.1007/s43465-026-01887-y","url":null,"abstract":"<p><strong>Introduction: </strong>External fixators have a limited role in the management of tibial plateau fractures (TPF). They are typically used as an initial management strategy. The Joshi External Stabilisation System (JESS) is a Kirschner wire-based fixator and has been used in TPF where plating may not be feasible due to poor skin conditions or delayed due to other soft tissue complications. This retrospective case series aimed to evaluate the radiological and functional outcomes of TPF managed using the JESS fixator.</p><p><strong>Materials and methods: </strong>Records of patients operated on with the JESS fixator for TPF between January 2021 and January 2024 were included in the case series. Data for each follow up at 2 weeks, 6 weeks, 12 weeks and 24 weeks was retrospectively collected. Demographic data, fracture classification using the Schatzker and Gustilo-Anderson and assessment of clinical, radiological union and complications on each follow-up were collected. The Knee Society Score (KSS) and visual analogue scale (VAS) were used for functional assessment of the patients.</p><p><strong>Results: </strong>Twenty-three patients were included, with an average age of 41 ± 11.18 years. The majority of injuries were due to road traffic accidents (69.6%) and were mostly closed fractures (73.9%). Schatzker type VI injuries were the most common (39.13%). The mean time from injury to surgery was 6.04 ± 2.6 days. Bridging callus was noted in all patients at 6 weeks follow up and complete union was noted in all patients by 14 weeks. VAS scores improved significantly with each follow-up. The KSS increased from 27.8 ± 15.7 at 2 weeks to 83.6 ± 7.5 at 24 weeks. The complication rate was 17.4%, with pin site infection being the most common (13%).</p><p><strong>Conclusion: </strong>The JESS is a useful option in high energy fractures with compromised soft tissues consistent with the principles of damage-control orthopaedics for the management of TPF. It offers good functional outcomes with a relatively low complication rate where plating may not be feasible as an early management. More studies with higher levels of evidence are required for validation of the results of this study.</p><p><strong>Level of evidence: </strong>Level IV.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01887-y.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2822-2830"},"PeriodicalIF":1.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181600","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":"Immediate Weight-Bearing and Early Ambulation Rehabilitation After Femoral Neck System Fixation for Undisplaced Femoral Neck Fractures: A Prospective Randomized Controlled Trial.","authors":"Chuanping Li, Shanzhong Yan, Fan Yu, Huajie Pan, Gang Yin, Bo Yu","doi":"10.1007/s43465-026-01894-z","DOIUrl":"https://doi.org/10.1007/s43465-026-01894-z","url":null,"abstract":"<p><strong>Objective: </strong>Internal fixation is the usual treatment for undisplaced intracapsular hip fractures (Garden I and II). This study aimed to determine the optimal rehabilitation protocol for patients undergoing femoral neck system (FNS) fixation.</p><p><strong>Methods: </strong>A prospective randomized controlled trial (RCT) was conducted involving 58 patients who underwent FNS fixation for femoral neck fractures (FNFs) during a 10-month period from September 2023 to June 2024. They were randomly assigned to two groups: an immediate weight-bearing and early ambulation (IWBEA) group (within 48 h) and a delayed weight-bearing and ambulation (DWBA) group (after 6 weeks). Outcomes included time of hospitalization, fracture healing time, in-hospital complications, functional performance, pain severity, and activities of daily living.</p><p><strong>Results: </strong>The IWBEA group showed a shorter time of hospitalization [median 6.0 (IQR 5.0-7.0) days vs. 7.0 (IQR 6.5-13.5) days, <i>P</i> = 0.002], a lesser fracture healing time [median 11.0 (IQR 10.0-12.5) weeks vs. 12.0 (IQR 11.0-13.0) weeks, <i>P</i> = 0.040], and a lower rate of in-hospital complications (6.9% vs. 27.6%, <i>P</i> = 0.037). At 12-month follow-up, activities of daily living [median 100.0 (IQR 95.0-100.0), <i>P</i> = 0.350], functional performance [median 12.0 (IQR 11.0-12.0), <i>P</i> = 0.289], pain severity [median 1.0 (IQR 0.0-2.0), <i>P</i> = 0.765], and Avascular Necrosis (AVN) incidence (<i>χ</i> ² = 1.673, <i>P</i> = 0.196) were comparable between groups.</p><p><strong>Conclusions: </strong>The IWBEA rehabilitation protocol can reduce time of hospitalization, fracture healing time, and incidence of in-hospital complications. In undisplaced intracapsular hip fractures treated with FNS, an IWBEA should be preferred.