Indian Journal of Orthopaedics最新文献

{"title":"Outcomes of Post-traumatic Infected Non-union of the Humerus Managed by Hybrid Ring Fixators.","authors":"Rajesh Rohilla, Jyotirmay Das, Pankaj Kumar Sharma, Tushar Lalchandani, Sarita Dhankhar, Abha Singh, Jyoti Sharma","doi":"10.1007/s43465-025-01376-8","DOIUrl":"10.1007/s43465-025-01376-8","url":null,"abstract":"<p><strong>Aims: </strong>The present study evaluated the functional and clinico-radiological outcomes of management of septic non-union of the humeral fractures managed with hybrid ring fixator. Patients and methods: A total of 18 patients with post-traumatic infected non-union of humerus were included. The mean age was 30.8 years and mean duration of presentation after injury was 19.1 weeks. Mean follow-up duration was 28.11 months and mean time of fixator removal was 25.28 weeks. Bone and functional results were evaluated using the modified Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, and disability of arm, shoulder and hand (DASH) scores. Results: Bone union was achieved primarily in 16 (88.8%) patients. According to modified ASAMI criteria, the bone results were excellent, good, fair, and poor in 9 (50%), 7 (38.9%), 0 and 2 (11.1%) patients, respectively, whilst functional results were excellent, good, fair, and poor in 11 (61.1%), 5 (27.8%), 0 and 2 (11.1%) patients, respectively. The mean DASH score was 15.27 (5.8-50) at the final follow-up. The mean limb length shortening was 2.67 cm (2-5 cm), whereas malunion of more than 15 ℃ angulation was observed in three patients. Conclusions: Hybrid ring fixator is very effective in management of post-traumatic infected non-union of the humerus. Good-to-excellent bone and functional results can be achieved in majority of patients. Elbow stiffness and superficial pin tract infections are common problems encountered by patients.</p><p><strong>Level of evidence: </strong>IV, A Retrospective study.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"602-610"},"PeriodicalIF":1.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008489","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":"Multiligament Knee Injuries: Updates of the Debates.","authors":"Elsayed Morsi, Adel Adawy, Mohamed Rabie, Ahmed Abdelrazek, Mohamed Elashab, Aya Morsi","doi":"10.1007/s43465-025-01375-9","DOIUrl":"10.1007/s43465-025-01375-9","url":null,"abstract":"<p><strong>Background: </strong>Multiligament knee injuries (MLKI) constitute a complex and challenging problem. They can have life-modifying consequences, such as the development of osteoarthritis, and an inability to return to work or sport. At present, there is insufficient high-level evidence or expert consensus to support one management strategy over another.</p><p><strong>Purpose: </strong>The purpose of this article is to review the updates of the debates about multiligament knee injuries, diagnosis, treatment options, and rehabilitation protocols. This article also aimed to elucidate expert opinions on controversial issues in MLKI from scholars from Egypt and the Arab world.</p><p><strong>Study design: </strong>Comprehensive review; Level of evidence, 5.</p><p><strong>Methods: </strong>Medline, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) databases were searched between inception and February 2024. The terms: 'multi-ligament' OR 'multiligament' OR 'multi ligament' OR multiple ligaments' AND 'knee' were used to extract relevant studies.</p><p><strong>Results: </strong>Overall, 1009 eligible studies were identified. After applying inclusion and exclusion criteria, there were 251 articles; of which there were 24 systematic reviews and 227 clinical studies.</p><p><strong>Conclusion: </strong>The relative rarity of MLKI makes it difficult to perform good-powered prospective randomized studies evaluating these injuries. The debates are expected due to the diversity of presentations of MLKI with regard to types of injured ligaments, site of injury within the ligament, time of presentation, and the different management methods. Thorough knowledge and experience are mandatory to tailor a diagnostic workup and management plan for each case.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 4","pages":"488-493"},"PeriodicalIF":1.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011035","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":"Base of Fifth Metatarsal Fractures: A Meta-analysis of Plate Fixation.","authors":"Keenan Horani, Christopher J Thang, Sean O'Leary, Ariadna Robledo, Cory F Janney, John C Hagedorn, Daniel C Jupiter, Vinod K Panchbhavi, Jie Chen","doi":"10.1007/s43465-025-01383-9","DOIUrl":"10.1007/s43465-025-01383-9","url":null,"abstract":"<p><strong>Purpose: </strong>Base of fifth metatarsal fractures are treated according to fracture zones. Proximal tuberosity avulsions (zone 1) are typically treated conservatively, while proximal metaphyseal-diaphyseal junction fractures (zone 2) or proximal diaphyseal fractures (zone 3) are usually treated with intramedullary screw fixation.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of plate fixation of base of fifth metatarsal fractures by zones to estimate mean time to union, mean time to return to daily activities, mean 1-year American Orthopaedic Foot and Ankle Society (AOFAS) score, and complication rate. Outcomes were pooled to determine aggregate outcomes if standard errors were included and there were at least 2 studies.