Indian Journal of Orthopaedics最新文献

{"title":"Surgical Considerations in Osteoporotic Dorso-Lumbar Spine Fractures.","authors":"Ram Chaddha, Gaurav Agrawal, Agnivesh Tikoo, Harsh Kotadia","doi":"10.1007/s43465-024-01333-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01333-x","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral fractures are exponentially impacting health-care systems globally with the rapid increase in geriatric population. These fractures are seen most commonly in the dorso-lumbar spine. Lack of timely diagnosis and adequate treatment contributes significantly to morbidity and mortality. It has become vital to thoroughly evaluate these patients clinically, investigate them, optimise them, plan conservative and / or surgical treatment and provide comprehensive pre, peri and post-operative counselling and support.</p><p><strong>Content: </strong>Historically, geriatric patients with multiple comorbidities with vertebral fractures were considered poor candidates for surgical treatment due to high anaesthetic and surgical risk. Those who were offered surgery were not adequately optimised pre-operatively and the fractures were under-stabilised surgically. Better understanding of the biomechanics of an osteoporotic vertebral column with dorso-lumbar fractures, combined with advances in anaesthetic and surgical techniques, implants and technologies facilitate successful surgeries on high-risk geriatric patients significantly reducing morbidity and improving quality of life. This article discusses the pathophysiology of dorso-lumbar osteoporotic vertebral fractures, their clinical presentation, investigative work-up, pre-operative optimization, indications for surgical intervention, various surgical modalities, techniques and technologies for optimal surgical outcomes, post-operative care and follow-up of patients.</p><p><strong>Implications: </strong>In this article, the authors aim to provide an overview of the various pre, peri and postoperative considerations while dealing with patients of osteoporotic dorso-lumbar vertebral fractures. This review provides a comprehensive set of guidelines for the medical optimization and surgical management of these patients with an overview of current techniques, strategies and technologies designed to address the challenges associated with spine surgery in geriatric comorbid osteoporotic patients.</p><p><strong>Sources: </strong>Content for this article has been sourced from routinely cited articles available via PubMed, National Institute of Health, census reports from United Nations, from previous articles by the authors and from the protocols established by the authors in their clinical practice based on experience and detailed case reviews.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"368-381"},"PeriodicalIF":1.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811263","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/s43465-024-01324-y","DOIUrl":"https://doi.org/10.1007/s43465-024-01324-y","url":null,"abstract":"<p><strong>Introduction: </strong>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 intraarticular distal femur physeal fractures.</p><p><strong>Materials and methods: </strong>A multicentric retrospective study involving six pediatric patients with delayed presentation of distal femur physeal fractures was conducted. Five patients underwent surgical intervention involving osteotomy and anatomical refixation 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.</p><p><strong>Results: </strong>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 degrees preoperatively to 6-128 degrees postoperatively 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.</p><p><strong>Conclusions: </strong>Surgical intervention involving osteotomy and anatomical reduction for malunited intraarticular 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.</p><p><strong>Level of evidence: </strong>Level IV (Case series). Therapeutic.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-024-01324-y.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"426-437"},"PeriodicalIF":1.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811140","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":"Comparison of 1 Week Accelerated Ponseti and Standard Ponseti Technique for Management of Idiopathic Congenital Talipes Equinovarus Deformity in Infants: A Randomized Controlled Trial.","authors":"Ritesh Arvind Pandey, Anup Kumar, Nadim Anjum Mollah, Prabhat Agrawal","doi":"10.1007/s43465-024-01314-0","DOIUrl":"10.1007/s43465-024-01314-0","url":null,"abstract":"<p><strong>Background: </strong>The implementation of the standard Ponseti technique (SPT) in management of idiopathic clubfoot can be challenging due to the need for frequent travelling and long duration to achieve correction. The one week accelerated Ponseti technique (OWAPT) reduces the duration of correction to seven days and has been reported to be effective and safe. However, children still need to travel for change of cast.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted to compare the SPT and OWAPT for their effectiveness, safety and treatment expenditure. Children under one year of age with untreated idiopathic CTEV were included. Those undergoing correction with OWAPT were hospitalized till tendo-achillis tenotomy. The relevant data was collected and analyzed using appropriate statistical methods.</p><p><strong>Results: </strong>Forty six children (68 feet) were enrolled with 22 (33 feet) in OWAPT group and 24 (35 feet) in SPT group. The mean age at treatment in OWAPT and SPT group was 1.55 months and 2.91 months, while their mean Pirani score was 4.59 and 4.70 respectively. The Pirani score improved significantly within both groups without any significant difference between the two groups. The total number of casts required to achieve correction were also comparable (<i>p</i> = 0.779). The OWAPT was observed to be more economical (<i>p</i> < 0.001) but had more minor complications.