Indian Journal of Orthopaedics最新文献

{"title":"When to Think and Do Bipolar in Inter Trochanteric Fractures.","authors":"Rajesh Kumar Rajnish, Sandeep Kumar Yadav, Akhil Mathew Jacob, Amit Srivastava, Saurabh Gupta, Abhay Elhence","doi":"10.1007/s43465-025-01413-6","DOIUrl":"10.1007/s43465-025-01413-6","url":null,"abstract":"<p><strong>Background: </strong>The life expectancy of the elderly population is increasing; hence, a rise in both intracapsular and extracapsular hip fractures. Early surgical intervention and ambulation are crucial to improving outcomes and reducing complications associated with recumbency. The optimal management of intertrochanteric femur fractures (IFFs) in elderly patients especially in cases of osteoporotic bone or high-risk fractures remains debated. Intramedullary fixation is most commonly used but may fail in patients with poor bone quality, making bipolar hemiarthroplasty (BHA) a potential alternative.</p><p><strong>Objectives: </strong>This review aims to evaluate the role of BHA in the management of IFFs in elderly patients, identifying fracture patterns amenable to BHA.</p><p><strong>Methods: </strong>A comprehensive literature review on BHA for IFFs in elderly patients was performed, focusing on indications, surgical techniques, and outcomes.</p><p><strong>Results: </strong>BHA can be considered beneficial for elderly patients with osteoporotic IFFs at high risk for fixation failure, particularly in fractures with severe comminution, reverse oblique patterns, or associated intraarticular pathologies. There is no consensus on definitive indications for BHA, with surgeon preference and fracture morphology guiding treatment decisions. The surgical technique varies, with approaches including posterolateral, direct lateral, and direct anterior methods. Cemented and uncemented femoral stems both have advantages and limitations, with cemented stems favoured for immediate weight-bearing in osteoporotic bone.</p><p><strong>Conclusion: </strong>BHA is a viable alternative to intramedullary fixation in elderly patients with high-risk IFFs. Further studies are needed to define clear indications and optimal techniques for BHA in this population.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 8","pages":"1026-1031"},"PeriodicalIF":1.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952457","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":"Assessing Sexual and Functional Outcomes After Direct Anterior Approach Total Hip Arthroplasty: Insights from a Retrospective Study.","authors":"Supreet Bajwa, Ravi Teja Rudraraju, Kunal Aneja, Ponnanna Karineravanda Machaiah, Nitin Dawre","doi":"10.1007/s43465-025-01399-1","DOIUrl":"https://doi.org/10.1007/s43465-025-01399-1","url":null,"abstract":"<p><strong>Purpose of the study: </strong>The direct anterior approach (DAA) is favored for its muscle-sparing benefits and rapid recovery after total hip arthroplasty (THA). While functional outcomes are well-documented, the impact of DAA THA on sexual health remains underexplored. This study evaluates the resumption of sexual activity and functional recovery in male patients following DAA THA.</p><p><strong>Methods: </strong>A retrospective review of male patients who underwent DAA THA (January 2023 and December 2023) was assessed pre- and post-operatively (2 weeks, 12 weeks, and 1-year) for sexual function using the Sexual Health Inventory for Men (SHIM) and hip functionality through the Harris Hip Score (HHS). Statistical significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Among 64 patients (mean age: 31.4 ± 4.9 years), 73.5% resumed sexual activity within 2 weeks, rising to 95% by 12 weeks. Of those sexually active within 2 weeks, 93% reported a SHIM score of ≥ 20. By 1 year, all patients resumed sexual activity with a mean SHIM score of 23.5. Functional recovery showed a significant improvement in HHS from 39.3 ± 1.4 pre-operatively to 98.9 ± 0.9 at 1 year (<i>p</i> < 0.05). Minor complications, including superficial wound dehiscence (<i>n</i> = 2), were conservatively managed, with no dislocations or major complications reported.</p><p><strong>Conclusion: </strong>DAA THA improves hip function and early resumption to sexual activity, an essential yet overlooked aspect in younger male patients. With 95% resuming sexual activity within 12 weeks and full functional restoration by 1 year, DAA THA proves as a safe and effective approach, making it an ideal choice for active, young individuals seeking physical and personal well-being after surgery.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"967-972"},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626160","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 Novel Anatomical Double Bundle Acromioclavicular Joint Reconstruction with Semi Tendinosus Graft-A Functional Outcome Assessment Study in a Tertiary Care Hospital Of Eastern India.","authors":"Chinmay Mandal, Udeepto Lodh, Anuvab Goswami, Anindya Basu, Aniruddha Sengupta, Subhan Adhikary","doi":"10.1007/s43465-025-01385-7","DOIUrl":"10.1007/s43465-025-01385-7","url":null,"abstract":"<p><strong>Aim: </strong>To assess the functional outcome of surgical treatment using anatomical double bundle acromioclavicular Joint Reconstruction (ACJR) with Semitendinosus graft (STG), a novel technique for the treatment of acromioclavicular joint (ACJ) dislocation.