</p><p><strong>Results: </strong>Six studies examined zone 1 and 2 fractures treated with plate fixation. Zone 1 fractures had a mean of 6.88 weeks union time, 11.34 weeks to return to daily activities, 1-year AOFAS score of 94.91, and 5.97% complications. Zone 2 fractures had a mean of 7.0 weeks union time and 20.45% complications.</p><p><strong>Conclusion: </strong>Zone 1 and 2 plate fixation demonstrated union rates comparable to those for traditional fifth metatarsal base fracture management.</p><p><strong>Level of clinical evidence: </strong>Level 3, Prognostic.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-025-01383-9.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"569-580"},"PeriodicalIF":1.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981931","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":"Tissue-Specific Immunity in Osteoarticular Tuberculosis.","authors":"Siddharth Sekhar Sethy, Gagan Deep, P V Sudhakar, Tarun Goyal, Pankaj Kandwal, Shobha Arora","doi":"10.1007/s43465-025-01371-z","DOIUrl":"10.1007/s43465-025-01371-z","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoarticular TB contributes to roughly 10% of the cases of extrapulmonary TB. The incidence of osteoarticular tuberculosis is one of the lowest in extrapulmonary tuberculosis, probably only next to cutaneous tuberculosis in non-HIV patients. Considering the low incidence of primary osteoarticular tuberculosis without pulmonary tuberculosis, we hypothesise that there is an element of tissue-specific immunity against tuberculosis in the body, which appears to be very high in bone and joints. The concept of immunity against tuberculosis in general is well-established for pulmonary tuberculosis but not so for osteoarticular tuberculosis.</p><p><strong>Materials and methods: </strong>A literature search was carried out using the online databases PubMed, EMBASE, and the Cochrane database for all studies published in the English language from May 2000 to September 2020. We compiled the available information in the literature related to the subject to analyse the concept of tissue-specific immunity for osteoarticular tuberculosis.</p><p><strong>Results: </strong>24 studies were included in the review. Bone receives less proportion of total body blood flow when compared to other organs. Lungs, the gastrointestinal system, and the urinary system receive a significantly higher proportion of total body blood flow than bones. This may decrease the chances of haematogenous spread of mycobacterium bacilli to bones rather than other systems. On the receptor level, T cells express a prolyl-hydroxylase domain (PHD) on their surface, which plays a pivotal role in orchestrating the effects of oxygen tension on immune response and T cell proliferation. In oxygen-replete states such as in the lungs, the PHD domain on the T-cells senses the high oxygen concentration and initiates the degradation of the hypoxia-inducible factor-1α (HIF-1α). The major role of HIF-1α is to downregulate the T regulatory cells and activate the Th-1 cells. The main function of Th-1 cells is to promote a cell-mediated immune response that is required for host defence against intracellular microbes. Vice versa happens in oxygen-depleted states, as in bones, more so in cortical bones. Our observations show that tuberculosis of long bones is uncommon compared to cancellous bone tuberculosis. The highest concentration of CD-4 cells is found in lymphoid tissue, followed by bone marrow, and the lowest is in the lungs. Tissue concentration of CD4 cells may be an important but not the sole factor responsible for immunity against MTb. The incidence of tubercular lymphadenitis is quite high despite the presence of a high amount of CD4 cells there. The submucosal layer of the GI tract is rich in lymphoid tissue. The GI tract receives a high proportion of cardiac output, but the incidence of GI tuberculosis is quite low. This may partially be due to the high amount of lymphoid tissue rich in CD4 cells in the intestine. Similarly, bone marrow has a high amount of CD4 ce","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 6","pages":"768-773"},"PeriodicalIF":1.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283789","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":"Brodie's Abscess: Case Report of an Unusual Presentation of <i>Neisseria gonorrhoeae</i>.","authors":"James C George, Brijesh Valsalan, Varsha Ingale, Ranjan Kumar Nag, Ranjana Jayan","doi":"10.1007/s43465-025-01381-x","DOIUrl":"10.1007/s43465-025-01381-x","url":null,"abstract":"<p><p>Brodie's abscess is a subacute osteomyelitis where there are no systemic signs and symptoms. Pain and swelling are the most common symptoms with which patients come to the clinic. <i>Neisseria gonorrhoeae</i> is a sexually transmitted organism with genital and extra-genital manifestations. We report here the first case of <i>Neisseria gonorrhoeae</i> causing Brodie's abscess, its clinical manifestation and treatment. A 26-year-old man presented with a 14-week history of slow progressive pain and swelling in the index finger of the right hand. Clinico-radiologically he was suspected to have a subacute osteomyelitis like Brodie's abscess of the middle phalanx. He underwent curettage, microbiological, immunological, and histopathological evaluation of the lesion. <i>Neisseria gonorrhoeae</i> was isolated, and he was treated with susceptible antibiotics. <i>Neisseria gonorrhoeae</i> has various clinical presentations reported in the literature. Our study demonstrates a new presentation of the pathogen as Brodie's abscess or subacute osteomyelitis.