</p><p><strong>Conclusion: </strong>The OWAPT is equally effective, achieves faster correction and is more cost-effective than SPT. Its implementation by hospitalizing the children avoids travelling issues and achieves 100% compliance during correction phase. Hospitalization also ensures better plaster care and monitoring for complications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"181-190"},"PeriodicalIF":1.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065271","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":"Role of Augmentation in the Fixation of Osteoporotic Fractures.","authors":"Chinmoy Das, Partha Pratim Das","doi":"10.1007/s43465-024-01323-z","DOIUrl":"https://doi.org/10.1007/s43465-024-01323-z","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporotic fractures present a significant challenge due to the compromised bone quality, leading to complications in traditional fracture fixation methods. Augmentation techniques have emerged as a valuable approach to enhance the stability of fracture fixation in osteoporotic patients.</p><p><strong>Aim: </strong>This review explores the various augmentation methods used in fracture management, including polymethylmethacrylate (PMMA) and calcium phosphate cements, as well as novel injectable materials. Additionally, the role of biomechanical augmentation techniques, such as locked plating and hybrid fixation, is discussed in enhancing fixation strength. Clinical applications in vertebral, proximal femur, and upper extremity fractures are examined, with a focus on the effectiveness of augmentation in improving patient outcomes. Despite the benefits, augmentation presents challenges, such as the risks associated with cement leakage and the economic burden on healthcare systems. The review also highlights future directions, including the development of bioactive and biodegradable materials, as well as innovations in minimally invasive techniques.</p><p><strong>Conclusion: </strong>Overall, augmentation plays a crucial role in addressing the limitations of traditional fixation in osteoporotic bone, offering promising solutions to improve fracture management.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"294-299"},"PeriodicalIF":1.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811261","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":"Functional Outcomes in Aseptic Humeral Shaft Nonunion Treated With Plate Osteosynthesis: A Retrospective Cohort Study.","authors":"John Mukhopadhaya, Janki Sharan Bhadani, Rajeev Ranjan, Shubhanshu Ranjan Kushwaha","doi":"10.1007/s43465-024-01317-x","DOIUrl":"10.1007/s43465-024-01317-x","url":null,"abstract":"<p><strong>Introduction: </strong>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 aseptic humeral shaft nonunion (AHSN), treated with plate osteosynthesis.</p><p><strong>Materials and methods: </strong>This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion 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, pathologic 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 Quick DASH, VAS, Constant Shoulder score at a minimum follow-up of 24 months.</p><p><strong>Results: </strong>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 with atrophic type of AHSN received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Constant Shoulder score improved from 22 to 88 and VAS score improved from 6.7 to 1.3. Union was achieved in 21 weeks on an average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful management of complications to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and two case of transient radial nerve palsy.</p><p><strong>Conclusion: </strong>Absolute stability using plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiologic and functional outcome.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"218-230"},"PeriodicalIF":1.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065288","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":"Oral Versus Injectable Vitamin D Therapy for Treating Nutritional Rickets in Indian Children: A Comparative Study.","authors":"Harshith Patel, Vikas Gupta, Kamal Jain, Purusharth Yagnik, Nandu M S Nair, G R Aditya Reddy","doi":"10.1007/s43465-024-01327-9","DOIUrl":"10.1007/s43465-024-01327-9","url":null,"abstract":"<p><strong>Background: </strong>Rickets is a common metabolic bone disease in children, primarily caused by vitamin D deficiency. This study aimed to compare the efficacy of oral weekly vitamin D supplementation and injectable stoss therapy in treating nutritional rickets in Indian children.</p><p><strong>Methods: </strong>This prospective, randomized, controlled trial was conducted over 18 months at a tertiary care center. Forty children aged 6 months to 16 years with clinical, biochemical, and radiological evidence of nutritional rickets were enrolled and randomly assigned to receive either oral vitamin D3 (60,000 IU weekly for 10 weeks) or a single intramuscular injection of vitamin D3 (600,000 IU). Clinical, biochemical, and radiological assessments were conducted at baseline and at 3 weeks, 6 weeks, 3 months, and 6 months post-treatment.</p><p><strong>Results: </strong>Both treatment regimens significantly improved vitamin D, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) levels, with no significant differences between the groups. Radiological healing, assessed by Thacher's score, was achieved in both groups by 6 months. While both treatments were effective, injectable stoss therapy resulted in a more sustained increase in vitamin D levels and may offer better compliance due to its single-dose administration. No cases of local skin complications or vitamin D toxicity or symptomatic hypercalcemia were observed.