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2500099199).</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2760-2766"},"PeriodicalIF":1.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181106","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":"Efficacy and Safety of Acellular Dermal Matrix for Prevention of Epidural Fibrosis after Lumbar Fusion Surgery: A Propensity Score-Matched Study.","authors":"Dong Hun Kim, Jin-Young Kim, Jae Taek Hong, Jung-Woo Hur","doi":"10.1007/s43465-026-01860-9","DOIUrl":"https://doi.org/10.1007/s43465-026-01860-9","url":null,"abstract":"<p><strong>Background/purpose: </strong>Epidural fibrosis is a common postoperative complication of lumbar spine surgery and may cause persistent pain and functional limitation. Although various anti-adhesive materials have been introduced, their clinical effectiveness remains uncertain. Acellular dermal matrix (ADM), a biologically derived scaffold with favorable biocompatibility, may help prevent postoperative adhesions. This study evaluated the clinical efficacy and safety of ADM following posterior lumbar interbody fusion (PLIF).</p><p><strong>Methods: </strong>This retrospective study included patients who underwent single-level PLIF for degenerative lumbar disease between July 2019 and January 2023. Patients were assigned to ADM and non-ADM groups based on intraoperative ADM use. Propensity score matching was performed to reduce baseline differences. Outcomes were assessed using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria.</p><p><strong>Results: </strong>After matching, 66 patients (33 per group) were analyzed, with a mean follow-up of 18.6 months. Both groups showed significant postoperative improvement. The ADM group demonstrated lower VAS back pain scores at 6 months (p = 0.02) and 12 months (p < 0.01), and lower ODI scores at 12 months (p = 0.03). Satisfactory outcomes were achieved in 93.9% of the ADM group and 87.9% of the non-ADM group. Radiologic evaluation in the ADM group demonstrated preservation of a distinct tissue layer over the thecal sac, consistent with a barrier effect. No ADM-related adverse events were observed.</p><p><strong>Conclusion: </strong>ADM use during lumbar fusion surgery was associated with improved pain control and functional outcomes without additional safety concerns. ADM may be a useful option for preventing epidural fibrosis. Further prospective studies are warranted.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2672-2681"},"PeriodicalIF":1.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181695","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":"Predictors of Non-union in Subtrochanteric Femur Fractures: A Multivariate Logistic Regression Analysis.","authors":"Kongoor Nishantha Bhat, Vishanth Krishna Rao, Lokesh Holagundi, Nachiketan Kempaiah Dore, Vaikunt Gopakumaran Nair","doi":"10.1007/s43465-026-01882-3","DOIUrl":"https://doi.org/10.1007/s43465-026-01882-3","url":null,"abstract":"<p><strong>Background: </strong>Subtrochanteric femur fractures account for 10-34% of all hip fractures. They typically occur in two distinct patient groups: young adults who sustain high-energy trauma and elderly individuals with osteoporotic bone following low-energy trauma. The subtrochanteric region has unique anatomical and biomechanical features, including poor vascularity, high cortical density, and strong deforming muscle forces. These factors make stable fixation and timely union difficult to achieve. Intramedullary nailing is the most commonly used treatment method. However, complications, such as mal-reduction, non-union, and implant failure remain common. Identifying predictors of poor outcomes is crucial for guiding surgical planning and enhancing functional outcomes.</p><p><strong>Methods: </strong>We analysed subtrochanteric fractures in skeletally mature patients treated surgically at our centre between January 2021 and December 2023. Patients with insufficient follow-up, pathological fractures, or prior surgery elsewhere were excluded. Radiographic and clinical records were reviewed to evaluate complications and outcomes. Statistical analysis included chi-square tests, ANOVA, and logistic regression.