Indian Journal of Orthopaedics最新文献

{"title":"Efficacy and Complications of External Fixator-Assisted Correction in Cubitus Varus Deformity.","authors":"Shrey Chauhan, Parmanand Gupta, Ashwani Soni","doi":"10.1007/s43465-024-01312-2","DOIUrl":"10.1007/s43465-024-01312-2","url":null,"abstract":"<p><strong>Background: </strong>Untreated cubitus varus results in cosmetic deformity as well as posterolateral rotatory instability at the elbow if longstanding. French osteotomy with its modifications is the most commonly done osteotomy and relies on a medial intact hinge and these osteotomies fail to address the lateral prominence. Intraoperative fixator assistance to adjust the translation and fine tune the osteotomy is a novel method to address the lateral prominence. This prospective study analyses the efficacy of the same.</p><p><strong>Materials and methods: </strong>A total of 16 consecutive patients presenting with unilateral cubitus varus resulting from mal-united supracondylar fracture of humerus were included. The humero-ulnar angle correction required, size of lateral closing wedge and amount of translation required were calculated. After a lateral surgical approach, one Schanz pin of size 2.5mm-3.5mm depending on age, was passed just above the level of distal humerus physis, lateral to medial; a second pin was inserted in the shaft of humerus, again lateral to medial. Pre-calculated wedge of bone was removed, angular correction as well as translation done; fine tuning of the osteotomy was achieved using fixator assistance. Rotational and hyperextension deformities were corrected simultaneously. Fixation of the osteotomy was done by multiple <i>K</i> wires or plates, depending on the age of the patient.</p><p><strong>Observation and results: </strong>The mean carrying angle corrected to 10.4 degrees valgus from a preoperative value of 19.8 degrees varus. The mean humero-ulnar angle corrected to 9.6 degrees valgus from a preoperative value of 19.6 degrees varus. The mean lateral prominence index reduced to - 3.8% from a preoperative value of - 5.5%. The mean cosmetic correction score was 9 (Max 10) from a preoperative value of 1.9. No patient had an 'S' shaped deformity in the operated elbow. No nerve palsies were observed in any of the operated patients.</p><p><strong>Conclusions: </strong>Fixator assistance during surgery allows angular, translation and rotational control of the fragments to fully correct the deformity. It also allows fine tuning of the osteotomy during surgery.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"156-163"},"PeriodicalIF":1.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065286","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":"Fixation Failure in Osteoporotic Bone: A Review of Complications and Outcomes.","authors":"John Mukhopadhaya, Janki Sharan Bhadani","doi":"10.1007/s43465-024-01316-y","DOIUrl":"https://doi.org/10.1007/s43465-024-01316-y","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic bone poses significant challenges for fixation of fractures due to its compromised bone quality. This issue impacts patient outcomes and, necessitate proper understanding of the biomechanical limitations and the adequacy of current fixation devices.</p><p><strong>Objective: </strong>This article aims to address the gaps in literature by examining both the biomechanical and biological factors that contribute to fixation failure in osteoporotic bone, and by analyzing the limitations of current management strategies, with the aim of identifying effective interventions for this vulnerable patient group.</p><p><strong>What is already known: </strong>Literature acknowledges that osteoporotic bones have reduced bone density and compromised structural integrity, making fixation devices less effective. Fixation failure frequently occurs in these patients due to diminished bone strength and insufficient fixation support, which collectively hinder optimal stabilization and healing.</p><p><strong>Gap in literature: </strong>Despite recognition of the high failure rates associated with osteoporotic bone fixation, there is limited literature detailing a comprehensive approach that integrates biomechanical, biological, and technological advancements to improve fixation outcomes. This article reviews current diagnostic techniques and explores potential innovations in materials and regenerative strategies aimed at enhancing fixation success. Which also guide us about need for future research to focus on developing and validating multifaceted approaches that combine advanced fixation materials and bone regeneration technologies to mitigate failure risks and improve patient outcomes.</p><p><strong>Conclusion: </strong>With increasing life expectancy, the incidence of osteoporosis and hence osteoporotic fractures steadily increasing there are multiple fractures which are responsible for this, however as orthopedic surgeon we are required to deal with these fractures in increasing numbers so we need to develop a comprehensive approach to prevention of these fractures' adequate treatment and also the prevention of refractures which are far too common.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"389-404"},"PeriodicalIF":1.