</p><p><strong>Conclusion: </strong>Oral weekly and injectable stoss therapies are both effective and safe for treating nutritional rickets. Injectable stoss therapy may be more suitable for the Indian population due to its cost-effectiveness and lower compliance demands. Serum parathyroid hormone (PTH) levels emerged as a useful early marker of rickets severity as well as treatment response. Early diagnosis and treatment are crucial to prevent long-term skeletal deformities.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"173-180"},"PeriodicalIF":1.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065228","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":"Challenges Posed by Osteoporosis in Arthroscopy and Sports Injury Management.","authors":"Ravi Gupta, Anil Kapoor","doi":"10.1007/s43465-024-01330-0","DOIUrl":"https://doi.org/10.1007/s43465-024-01330-0","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis, whether generalized or localized, presents significant challenges in arthroscopic procedures, particularly in surgeries such as ligament reconstructions and rotator cuff repairs, which depend on fixation through interference screws and/or anchors. These challenges are especially pronounced in women, the elderly, and individuals with chronic injuries. The literature discusses various techniques to mitigate these issues.</p><p><strong>Objective: </strong>Despite the recognition of these challenges, there is no clear consensus on the most effective methods to address them. Current literature lacks comprehensive information on the specific difficulties surgeons encounter when managing sports injuries in osteoporotic bones, particularly around the knee. This manuscript aims to outline and describe various treatment strategies to manage sports injuries in patients with osteoporotic bones.</p><p><strong>Current knowledge: </strong>Numerous studies acknowledge the heightened risk of fixation failure in osteoporotic bones. Surgeons have described various techniques to address these fixation issues, such as alternative fixation methods, preserved insertion techniques, bone bridge techniques, larger diameter screws, and supplementary fixation strategies. Techniques such as transosseous equivalent (TOE) repair, special suture configurations, multiple fixation points, medial anchor placement in subchondral bone, and bone cement augmentation are among the methods used to improve anchor fixation in osteoporotic bone.</p><p><strong>Literature gap: </strong>Although multiple surgical techniques are available for graft and tendon fixation in osteoporotic bones, there is no clear guideline on which method offers the best combination of biological and mechanical superiority. This article reviews the various fixation techniques and explores innovative approaches to graft fixation. In addition, the authors emphasize the importance of medical management of osteoporosis in patients undergoing surgical interventions, highlighting the role of bisphosphonate, teriparatide, denosumab. Medical therapy not only reduces the risk of fixation failure but also plays a crucial role in post-operative recovery.</p><p><strong>Conclusions: </strong>With the growing emphasis on healthy lifestyles, increasing numbers of elderly patients are participating in sports activities. As a result, more patients with low bone mineral density (BMD) are seeking treatment for sports injuries. Anticipating the issue of regional low BMD is essential, even in younger patients, to ensure that alternative fixation techniques are employed when necessary.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"382-388"},"PeriodicalIF":1.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811432","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":"Study of Factors Affecting the Clinical and Radiological Outcome in Management of Infected Non-Union of Tibia Managed with Ilizarov Ring Fixator and its Correlation with Patient-Reported Outcome: Prospective Descriptive Study.","authors":"Aradhana Rathod, K Ramesh Krishna, P V Sharath Kumar","doi":"10.1007/s43465-024-01326-w","DOIUrl":"10.1007/s43465-024-01326-w","url":null,"abstract":"<p><strong>Background: </strong>Non-union of fracture of tibia is often associated with multiple problems like infection, deformity, bone loss, and soft tissue loss. Ilizarov is a worldwide accepted treatment for infected non-union of tibia, but correlation of patient-rated outcome measures with surgeon-assessed clinical and radiological outcomes is not being done in the literature.</p><p><strong>Objectives: </strong>To analyze the variables affecting clinical and radiological outcomes and patient-reported outcomes (EQ5D5L) and to assess correlation between patient-reported outcome measures and ASAMI scores during management of infected nonunion of tibia with Ilizarov ring fixator.</p><p><strong>Patients and methods: </strong>Thirty three patients aged between 18 and 70 years, both sexes, presenting with infected non-union tibia.</p><p><strong>Results: </strong>The mean age was 39.51 ± 14.94 years ± SD, pre-operative EQ5D5L score was > 20 in 87.9%, patients mean value is 21.061 ± 3.508 SD, mean non-union severity score was 51.7 ± 15.7 SD, mean Infection Severity Score is 44.485 ± 18.755 SD. The correlation of the variables affecting the ASAMI radiological score: Distal 1/3rd and midshaft, Smoking, Alcohol, Non-union severity score, Infection severity score had negative correlation, with significant p value and EQ5D5L score immediate post-operative score and EQ5D5L follow up had positive correlation with ASAMI radiological score. Gap / bone loss score had negative correlation, p value being 0.058+. EQ5D5L immediate post-operative score and EQ5D5L follow up had positive correlation with significant p value with ASAMI clinical score.