</p><p><strong>Results: </strong>A total of 85 patients were included (mean age: 45.3 ± 16.8 years; 83.5% male). Most fractures were caused by high-energy trauma, with 55% classified as Seinsheimer Type 3-5. Proximal femoral nailing (PFN) was used in 84.7% of cases. Radiological union was achieved in 75.3% of patients, with a mean healing time of 18.5 weeks. Non-union occurred in 16.5%, delayed union in 7%, and varus malalignment in 14.1%. Functional outcomes were good to excellent in 84.7% based on the Harris Hip Score. Multivariate analysis identified age ≥ 60 years (aOR 3.12), diabetes mellitus (aOR 2.67), Seinsheimer Type 3-5 fractures (aOR 2.89), and medial wall comminution (aOR 4.05) as independent predictors of poor outcomes.</p><p><strong>Conclusion: </strong>Subtrochanteric fracture outcomes are strongly influenced by fracture complexity, patient comorbidities, and reduction quality. Medial wall integrity is a key determinant of union and implant success. Tailored surgical strategies and early risk identification are critical to improving prognosis.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2749-2759"},"PeriodicalIF":1.3,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181559","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":"Confounding by Indication in Reduction Maneuver Selection: Interpreting the Association Between Maneuver Type and Recurrence in Pediatric Radial Head Subluxation.","authors":"Zhehan Shen, Zhongjie Ma, Huan Du, Xiaojun Fei","doi":"10.1007/s43465-026-01892-1","DOIUrl":"https://doi.org/10.1007/s43465-026-01892-1","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2912-2913"},"PeriodicalIF":1.3,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181681","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 the Margins.","authors":"A Gulia, R B Rajasekaran","doi":"10.1007/s43465-026-01871-6","DOIUrl":"10.1007/s43465-026-01871-6","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 7","pages":"1565-1566"},"PeriodicalIF":1.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548815","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":"Intraosseous Schwannoma of the Spine: A Report of Three Cases.","authors":"Debobrato Saha, Pratyush Shahi, Abhishek Ghavalkar, Mona Tiwari, Christopher Gerber, Anindya Basu","doi":"10.1007/s43465-026-01856-5","DOIUrl":"https://doi.org/10.1007/s43465-026-01856-5","url":null,"abstract":"<p><strong>Background: </strong>Intraosseous schwannomas (IOS) of the spine are exceptionally rare tumours. Their nonspecific presentation and overlapping imaging features often lead to misdiagnosis as metastasis, chordoma, or giant cell tumour. In this series, we report three cases of spinal IOS-two thoracic and one sacral.</p><p><strong>Case presentation: </strong>The thoracic cases presented with progressive myelopathy, while the sacral case presented with chronic low back pain. All patients underwent gross total resection with instrumented stabilization, and histopathology confirmed benign schwannoma.</p><p><strong>Results: </strong>Both thoracic cases showed excellent outcomes, whereas the sacral case had a fatal postoperative course due to urosepsis.</p><p><strong>Conclusion: </strong>This series highlights the spectrum of clinical and radiologic presentations of spinal IOS and emphasizes the importance of early diagnosis, complete excision, and postoperative care to achieve favourable outcomes in these rare tumours.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2714-2721"},"PeriodicalIF":1.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181248","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":"Association of Pelvic Incidence with Age, Sex, and Degenerative Spinal Pathology: A Retrospective Radiological Study.","authors":"Mustafa Bulut, Muhammed Furkan Darılmaz","doi":"10.1007/s43465-026-01888-x","DOIUrl":"https://doi.org/10.1007/s43465-026-01888-x","url":null,"abstract":"<p><strong>Background: </strong>Pelvic incidence (PI) is a fundamental morphologic parameter of spinopelvic alignment and is traditionally considered largely constant in adulthood. However, the extent to which PI is influenced by age, sex, or degenerative spinal pathology remains uncertain.</p><p><strong>Objective: </strong>To evaluate the relationship of PI with age, sex, and degenerative disc disease (DDD) in an adult population and to identify independent predictors of lumbar lordosis (LL) and DDD.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included adults aged 40-60 years who underwent standardized lateral lumbopelvic radiography between 2019 and 2024. Individuals with prior spinal surgery, congenital anomalies, infection, tumor, or inadequate imaging were excluded. Spinopelvic parameters (PI, pelvic tilt [PT], sacral slope [SS], LL) were measured by two independent observers, and interobserver reliability was assessed using intraclass correlation coefficients. Group comparisons were performed using the Mann-Whitney <i>U</i> test, correlations with Spearman analysis, and multivariable regression models were constructed to determine independent predictors of LL and DDD.