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810494","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":"Rehabilitation After Lower Limb Fracture Fixation in Osteoporotic Bone.","authors":"Akashdeep Singh, Akhilesh Kumar, Sachin Yashwant Kale, Suraj Prakash, Vishal Kumar","doi":"10.1007/s43465-024-01325-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01325-x","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic fractures, particularly in the lower limbs, are a significant health burden, especially in elderly patients. With an increasing aging population globally, effective fracture fixation and rehabilitation are critical to restoring mobility and reducing complications.</p><p><strong>Objectives: </strong>This study aims to review rehabilitation approaches following lower limb fracture fixation in osteoporotic bones, emphasizing the biomechanics of fracture fixation and post-surgical rehabilitation.</p><p><strong>Methods: </strong>A detailed analysis of current surgical techniques for fixing osteoporotic fractures is presented, including internal fixation strategies, the use of implants, and their biomechanical performance. In addition, rehabilitation protocols post-surgery are reviewed to highlight early mobilization strategies and their impact on recovery outcomes.</p><p><strong>Results: </strong>The review highlights that, despite challenges posed by osteoporotic bone quality, advancements in surgical implants and fixation techniques allow for stable fracture management. Early mobilization, while previously controversial, is increasingly supported by recent evidence, showing improved functional outcomes and reduced complications, particularly in elderly patients.</p><p><strong>Conclusions: </strong>Early rehabilitation and weight-bearing strategies play a pivotal role in restoring function after osteoporotic fractures of the lower limbs. This review advocates for tailored rehabilitation protocols, considering patient age, fracture type, and the mechanical stability of the fixation.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"405-413"},"PeriodicalIF":1.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811171","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":"Effectiveness of Hybrid Fixation in the Treatment of Proximal Diaphyseal Both Bone Forearm Fractures in Adolescents.","authors":"Mohamed Abdelhamed Romeih, Abdullah Khaled","doi":"10.1007/s43465-024-01300-6","DOIUrl":"10.1007/s43465-024-01300-6","url":null,"abstract":"<p><strong>Background: </strong>Pediatric diaphyseal both-bone forearm fractures are one of the most prevalent fractures in orthopedic practice.</p><p><strong>Purpose of the study: </strong>To assess the anatomical and functional outcomes of hybrid fixation (radius nailing and ulna plating) in treating closed proximal radius and ulna fractures in adolescents.</p><p><strong>Methods: </strong>This prospective cohort study was performed on 41 patients between the ages of 10 and 16 years, both sexes, with recent trauma (less than 2 weeks) suffering from closed proximal diaphyseal radius and ulna fractures. Functional outcomes were assessed according to the price score grading criteria, along with the radiological assessment of the union.</p><p><strong>Results: </strong>Regarding Price score grading, 28 (68.29%) cases had an excellent function, 8 (19.51%) had a good function, 3 (7.32%) had a fair function, and 2 (4.88%) cases had a poor function. The mean union time was 7.41 ± 2.65 weeks. Four patients complained of prominent hardware, three cases developed neuropraxia resolved, and two cases had nonunion of both bones and one of them had nail migration.</p><p><strong>Conclusion: </strong>The hybrid fixation technique could be effectively used in the treatment of adolescent proximal both-bone forearm fractures.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"148-155"},"PeriodicalIF":1.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065284","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":"Change of Guard: Mission and Directions.","authors":"Murali Poduval, Srinivas B S Kambhampati","doi":"10.1007/s43465-024-01309-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01309-x","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 1","pages":"1-2"},"PeriodicalIF":1.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11680523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902649","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":"Deciphering the Frailty Factor: Comprehensive Insights Into Its Impact on Postoperative Complications and Recovery Among Elderly Orthopedic Surgery Patients.","authors":"Rushama Tandon, Rajan Kumar Singh, Ashutosh Kapoor","doi":"10.1007/s43465-024-01299-w","DOIUrl":"10.1007/s43465-024-01299-w","url":null,"abstract":"<p><strong>Background: </strong>This single center-based prospective cohort study was conducted, on 157 patients over 60 years old patients requiring major orthopedic surgery, from June 2019 to June 2021. Frailty was assessed using the Edmonton Frailty Scale pre-operatively. Post-operative complications, ambulatory status, readmission rates, and mortality were monitored up to three months post-surgery, and statistical analysis was performed.</p><p><strong>Materials and methods: </strong>With India's elderly population projected to reach 324 million by 2050, the prevalence of orthopedic surgeries among this demographic is increasing. frailty, a measure of decreased strength, endurance, and physiological function with aging, may significantly affect surgical outcomes. This study aimed to evaluate the correlation between frailty, as measured by the Edmonton Frailty Scale, and postoperative outcomes in elderly patients undergoing major orthopedic surgeries.