Journal of Orthopaedic Case Reports最新文献

{"title":"Minimally Invasive J-Nail Fixation for Neer Type 2, 3, and 4 Proximal Humerus Fractures in Elderly Patients: A Prospective Clinical and Radiological Outcome Study.","authors":"Aditya Pathak, Santosh Mishra, Akhil Bansal, Anil Chouksey, Obeir Martin, Sunil Parmar","doi":"10.13107/jocr.2026.v16.i10.8312","DOIUrl":"10.13107/jocr.2026.v16.i10.8312","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal humerus fractures are common in the elderly population and present significant management challenges. This study evaluates the efficacy of minimally invasive J-nail fixation for Neer type 2, 3, and 4 proximal humerus fractures in elderly patients.</p><p><strong>Material and methods: </strong>Thirty patients aged over 60 years with proximal humerus fractures were treated with J-nail fixation at our institution between May 2023 and October 2024. Functional outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) and Constant-Murley scores at regular intervals up to 6 months post-operatively. Radiological union and complications, including shoulder stiffness, were documented.</p><p><strong>Results: </strong>The mean age was 67.3 ± 6.71 years with 56.7% males. Fall was the predominant injury mechanism (46.7%). Neer type 2 fractures were most common (63.3%). The mean DASH score improved from 85.19 at 2 weeks to 19.4 at 6 months post-operatively (P < 0.001). The mean Constant-Murley score improved from 12.60 pre-operatively to 82.96 at 6 months (P < 0.001). Radiological union was achieved in all cases with a mean time of 12.8 ± 1.83 weeks. The complication rate was 30%, with stiffness (13.3%) being the most common.</p><p><strong>Conclusion: </strong>J-nail fixation is a viable minimally invasive technique for proximal humerus fractures in elderly patients, providing good functional outcomes with an acceptable complication profile. It offers advantages of minimal soft tissue disruption, preservation of vascularity, and early mobilization potential.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"448-454"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myositis Ossificans of the Thenar Eminence mimicking a Fracture of an Accessory Trapezium: A Case Report.","authors":"Wendy Ghanem, Fouad Jabbour, Hicham AbdelNour, Hady Ezzeddine, Sami Faddoul, Ramzi Moucharafieh","doi":"10.13107/jocr.2026.v16.i10.8196","DOIUrl":"10.13107/jocr.2026.v16.i10.8196","url":null,"abstract":"<p><strong>Introduction: </strong>Myositis ossificans (MO) is a rare condition characterized by heterotopic ossification within muscle tissue, often mimicking more common pathologies. We present a case of MO involving the thenar eminence, initially suspected and managed as an accessory trapezium fracture.</p><p><strong>Case report: </strong>A 66-year-old male presented with acute pain and swelling in the base of his left thumb. Initial imaging suggested a possible accessory trapezium fracture, prompting immobilization and conservative management. Subsequent clinical course and imaging over weeks revealed resorption of the calcification on follow-up radiographs, consistent with MO rather than a fracture.</p><p><strong>Discussion: </strong>This case highlights the diagnostic challenges posed by MO in the upper extremities and underscores the importance of serial imaging and clinical correlation in distinguishing it from other conditions, particularly fractures, to guide appropriate management.</p><p><strong>Conclusion: </strong>Physicians are encouraged to consider MO as a possible diagnosis for soft-tissue swelling of the hand.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"86-89"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study of Spinopelvic Relationship and its Impact on Functional Outcome of Total Hip Arthroplasty.","authors":"Parv Bhargava, Harish Rao, Mrudul Shah, Mohit Dashore, Ravi Mehrotra, Syed Tariq Mahmood","doi":"10.13107/jocr.2026.v16.i10.8286","DOIUrl":"10.13107/jocr.2026.v16.i10.8286","url":null,"abstract":"<p><strong>Introduction: </strong>Spinopelvic alignment plays a critical role in the biomechanics and functional outcomes of total hip arthroplasty (THA). This study evaluated changes in spinopelvic parameters following primary THA and their association with post-operative functional outcome.</p><p><strong>Materials and methods: </strong>This prospective observational study included 80 patients undergoing primary THA at a tertiary care teaching hospital between April 2024 and June 2025. Demographic characteristics, spinopelvic parameters in standing, sitting, lateral decubitus, and lateral decubitus with 90° hip flexion positions, and Harris hip score (HHS) were assessed preoperatively and postoperatively. Functional outcomes were evaluated at 2 days, 14 days, 3 months, and 6 months after surgery. Correlations between spinopelvic parameters and HHS were analyzed using Pearson's correlation coefficient.