</p><p><strong>Methods: </strong>In this prospective study, patients with ACJ dislocation with acute (< 6 weeks) and chronic injury (> 6 weeks), categorized according to Rockwood classification were included, operated using a novel technique. Patients were evaluated using Oxford shoulder score (OSS) and visual analog score (VAS) at months 1, 3, 6 and 12.</p><p><strong>Results: </strong>Of the thirty adult patients (males 22; females 08), 5, 10 and 15 were in Rockwood Grade 3, 4 and 5, respectively. The mean ± SD age was 33 ± 7.5 years (range 18-48 years). Right sided injury (<i>n</i> = 18), involvement of dominant side (<i>n</i> = 21) was more frequent. The mean duration from the time of injury to surgery was 15 days (range 4-26 days). The mean follow-up period was 12 months (range 8-16 months). The mean OSS improved from 26 ± 7.3 to 37.88 ± 5.78 at month 3 and 44 ± 6.4 (<i>P</i> = 0.001) at month 12; VAS score increased from a mean 8.5 ± 1.02 at baseline to 3.53 ± 1.42 at month 3 and 0.95 ± 0.22 at month 12 (<i>P</i> = 0.001). The outcome was satisfactory in 86.66% patients while 13.34% had mild shoulder dysfunction. Intermittent mild pain without any functional disability (<i>n</i> = 02), and a moderate restriction of shoulder movements (<i>n</i> = 01) were reported.</p><p><strong>Conclusion: </strong>ACJR using anatomical double bundle STG in ACJ dislocation is a functional, efficient, reproducible and cost-effective procedure in all the patients including sportspersons and high demand professionals.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 6","pages":"840-847"},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283762","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 Novel Technique of Femoral Supracondylar Focal Dome Osteotomy for Correction of Frontal Plane Knee Deformities in Children and Young Adults.","authors":"Swapnil Keny, Nihar Modi","doi":"10.1007/s43465-025-01388-4","DOIUrl":"https://doi.org/10.1007/s43465-025-01388-4","url":null,"abstract":"<p><strong>Introduction: </strong>Frontal plane knee deformities in adolescents and young adults often require corrective osteotomy to realign the mechanical axis. Numerous methods have been described in the literature, but the method of choice continues to be debatable. The purpose of our study was to evaluate outcomes with a novel technique of focal dome osteotomy (FDO).</p><p><strong>Methods: </strong>Our prospective study included 20 adolescents/young adults with lower limb deformities eligible for corrective surgical procedures. These patients underwent an FDO, post which they were evaluated clinically, radiologically, functionally, and cosmetically.</p><p><strong>Results: </strong>21 distal femur FDOs were performed in 20 patients with frontal plane knee deformities. Clinically, the tibiofemoral angle and the <i>Q</i> angle were restored to normal post-surgery. Radiological evaluation showed a statistical difference in immediate postoperative values of mechanical lateral distal femoral angle (mLDFA) and radiological anatomic tibiofemoral angle (TFA), with restoration to the normal range. Hospital for Special Surgery (HSS) scoring for functional outcome showed significant improvement with an excellent score of 86.47 at the 1-year follow-up. Range of motion was restored to normal at the 2-month follow-up. Cosmetic visual analog score (VAS) and Patient Satisfaction Scores showed good outcomes, too.</p><p><strong>Conclusion: </strong>FDO is an effective treatment for frontal plane knee deformities mandating a surgical procedure, in children and young adults. It helps to correct deformity without limb length discrepancies. The novel surgical technique ensured good clinical, radiological, and functional outcomes, along with the advantage of cosmetic superiority over other techniques.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-025-01388-4.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"990-999"},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626157","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 Between 3D-Printed Drill Guides and Freehand Surgery for Pedicle Screw Instrumentation in Children and Adolescents with Congenital Scoliosis: A Systematic Review and Meta-analysis.","authors":"Paweł Łajczak, Anna Łajczak","doi":"10.1007/s43465-025-01401-w","DOIUrl":"https://doi.org/10.1007/s43465-025-01401-w","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital scoliosis (CS) is a spinal deformity with a heterogeneous presentation, significantly affecting spinal development if untreated. Pedicle screw instrumentation is a common surgical intervention for CS, but the freehand technique often leads to inaccuracies, increasing the risk of complications. Recently, 3D-printed drill guides have emerged as a cost-effective and accurate alternative to computer-assisted navigation systems. This study systematically reviewed and compared the effectiveness of 3D-printed drill guides and the freehand technique in pedicle screw placement for children with CS.