</p><p><strong>Results: </strong>A total of 319 participants (mean age 49.7 ± 6.1 years) were analyzed. No sex-related differences were observed in PI, PT, SS, or LL (<i>p</i> > 0.05). Individuals with DDD had higher SS and LL (both <i>p</i> < 0.001), whereas PI did not differ between the groups (<i>p</i> = 0.166). Age showed a moderate negative correlation with PI (<i>ρ</i> = -0.346, <i>p</i> < 0.001). In multivariable analysis, SS (<i>β</i> = 1.83), PI (<i>β</i> = -0.88), PT (<i>β</i> = 0.44), and female sex (<i>β</i> = 5.01) independently predicted LL. Age was the sole independent predictor of DDD (OR = 1.29 per year).</p><p><strong>Conclusion: </strong>In adults aged 40-60 years, pelvic incidence was not significantly associated with sex or radiographically detectable degenerative disc disease and appeared largely stable, although lower PI values were associated with older age in this cross-sectional cohort. Degenerative changes predominantly affect positional parameters (SS and LL) rather than the morphologic parameter PI. These findings reinforce the role of pelvic incidence as a key structural reference in the assessment of sagittal balance.</p><p><strong>Level of evidence: </strong>Level III (retrospective cross-sectional study).</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2682-2689"},"PeriodicalIF":1.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181558","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":"Surgical Methods for the Management of Intra-articular Distal Humerus Fracture: A Systematic Review and Bayesian Network Meta-analysis.","authors":"Ali H Alyami, Abdullah A Ghaddaf, Mohammed S Alquhaibi, Abdullah Almansor, Abdullah Alharbi, Ali Althagafi, Saeed Alzahrani, Dhafer Almuffarh, Hani Sulimani","doi":"10.1007/s43465-026-01854-7","DOIUrl":"https://doi.org/10.1007/s43465-026-01854-7","url":null,"abstract":"<p><strong>Background: </strong>Intra-articular distal humerus fractures (DHF) carry a technical challenge for orthopedic surgeons, owing to the complex geometry of the distal humerus. Surgical management is the standard of care for these fractures. The aim of this network meta-analysis was to compare the clinical outcomes of the different open reduction and internal fixation (ORIF) and arthroplasty techniques for the management of intra-articular DHFs.</p><p><strong>Methods: </strong>The databases Medline, Embase, and CENTRAL were searched for relevant studies. Randomized controlled trials (RCTs) were included if they matched the following criteria: skeletally mature adult patients, including elderly and young adults, with type C bicolumnar intra-articular DHF according to the AO classification, and performed a pairwise comparison between any of the following interventions: (1) ORIF with perpendicular double plating; (2) ORIF with parallel double plating; (3) ORIF with Y-shaped double plating); (4) EHA; (5) TEA. The outcomes of interest in this study were arc of motion, Mayo Elbow Performance Score (MEPS), and adverse event rate. The network meta-analysis was performed through a Bayesian-based framework using the BUGSnet package in R software. Treatments ranking was performed through the Surface Under the Cumulative Ranking (SUCRA).</p><p><strong>Results: </strong>Ten RCTs were found eligible for inclusion, representing 357 patients. The different surgical techniques showed similar results with respect to the arc of motion, and ORIF with parallel plating had the best rank (SUCRA = 83.56). ORIF techniques showed a significantly better MEPS score compared to arthroplasty, and ORIF with parallel plating had the best rank (SUCRA = 85.63). The adverse event rate was similar across the different surgical interventions and EHA showed the best rank (SUCRA = 67.53).</p><p><strong>Conclusion: </strong>No substantial difference was found between the different surgical techniques with respect to the clinical outcomes and adverse events. ORIF with parallel plating showed the highest ranking with respect to arc of motion, MEPS score, and reducing risk of HO but without statistical significance. The choice of the appropriate surgical technique should be tailored to each patient under the consideration of the age, fracture pattern, and salvageability.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD42024603193.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01854-7.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"60 10","pages":"2727-2739"},"PeriodicalIF":1.3,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181569","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}