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"702-705"},"PeriodicalIF":1.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003663","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":"Comments on \"Does early and late weight bearing have an effect in the results of elderly tibial plateau fractures with internal fixation? A Multicenter (TRON Group) Study\".","authors":"Udit Kumar Jayant, Devendra Kumar Chouhan, Mandeep Singh Dhillon","doi":"10.1007/s43465-025-01382-w","DOIUrl":"10.1007/s43465-025-01382-w","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"706-707"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984771","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":"Arthroscopic Evaluation of Cyclops Lesions and Clinical Outcomes Following Remnant-Preserved ACL Reconstruction: A Comparative Study of Two Truncated Remnant Preservation Techniques.","authors":"Sun-Ho Lee, Keun-Churl Chun, Jong-Seok Baik, Kwang-Il Koh, Sung-Hoon Kim, Churl Hong Chun","doi":"10.1007/s43465-025-01378-6","DOIUrl":"10.1007/s43465-025-01378-6","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the prevalence of cyclops lesions and the clinical outcomes between two types of anterior cruciate ligament (ACL) reconstruction using a truncated remnant technique: tie with allograft ACL reconstruction and re-tensioning of remnant ACL with allograft ACL reconstruction.</p><p><strong>Materials and methods: </strong>This is a retrospective study of 58 cases of ACL reconstruction using a truncated remnant preservation technique performed by a single surgeon from March 2019 to December 2022. Second-look arthroscopy was performed in each group, and pathologic evaluation was performed focusing on cyclops lesions. The cases were divided into two groups according to the type of remnant technique: tie with allograft ACL reconstruction group (<i>n</i> = 16) and re-tensioning of remnant ACL with allograft ACL reconstruction group (<i>n</i> = 42). We evaluated the prevalence of cyclops lesions and the clinical outcomes in the two groups using follow-up magnetic resonance imaging and second-look arthroscopy.</p><p><strong>Results: </strong>No difference in patient characteristics was observed between the two groups. The clinical outcomes showed no significant differences between the two groups.</p><p><strong>Conclusion: </strong>Re-tensioning of remnant ACL with allograft significantly reduces cyclops lesion occurrence compared to the tie technique, while maintaining comparable clinical outcomes. This technique is particularly beneficial in cases with sufficient remnant tissue and minimizes complications associated with cyclops lesions, such as extension loss and the need for secondary surgical interventions. Therefore, we recommend re-tensioning of remnant ACL with allograft ACL reconstruction.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"681-688"},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008860","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":"Treatment of Cubital Tunnel Syndrome Under WALANT Technique Through a Mini-Open Approach: Surgical Technique and Case Series with Short-Term Follow-up.","authors":"Ignacio Rellán, Agustín Guillermo Donndorff, Gerardo Luis Gallucci, Pedro Bronenberg Victorica, Fernando Holc, Mariano Abrego, Jorge Guillermo Boretto","doi":"10.1007/s43465-025-01362-0","DOIUrl":"10.1007/s43465-025-01362-0","url":null,"abstract":"<p><strong>Introduction: </strong>Wide-Awake Local Anesthesia No Tourniquet (WALANT) has expanded its applications over the past decade from common hand procedures to a broader range of more complex surgeries. However, despite its frequent use, there is limited literature on WALANT for cubital tunnel syndrome. We have adapted the endoscopic technique reported by other colleagues to a mini-open approach. This approach is characterized by a smaller incision while preserving its blood supply. Our objective is to describe this two-stage local anesthetic injection method that has enabled us to safely and successfully treat 16 patients without complications.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study. Sixteen patients meeting specific inclusion criteria underwent ulnar nerve decompression under WALANT. Patients were preoperatively classified according to Dellon's classification. Surgical technique included a staged local anesthetic solution infiltration and careful dissection to preserve nerve stability.</p><p><strong>Results: </strong>Preoperative classification revealed six mild, six moderate, and four severe cases. Intraoperative discomfort was reported by four patients before incorporating a second stage of distal local anesthetic infiltration. All patients exhibited stable intraoperative ulnar nerve positioning and were discharged independently 20 min post-surgery. Follow-up at an average of 12 weeks (range 10 -18 weeks) showed symptom resolution in all patients. No complications, including iatrogenic injury to medial antebrachial cutaneous nerve branches, were reported.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility and effectiveness of the WALANT technique for ulnar nerve decompression at the elbow. Incorporating a staged local anesthetic infiltration enhances patient comfort.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s43465-025-01362-0.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 5","pages":"659-666"},"PeriodicalIF":1.