</p><p><strong>Methods: </strong>A systematic search across five databases identified eligible studies comparing 3D-printed drill guides with freehand for pedicle screw instrumentation in CS patients. A total of three studies, involving 123 patients (60 in the 3D printing group and 63 in the freehand group), were included. Outcomes assessed included screw placement accuracy, complication rates, operation time, and surgical outcomes. Statistical analyses were conducted using a random-effects model in R software.</p><p><strong>Results: </strong>3D-printed drill guides demonstrated statistically significant improvements in screw placement accuracy (GR 0: OR 1.80, <i>p</i> = 0.015; GR 0 + 1: OR 3.69, <i>p</i> < 0.001) and reduced rates of severe screw misplacement (GR 3: OR 0.20, <i>p</i> = 0.019). Additionally, the 3D printing group experienced significantly fewer complications (OR 0.16, <i>p</i> = 0.02). No statistically significant differences were observed in operation time, operation time per screw, bleeding volume, or spinal curve correction outcomes between the two techniques.</p><p><strong>Conclusion: </strong>3D-printed drill guides offer a superior alternative to FH techniques in improving pedicle screw accuracy and reducing complication rates for CS surgery without increasing operation time or bleeding. While promising, the limited sample size and focus on a single geographic region highlight the need for further multicenter studies to validate these findings and explore broader clinical applications.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"888-900"},"PeriodicalIF":1.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626163","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 and Radiological Outcomes of Single-Stage Bilateral Total Hip Replacement: A Retrospective Observational Study.","authors":"Rajendra Kumar Kanojia, Ramesh Kalappagol Basappa, Dipesh Shah, Himanshu Bhayana","doi":"10.1007/s43465-025-01369-7","DOIUrl":"10.1007/s43465-025-01369-7","url":null,"abstract":"<p><strong>Introduction: </strong>One-stage bilateral total hip replacement (THR) offers numerous benefits including reduced anesthetic exposure, single hospital admission, shorter hospital stay, quicker rehabilitation, and lower expenses. We conducted a retrospective study to evaluate the functional and radiological outcomes following this procedure.</p><p><strong>Material and methods: </strong>Our observational retrospective study included 30 patients undergoing one-stage bilateral THR via posterior approach by a single specialist surgeon. Data on ASA grade, hospital stay, preoperative and postoperative hemoglobin levels, and complications were collected from hospital records. The radiological outcomes were evaluated from the postoperative radiographs. Functional outcomes were assessed using modified Harris Hip Score, SF-36 score for quality-of-life, and the Self-Administered Patient Satisfaction Scale for Primary Hip and Knee Arthroplasty.</p><p><strong>Results: </strong>In our cohort, 83% were ASA 1, 70% were male, with mean age was 45.1 years. Mean surgical duration was 175 min, with mean intra-operative blood loss was 834 ml. Mean length of stay was 9.9 days. Pre-operative hemoglobin averaged 12.45 g/dl, dropping by 2.15 g/dl postoperatively. No major complications were observed. Radiologically, mean values for Hip Offset, leg length, acetabular anteversion and inclination were within acceptable ranges. Statistically significant improvements were observed in Modified HHS (preoperative: 31.0 ± 16.2, postoperative: 86.7 ± 7.2). Patient satisfaction was high, with 86.66% reporting being very satisfied with surgery outcome.</p><p><strong>Conclusion: </strong>Our study suggests that single anesthesia bilateral THR in ASA 1 and 2 patients is associated with low complication rate and good functional outcomes. One-stage bilateral THR remains a safe option for patients with bilateral hip disease, provided appropriate patient selection and skilled surgical expertise are ensured.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 8","pages":"1180-1186"},"PeriodicalIF":1.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952335","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":"Fracture Neck Femur Between 60 and 75 Years Treated by Dynamic Hip Screw Along with Autologous Hemi-fibular Graft: Analysis of Results.","authors":"Srinivas Reddy Nookala, Shravan Kumar Yadala, Karthik Reddy Ratna, Meghana Kaveti","doi":"10.1007/s43465-025-01377-7","DOIUrl":"https://doi.org/10.1007/s43465-025-01377-7","url":null,"abstract":"<p><strong>Aim and objective: </strong>The aim of our study is to evaluate the efficacy of dynamic hip screw (DHS) combined with autologous half-fibular grafting in treating displaced femoral neck fractures in elderly patients aged 60-75 years, focusing on the potential for achieving stable fracture union and preserving joint functionality.