</p><p><strong>Results: </strong>The study found that 60% of patients were categorized as either vulnerable or frail. Surgical site infection (15.9%) was the most common postoperative complication across all frailty levels. Cardiac complications and deep vein thrombosis were significantly associated with higher frailty levels. At discharge, 78% of patients were ambulatory, improving to over 91% at the three-month follow-up. However, frailty significantly delayed recovery to ambulatory status. The incidence of death during the study was 3.2%, and readmission within 30 days post-surgery was 3.8%. Statistical analysis revealed significant differences between frailty levels and post-operative complications, ambulatory status, and, to a lesser extent, readmission, and mortality rates.</p><p><strong>Conclusion: </strong>The study demonstrates a significant correlation between frailty and adverse postoperative outcomes in elderly patients undergoing major orthopedic surgeries. It underscores the necessity of incorporating frailty assessment into preoperative evaluations to tailor care plans and improve surgical outcomes. Tailored rehabilitation programs and preoperative optimization may mitigate the risks associated with frailty, enhancing recovery and reducing the burden of postoperative complications and readmission.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"208-217"},"PeriodicalIF":1.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065281","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":"Which Method of the Radiologic Measurements of the Angle of Curvature in Idiopathic Scoliosis is the Most Reliable for an Inexperienced Researcher?","authors":"Patryk Wiliński, Aleksandra Piekutin, Klementyna Dmowska, Wojciech Zawieja, Piotr Janusz","doi":"10.1007/s43465-024-01307-z","DOIUrl":"10.1007/s43465-024-01307-z","url":null,"abstract":"<p><strong>Aim: </strong>The aim of the examination was to determine which of the three measurement methods Cobb (CB), Ferguson (FR), and Centroid (CN) has the best repeatability and reliability when the measurements are made by inexperienced researchers.</p><p><strong>Methods: </strong>Three researchers (from the student research group) measured the angle of spine curvature on X-rays of the entire spine in standing anteroposterior view in 50 patients with severe idiopathic scoliosis qualified for surgery. Cobb, Ferguson, and Centroid methods were used. One of the researchers repeated all examinations twice at 3-week intervals. The measurements were compared with each other using the intraclass correlation coefficient (ICC) method. Values less than 0.5 are indicative of poor reliability, values between 0.5 and 0.75 indicate moderate reliability, values between 0.75 and 0.9 indicate good reliability and values greater than 0.90 indicate excellent reliability.</p><p><strong>Results: </strong>The ICC (inter-rater) between the researchers' measurements was 0.9387 for CB, 0.9169 for FR, and 0.9061 for CR. Whereas the ICC (intra-rater) between measurements taken by a single researcher was 0.9824 for CB, 0.9088 for FR, and 0.9546 for CR.</p><p><strong>Conclusions: </strong>The above results show that Cobb angle measurement method is the most reliable for measuring the curvature angle of the spine for novice researchers. Although it seems to be difficult to measure, it provides the most repeatable results.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"140-147"},"PeriodicalIF":1.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065206","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":"What is the Incidence of Bone Cement Implantation Syndrome in Elderly patients Undergoing Cemented Stem Hemiarthroplasty ? An Evaluation of 40 Patients.","authors":"Mehar Dhillon, Sudhir Kumar Garg, Rohit Jindal, Lakesh Anand, Sandeep Gupta","doi":"10.1007/s43465-024-01304-2","DOIUrl":"10.1007/s43465-024-01304-2","url":null,"abstract":"<p><strong>Introduction: </strong>To study the incidence of bone cement implantation syndrome in elderly patients undergoing cemented stem hip arthroplasty with the use of pulse lavage.</p><p><strong>Materials and methods: </strong>40 consecutive patients undergoing cemented stem hip arthroplasty enrolled in the study and intra-operative vitals post induction and post cementing were recorded at 5, 10 and 15 min.</p><p><strong>Results: </strong>Study depicted an incidence of 32.5%. The incidence of grade 1, 2 ,3 was 22.5%,7.5% and 2.5%, respectively. There was a significant correlation between increased age and those patients suffering from BCIS grade 2 and 3 (<i>p</i> = 0.016). There was no correlation drawn between the comorbidities of the patients and the presence of the condition. However, all the patients with a history of dementia, myocardial infarction and stroke developed the syndrome. A significant correlation was drawn with patients suffering from left ventricular failure (<i>p</i>-value 0.03) pre-operatively. The severity of bone cement implantation syndrome was associated with a significant increase in pre-operative neutrophils (<i>p</i>-value 0.037) and hyponatremia (<i>p</i>-value 0.042) compared to patients with a mild condition, indicated the need for optimisation of the patient. A severe case leading to cardio-pulmonary collapse post cementing was recorded.