</p><p><strong>Conclusion: </strong>Ilizarov fixator is an excellent tool in managing infected nonunion of tibia with bone loss with good patient rated outcome and ASAMI clinical and radiological score.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"231-238"},"PeriodicalIF":1.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065233","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":"Stabilization of Osteoporotic Pelvis and Acetabular Fractures.","authors":"Ramesh Kumar Sen, Sujit Kumar Tripathy","doi":"10.1007/s43465-024-01329-7","DOIUrl":"https://doi.org/10.1007/s43465-024-01329-7","url":null,"abstract":"<p><strong>Background: </strong>The surgical management of osteoporotic pelviacetabular fractures poses distinct challenges due to poor screw purchase, severe comminution of fractures, and the inability to perform prolonged surgeries in patients with significant comorbidities. These fractures necessitate tailored modifications in surgical approaches, implant selection, and techniques based on the patient's overall health, fracture complexity, and bone quality.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed and Google Scholar databases to identify relevant articles on the management of osteoporotic pelvi-acetabular fractures.</p><p><strong>Results: </strong>Implant selection plays a pivotal role in addressing the fragility of osteoporotic fractures. Specialized implants, such as locking plates with multidirectional screw holes, along with augmentation using polymethylmethacrylate (PMMA) or bone substitutes, enhance screw fixation in compromised bone. Sacral fractures, which are commonly involved, are often managed with percutaneous fixation using long cancellous screws. Minimally invasive long-screw fixation techniques are particularly effective for less displaced acetabular fractures. For displaced acetabular fractures with articular impaction, fracture elevation and stabilization using bone grafts or bone graft substitutes are crucial. When feasible, less invasive surgical techniques are preferred to minimize operative trauma. In some cases, the fixation of acetabular fractures in osteoporotic bone may fail over time, necessitating conversion to total hip arthroplasty (THA). For fractures with severe comminution, primary THA combined with column reduction and fixation is frequently a safer and more effective approach. Early postoperative mobilization is critical to reduce the risk of complications such as deep vein thrombosis and pressure ulcers.</p><p><strong>Conclusion: </strong>The stabilization of osteoporotic pelvic and acetabular fractures requires a multifaceted approach incorporating advanced surgical techniques, specialized implants, and augmentation methods. Early mobilization and individualized postoperative management are essential for optimizing patient outcomes and minimizing complications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"300-310"},"PeriodicalIF":1.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811262","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":"Developmental Dysplasia of the Hip: Factors Related to the Diagnosis and Characteristics of Selective Screening for its Detection.","authors":"I Miras Aguilar, M Pangua Gómez, L Fidalgo Marrón, E Castaño Andreu, C Llorente Ruiz, G Galicia Poblet, A Aldea Romero, P Álvarez Estrada, A Ortigado Matamala","doi":"10.1007/s43465-024-01315-z","DOIUrl":"10.1007/s43465-024-01315-z","url":null,"abstract":"<p><strong>Backgrounds: </strong>Breech presentation, family history, and physical examination are the most recognized risk factors for DDH, which form the basis of selective screening. However, this approach can lead to late diagnosis, invasive treatments, and complications. This study analyzes the effectiveness of selective screening and identifies additional factors related to DDH.</p><p><strong>Methods: </strong>A retrospective case-control analytical study is designed, including children who are assessed through screening between 2012 and 2019. The variables examined include clinical and gestational characteristics, as well as examination findings. Descriptive analysis is conducted, followed by univariate analysis using Chi-squared, Fisher's exact, or Student's <i>T</i> tests. For multivariate analysis, the \"all set\" user command is employed. Sensitivity, specificity, and ROC curve are calculated, with a significance level set at <i>p</i> < 0.05. StataIC 16 and SAS System 9.4 are used.</p><p><strong>Results: </strong>762 children are included in the study, of which 33 are diagnosis with DDH. A total of 8,191 models are developed to predict DDH. The best logistic regression model identified the following independent predictors of dysplasia: newborn weight (OR 1.2, 95% CI 1.1-1.4), female sex (OR 3.9; 95% CI 1.4-10.9), cephalic presentation (OR 17.8; 95% CI 2.3-137.3), primiparity (OR 2.6; 95% CI 1.1-5.7), and examination (OR 149.6; 95% CI 18-1121.4). This model correctly classifies 83.6% patients (ROC curve 0.86). In selective screening, examination is the only identified risk factor for DDH, yet its sensitivity does not exceed 10%.</p><p><strong>Conclusions: </strong>This study proposed a total of 8191 models to predict DDH. The identified predictors include female sex, birth weight, cephalic presentation, and primiparity. While physical examination is the primary risk factor, it detects only decentred hips. The low sensitivity of selective screening raises questions about whether it remains the most appropriate method for identifying DDH in current practice.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"164-172"},"PeriodicalIF":1.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065282","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}