</p><p><strong>Materials and methods: </strong>32 patients with displaced femur neck fracture aged 60-75 years were treated from 2014 to 2024. 21 were transcervical, and 11 were subcapital. A prospective clinical study consisted of 19 males and 13 females. Patients were selected as per the inclusion and exclusion criteria. Two holed DHS plates with long barrels were used in all cases. The tip-apex distance (TAD) was maintained at a lowest possible level with the screw subchondral<i>.</i> The size of the lag screw was chosen, so that the lateral end of the screw  was at a distance of 8-10 mm medial from the lateral cortex. A half-fibular autograft was used in all cases. All cases were treated with closed reduction on a fracture table with C-arm IITV. Derotation screws were avoided in all cases to reduce the metal work in the femoral head. All surgeries were performed within 72 h of hospitalization, and the patients were discharged on the 6 th postoperative day (range 4-9 days). The mean duration for DHS fixation is 70 min and for fibular grafting is 35 min. All patients who achieved union were advised to undergo implant removal at the end of 18 months. Only six patients turned up for implant removal.</p><p><strong>Results: </strong>Fracture union achieved in 30 cases (94%). The mean shortening of the neck was 5 mm. Functional outcome was measured using the Harris Hip Score at 1 year; 20 (63%) patients had excellent results, 6 (19%) had good results, 3 (9%) had fair results, and 3 (9%) had poor results. The patients were advised to come for follow-up for a period of 5 years. Two cases failed to unite. One patient was advised hemiarthroplasty, and the other was advised total hip arthroplasty. Avascular necrosis (stage II) was observed in two cases, but pain subsided with implant removal and decompression.</p><p><strong>Conclusion: </strong>Joint preservation can be considered in patients with femur neck fractures in the age group of 60-75 years. DHS plating along with half-fibular grafting has given a good functional outcome with a lower complication rate, thereby preserving the hip joint.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"957-966"},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626166","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":"Sex-Related Differences in Human Tendon Stiffness: A Systematic Review and Meta-analysis.","authors":"Serkan Taş, Ümit Yüzbaşıoğlu, Ece Ekici, Aysun Katmerlikaya","doi":"10.1007/s43465-025-01398-2","DOIUrl":"https://doi.org/10.1007/s43465-025-01398-2","url":null,"abstract":"<p><strong>Background: </strong>The identification of sex-specific differences in tendon stiffness may facilitate better understanding of the underlying mechanisms of differences in tendon injuries between sexes. Consequently, the objective of this meta-analysis was to examine the influence of sex on human tendon stiffness.</p><p><strong>Methods: </strong>Literature search was conducted for the systematic review and meta-analysis through the PubMed, Web of Science and Scopus electronic databases. Studies comparing tendon stiffness in males and females written in English were included. The methodological quality assessment of the included studies was conducted with the adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. The standardised mean difference (SMD) with corresponding 95% confidence intervals (CIs) was employed to quantify the effects between males and females.</p><p><strong>Results: </strong>A total of 32 studies that met the inclusion criteria were analysed in the study. Four studies were classified as of high quality, 27 as of medium quality, and the remainder as of low quality. The Achilles tendon stiffness (SMD = - 0.88, 95% CI = - 1.30, - 0.46; <i>p</i> < 0.001) and patellar tendon stiffness (SMD = - 0.62, 95% CI = - 1.17, - 0.07; <i>p</i> = 0.03) were found to be higher in males compared to females. Conversely, the values for quadriceps tendon stiffness were similar across sexes (SMD = - 0.19, 95% CI = - 1.14, 0.74; <i>p</i> = 0.69).</p><p><strong>Conclusion: </strong>The findings of this meta-analysis indicate that males exhibit greater Achilles and patellar tendon stiffness than females. The observed differences regarding Achilles and patellar tendon stiffness may have an effect on the differing prevalence of tendon injury between males and females.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-025-01398-2.