</p><p><strong>Conclusions: </strong>BCIS is a commonly occurring under-reported phenomenon in the elderly, leading to significant intra-operative complications. Pre-operative risk assessment along with good coordination between anaesthetist and surgeon is imperative.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"191-197"},"PeriodicalIF":1.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065205","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 Antimicrobial Prophylaxis in Orthopedic Implant Surgeries: An Analysis of Practices, Outcomes, and Costs.","authors":"Anurag Virmani, Vandana Roy, Girish Gulab Meshram, Sumit Sural","doi":"10.1007/s43465-024-01303-3","DOIUrl":"10.1007/s43465-024-01303-3","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize various regimens used for surgical antimicrobial prophylaxis (SAP) in patients undergoing orthopedic implant surgeries (OISs).</p><p><strong>Method: </strong>A prospective observational study was conducted in patients undergoing OISs to identify various antimicrobial regimens used for SAP. Patients were followed up for a month to detect signs of surgical site infections (SSIs). Risk factors that increase the likelihood of SSIs were determined. Adherence to standard guidelines for SAP was evaluated. Cost analysis and adverse drug reaction (ADR) profiling of each of the regimens used were also done.</p><p><strong>Results: </strong>Among the 264 patients included, 11 regimens for SAP were followed. Ceftriaxone + amikacin given for 1-5 days was the most common regimen employed (37.87%). One-day regimens (< 24 h) were more commonly prescribed (34.84%) than all other durations (2-5 days). SSIs were observed in 2.37% of the included patients. Gender, presence of cardiovascular comorbidities, low preoperative Hb, and the choice of antimicrobial regimen selected for SAP were associated with SSIs. The adherence rate to standard guidelines for SAP was 35.5%. In our study, ceftriaxone given for < 24 h was the most cost-effective regimen, with the lowest cost per patient (0.28 USD) and no infections. Procurement of ceftriaxone and amikacin contributed to > 70% of the total cost of SAP. Vomiting, epigastric pain, and thrombophlebitis were the common ADRs observed.</p><p><strong>Conclusion: </strong>SAP practices for patients undergoing OISs are highly variable, with low adherence to standard guidelines. Development of evidence-based national and institution-specific guidelines, along with regular antibiotic stewardship activities, could help curb the heterogeneity in SAP practices.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 2","pages":"198-207"},"PeriodicalIF":1.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065200","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 Humerus Fractures in the Elderly.","authors":"Shailesh Pai, Mohamed Faheem Kotekar, Siddharth M Pawaskar, M Ajith Kumar","doi":"10.1007/s43465-024-01301-5","DOIUrl":"https://doi.org/10.1007/s43465-024-01301-5","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal humerus fractures are the second most common upper limb injury among the elderly, with a notable increase in incidence attributed to osteoporosis. This chapter addresses the complexities involved in managing these fractures, particularly in older patients who may have unique challenges and risks.</p><p><strong>Methods: </strong>A review of current management strategies for proximal humerus fractures in elderly patients was conducted, focusing on both conservative and surgical approaches. Conservative management was evaluated for its efficacy in treating minimally displaced fractures, especially in patients with lower functional demands or those unfit for surgical intervention. Surgical options, including open reduction and internal fixation (ORIF) with locking plates (PHILOS) and newer intramedullary nail designs (MULTILOC), were also examined. Additionally, minimally invasive techniques such as Resch and MIROS were considered for high-risk surgical candidates.</p><p><strong>Discussion: </strong>Conservative management, while often preferred, carries potential complications such as malunion, nonunion, and stiffness, which can adversely affect patient outcomes. Surgical intervention is frequently required for displaced or complex fractures, with ORIF being the gold standard due to its ability to provide stability and enhance outcomes in osteoporotic bone. The introduction of innovative intramedullary nail designs and minimally invasive techniques offers promising alternatives, particularly for patients at high surgical risk, by reducing soft tissue disruption and facilitating quicker recovery.</p><p><strong>Conclusion: </strong>Effective management of proximal humerus fractures in the elderly requires a tailored approach, balancing the benefits and risks of conservative versus surgical treatment. Ongoing advancements in surgical techniques and devices hold the potential to improve outcomes for this vulnerable population, emphasizing the importance of individualized care in fracture management.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"346-357"},"PeriodicalIF":1.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811155","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}