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978170","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":"Graft Options for the Reconstruction of Multi-ligament Knee Injury: A Systematic Review.","authors":"Joshi Amit, Regmi Subhash, Poudel Pranodan, Basukala Bibek","doi":"10.1007/s43465-024-01318-w","DOIUrl":"10.1007/s43465-024-01318-w","url":null,"abstract":"<p><strong>Introduction: </strong>The literature lacks enough synthesis on which autograft option is suitable for a particular ligament reconstruction during multi-ligament reconstruction. This study aims to conduct a systematic review of existing literature to determine graft options available for the reconstruction of various ligaments in the context of multi-ligament knee injury.</p><p><strong>Methods: </strong>A systematic review was conducted following the preferred research items for systematic reviews and meta-analyses (PRISMA) guidelines. It was registered in PROSPERO (CRD42024498917). Studies that met the predefined inclusion and exclusion criteria were included in this systematic review.</p><p><strong>Results: </strong>Out of 8070 identified citations, 16 studies with a total of 640 patients(645 knees), including 420(65.6%) males and 220(34.4%) females, with a mean age of 35.1 years were included. Among 16 papers included in this review, combining autografts, allografts, or synthetic grafts was the preferred choice in seven studies. Autografts were chosen in five research studies, while allografts were preferred in four. For Anterior Cruciate Ligament (ACL) reconstruction: Eleven studies used only autografts, two used only allografts, and 1 study used both autografts and allografts. For Posterior Cruciate Ligament (PCL) reconstruction, nine studies used allografts, six used autografts, and 1 study used synthetic graft. For Posterior Lateral Corner (PLC) reconstruction, six studies used allografts, five used autografts, and 1 study used synthetic graft. For posterior medial corner (PMC) reconstruction, eight studies used autografts, five used allografts, and only one used synthetic grafts.</p><p><strong>Conclusion: </strong>A combination of autografts, allografts, or synthetic grafts was the preferred graft option for multi-ligament knee reconstruction. Autografts are the most preferred option for ACL and PMC reconstruction, whereas allografts are the most preferred option for PCL and PLC reconstruction. The most preferred autograft was the Hamstring Tendon (HT) autograft. Similarly, the tendoachillies (TA) was the most used allograft. However, the strength of the evidence in this review is moderate to low.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 4","pages":"453-463"},"PeriodicalIF":1.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011031","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":"Fragility Fracture: 10 Commandments.","authors":"S S Jha","doi":"10.1007/s43465-025-01356-y","DOIUrl":"10.1007/s43465-025-01356-y","url":null,"abstract":"<p><strong>Background: </strong>Fragility fractures are a major health concern. It is a fracture that occurs from a low-impact event, such as a fall from standing height or less typically due to weakened bones. These fractures are most commonly associated with conditions like osteoporosis, where the bone density is reduced, making the bones more susceptible to get fractured. Fragility fractures often occur in older adults including post-menopausal women and commonly affect areas, such as the hip, spine, and wrist. These fractures reflect the underlying bone fragility, and following first fragility fracture, there is increased risk of getting further fractures. Apart from osteoporosis, the contributing factors have also to be considered like age, gender, nutritional deficiencies, physical activities, and medical conditions like chronic kidney disease. The other risk factors like smoking, and excessive alcohol consumption, and certain medications such as corticosteroids and anti-convulsants like sodium valproate, can overtime result into osteoporosis.</p><p><strong>Methods: </strong>Fragility fractures basically revolve around the terminal management of osteoporosis and many issues have not been over emphasized. Hence, these 10 commandments have been crafted to focus on the areas which can help prevent fragility fractures or combat those cases who come with a history of fragility fractures.</p><p><strong>Results: </strong>The ten commandments have crystallized into various headings, including fragility fracture-the risk factors & DEXA, subnormal turnover bone diseases, microbiota & microbiome, inflammaging including obesity, parathyroid, thyroid & testosterone, dilemmas in the management of osteoporosis in younger adults, vitamin D, calcium & albumin, pharmacologic treatment options, associated medications & alternative therapies, and monitoring. High and low turnover bone disease, dysbiosis in gut, and inflammaging are the highlights including therapy and monitoring.</p><p><strong>Conclusion: </strong>Fragility fracture also known as osteoporotic fracture has significant morbidity and mortality. Management of osteoporosis has been emboldened with the existing basket of both anti-resorptive and anabolic drugs. Safety concerns on long-term use of these drugs are emerging. These ten commandments will help management strategies to concentrate on targeting therapy to persons most \"at risk\" of getting these fractures.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":"59 3","pages":"244-255"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810507","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}