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"876-887"},"PeriodicalIF":1.1,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626185","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":"Pre-operative and Intra-operative Factors Affecting Post-operative Range of Motion in Total Knee Arthroplasty: A Prospective Clinical and Radiological Study.","authors":"Yuvarajan Palanisamy, Arjun R Prasad, Rajshekhar Kollar, Sugumar Natarajan, David V Rajan","doi":"10.1007/s43465-025-01373-x","DOIUrl":"https://doi.org/10.1007/s43465-025-01373-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify the key factors influencing post-operative range of motion after total knee arthroplasty. The primary determinants investigated were preoperative range of motion, intra-operative posterior condylar offset (PCO), posterior condylar offset ratio (PCOR), posterior tibial slope (PTS), and joint line height (JLH).</p><p><strong>Methods: </strong>This prospective study enrolled 68 patients. PCO, PCOR, PTS, and JLH were assessed radiologically in both pre-operative and post-operative X-rays. The knee range of motion and Oxford Knee Score (OKS) were assessed at 2-year follow-up. Statistical analysis, including Student's t test and correlation analysis, was employed to compare and correlate pre-operative and post-operative parameters.</p><p><strong>Results: </strong>Pre-operative range of motion correlated with post-operative range of motion (<i>p</i> = 0.001). The study did not find a significant correlation when post-operative range of motion was correlated with PCO (<i>p</i> = 0.923), PCOR (<i>p</i> = 0.278), PTS (<i>p</i> = 0.604), and JLH (<i>p</i> = 0.488). Post-operative changes in PCO (<i>p</i> = 0.001) and PTS (<i>p</i> = 0.001) when compared to pre-operative values were significant. PCOR (<i>p</i> = 0.468) and JLH (<i>p</i> = 0.108) had no significant correlation with their respective pre-operative values. Pre-operative OKS: 18.23 ± 8.53, Post-operative OKS: 40.92 ± 4.0 (<i>p</i> = 0.001). Pre-operative maximum flexion: 93.31° ± 7.73°, post-operative maximum flexion angle: 111.83° ± 9.69° (<i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Amongst the measured parameters, pre-operative range of motion was the primary factor influencing the range of motion attained after total knee arthroplasty (TKA).</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"951-956"},"PeriodicalIF":1.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626169","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":"Unitized Nail-Plate Construct (NPC) for Atypical Femur Fracture Fixation: A Retrospective Study on Clinical Outcomes.","authors":"Vivek Shetty, Vikas Agashe, Shaswat Mishra, Mrinal Kambli, Manish Jain, Raunak Dhawale","doi":"10.1007/s43465-025-01396-4","DOIUrl":"https://doi.org/10.1007/s43465-025-01396-4","url":null,"abstract":"<p><strong>Introduction: </strong>Atypical femoral fractures (AFFs) are an uncommon yet serious complication associated with long-term bisphosphonate use for osteoporosis treatment. Despite their rising incidence, the optimal management strategy for AFFs is still a work in progress. Intramedullary nailing has traditionally been the preferred treatment; however, literature reports surprisingly high complication rates. This study evaluates the clinical outcomes of unitized nail-plate construct (NPC)-\"Linking the nail with the plate with locking bolts through the plate and nail, proximal and distal to the fracture site\"-as a primary fixation method for AFFs.</p><p><strong>Materials and methods: </strong>A retrospective review of 17 AFF cases was conducted from 2019 to 2023. After applying inclusion criteria defined by the 2013 American Society of Bone and Mineral Research (ASBMR) task force document, 14 AFFs (13 patients: 12 unilateral AFFs and 1 bilateral AFF) treated with unitized NPC were included in the study. Outcomes were assessed based on time to fracture union, independent mobilization, and return to activities of daily living (ADL).</p><p><strong>Results: </strong>The cohort consisted entirely of female patients with a mean age of 70.1 years (range: 56-84) and an average bisphosphonate therapy duration of 5.1 years (range: 1.5-11.5) prior to fracture. The group included 3 subtrochanteric and 11 diaphyseal fractures. The mean follow-up duration was 22 months (range: 14-58 months), with an average hospital stay of 7.2 days (range: 4-13 days) and a mean surgical time of 72 min (range 58-96 min). All 14 fractures healed without complications, with a mean time to union of 17.5 weeks (range: 12-23 weeks). There were no cases of non-union, implant failure, delayed union, or need for secondary procedures. The mean time to independent mobilization was 14 weeks (range: 9-23 weeks), and 12 patients were able to resume ADL independently by the 1-year follow-up.</p><p><strong>Conclusion: </strong>While unitized NPC requires additional surgical time and expertise, its superior outcomes in AFFs suggest it may be a viable primary fixation strategy, especially in these notorious fractures where failure rates have been historically high.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 7","pages":"945-950"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626188","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}