</p><p><strong>Results: </strong>The mean age of the patients was 48.33 ± 6.29 years, with males accounting for 60.0% of the study population. Significant post-operative improvements were observed in pelvic tilt (PT), sacral slope (SS), lumbar lordosis, and pelvic femoral angle (PFA) across different functional positions (all P < 0.05), whereas pelvic incidence (PI) remained unchanged (P = 0.87). Mean HHS improved significantly from 42.80 ± 6.50 preoperatively to 90.35 ± 4.75 at 6 months (P < 0.0001). PT demonstrated a significant negative correlation (r = -0.36, P = 0.010), while SS (r = 0.41, P = 0.003), PI (r = 0.39, P = 0.005), and PFA (r = 0.33, P = 0.018) showed significant positive correlations with functional outcome. All acetabular components were positioned within the Lewinnek safe zone.</p><p><strong>Conclusion: </strong>Primary THA significantly improved spinopelvic alignment and hip function. Several spinopelvic parameters were significantly associated with post-operative functional outcome, highlighting the importance of comprehensive spinopelvic assessment during pre-operative planning and post-operative evaluation.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"345-352"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde Intramedullary Nailing Versus Locking Plate Fixation in Extra-Articular Distal Femur Fractures: A Prospective Study.","authors":"Shatrughan Singh Tomar, Abhilekh Mishra, Arunaditya Singh Thakur","doi":"10.13107/jocr.2026.v16.i10.8316","DOIUrl":"10.13107/jocr.2026.v16.i10.8316","url":null,"abstract":"<p><strong>Introduction: </strong>Distal femur fractures require stable fixation that permits restoration of alignment and early functional recovery. Retrograde intramedullary nailing distal femur nailing (DFN) and distal femoral locking plate fixation locking compression plate (LCP) are commonly used for extra-articular fractures, but their comparative functional and radiological outcomes remain debated.</p><p><strong>Aim: </strong>This study compared operative, functional, radiological, and complication outcomes of DFN and LCP in adult patients with extra-articular distal femur fractures.</p><p><strong>Materials and methods: </strong>This prospective study was conducted at the Department of Orthopaedics, Gajra Raja Medical College, Gwalior, from November 2023 to March 2025. A total of 36 adults with AO/OTA type 33-A extra-articular distal femur fractures were included, with 18 patients treated with DFN and 18 with LCP. Patients with pathological fractures, Gustilo type III open fractures, intra-articular fractures, or incomplete consent were excluded. Operative parameters, functional outcomes, radiological outcomes, time to full weight bearing, and complications were assessed.</p><p><strong>Results: </strong>DFN was associated with significantly shorter operative time than LCP (75.67 ± 7.58 vs. 105.61 ± 10.51 min) and earlier full weight bearing (16.50 ± 3.75 vs. 26.19 ± 3.92 weeks). DFN also demonstrated significantly better knee flexion scores (17.78 ± 2.46 vs. 12.89 ± 4.01), work scores (10.00 ± 0.00 vs. 8.89 ± 1.97), roentgenogram scores (13.83 ± 2.33 vs. 11.67 ± 3.40), and total anatomical scores (28.50 ± 3.60 vs. 25.33 ± 5.37). Overall complication rates were identical (11.1% in each group; P = 1.000), whereas non-union was numerically less frequent with DFN (5.6% vs. 16.7%; P = 0.603).</p><p><strong>Conclusion: </strong>Retrograde intramedullary nailing was associated with shorter operative time, better knee flexion, improved work-related function, superior selected radiological outcomes, and substantially earlier full weight bearing than locking plate fixation. Although overall complication rates were comparable, the findings favor DFN for clinically suitable extra-articular AO/OTA 33-A distal femur fractures. Larger randomized studies are warranted to confirm these findings.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"464-469"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphometric Variants of the Coccyx in an Eastern Indian Cohort: Analysis from a Tertiary Care Center.","authors":"Manoj K Nayak, Biswajit Sahoo, Sneha Aribaskar, M Mayur, Mantu Jain, Kulbhushan Kamboj","doi":"10.13107/jocr.2026.v16.i10.8278","DOIUrl":"10.13107/jocr.2026.v16.i10.8278","url":null,"abstract":"<p><strong>Introduction: </strong>The coccyx, forming the terminal portion of the human spine, has anatomical variations among countries, populations, and ethnicities. Given its complex structure involving multiple ligaments, muscles, and neural elements, the study of anatomical variations can provide valuable insight into the mechanisms underlying idiopathic coccydynia. Due to limited existing research on the morphometry of the Indian population, this study aims to examine the morphometry observed in the eastern Indian population.</p><p><strong>Materials and methods: </strong>A cross-sectional study of coccyx morphometry was conducted on patients who visited the radiology department of a tertiary care hospital in eastern India. A total of 109 patients were included, who had a computed tomography scan of the abdomen and pelvis. Patients with complaints of tumors or trauma to the spine were excluded. The coccygeal images were evaluated using the modified classification by Nathan et al.</p><p><strong>Results: </strong>Among the 109 patients, Type I coccyx was the most common type, with four segments in the coccyx. The mean straight and curved sacral lengths are 10.38 cm and 11.08 cm, and the straight sacrococcygeal length is 11.9 cm. The mean sacrococcygeal angle and intercoccygeal angle are 116.2° and 38.99°, respectively. Coccygeal spicules were seen in 30.3% of patients. 74.3% of the population had no intercoccygeal or sacrococcygeal joint subluxation.</p><p><strong>Conclusion: </strong>Our analysis showed Type I of the coccyx was the most prevalent type, with four segments being most common. Our study also indicated that our population has a straighter coccyx. Our study can be correlated with the Southeast Asian population and can act as a baseline study for future anthropometric studies.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"314-319"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Cell-Free Collagen Matrix Effective in the Treatment of Large Cartilage Defects of Knee? Early Functional and Quantitative Magnetic Resonance Imaging Cartigram Assessment in Two Patients.","authors":"Ajay, Ruhi Parveen, Subhashis Mandal, Pallav Mishra, Yassir Mehmood, Ankit Ruhela","doi":"10.13107/jocr.2026.v16.i10.8186","DOIUrl":"10.13107/jocr.2026.v16.i10.8186","url":null,"abstract":"<p><strong>Introduction: </strong>Articular cartilage injuries, particularly large full-thickness defects (International Cartilage Repair Society Grade IV), present a significant challenge due to the tissue's limited regenerative capacity. Cell-free collagen matrix, an acellular Type I collagen matrix, has shown promise in promoting cartilage repair. However, its role in treating large chondral defects of the knee with objective radiological correlation remains underexplored. Through two case reports, we have shown that cell free collagen matrix is also effective in early healing of large cartilage defects of knee. To the best of our knowledge, this is among the first reports to document healing of large chondral defects using cell free collagen matrix assessed by quantitative T2 mapping.</p><p><strong>Case report: </strong>We have presented two cases of large, isolated chondral defects of the medial femoral condyle treated with acellular collagen matrix. Both patients, one 17-year-old male and another 33-year-old male with large chondral defects (3.5 × 2.5 cm and 4 × 2 cm) of knee underwent diagnostic arthroscopy and loose body removal followed by cartilage repair using acellular collagen matrix through mini-open arthrotomy. Functional outcomes were evaluated using International Knee Documentation Committee (IKDC) and Lysholm scores. Cartilage healing was assessed at 6 months with quantitative magnetic resonance imaging using T2 mapping (Cartigram). Both patients demonstrated marked early functional improvement, with IKDC scores increasing from 31.03 to 71.26 in first case and 33.33-73.56 in second case, while Lysholm scores increased from 38 and 42 to 85 in both the patients at 6 months. Cartigram revealed T2 relaxation times at the repair sites are comparable to the adjacent normal cartilage, suggesting excellent hyaline-like cartilage regeneration.</p><p><strong>Conclusion: </strong>Cell free collagen matrix is effective in early healing of isolated large Grade IV cartilage defects of knee, by promoting hyaline like cartilage regeneration with excellent radiological and functional outcomes. Further studies with large population size and longer follow-up are needed to be done to establish its long-term efficacy.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"57-62"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior Gluteal Artery Injury After Cephalomedullary Nailing of a Hip Fracture in a Patient on Anticoagulation: A Case Report and Literature Review.","authors":"Aaron Pang, Mazen Zamzam, Antonio Pellerito, Erik Eller","doi":"10.13107/jocr.2026.v16.i10.8248","DOIUrl":"10.13107/jocr.2026.v16.i10.8248","url":null,"abstract":"<p><strong>Introduction: </strong>Superior gluteal artery (SGA) injury following cephalomedullary nailing (CMN) is exceedingly rare. To our knowledge, this is the first reported case of acute SGA hemorrhage in a patient on therapeutic direct oral anticoagulant therapy, representing a clinically distinct presentation from previously described delayed pseudoaneurysm formation.</p><p><strong>Case report: </strong>A 75-year-old anticoagulated female (apixaban, Factor V Leiden) sustained an intertrochanteric femur fracture treated with CMN. Three hours postoperatively, she developed hypotension, tachycardia, and a hemoglobin drop to 6.9 g/dL despite a dry wound. Gluteal swelling prompted computed tomography (CT) angiography, which identified active extravasation from an SGA branch. Selective coil embolization achieved hemostasis, and the patient was discharged on post-operative day 11.</p><p><strong>Conclusion: </strong>SGA injury is a rare but life-threatening complication of CMN. Unexplained hemodynamic instability with gluteal swelling should prompt urgent CT angiography and interventional radiology consultation. Anticoagulation should not delay timely hip fracture fixation.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"233-237"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Excision and Gastrosoleus Turn-Down Reconstruction for Achilles Tendon Xanthoma: A Case Report.","authors":"Ankit Gaurav, Rajesh Meena, Sachin Kanwar, Parshwanath Bondarde, Sanchit Gupta, Pradeep Meena","doi":"10.13107/jocr.2026.v16.i10.8274","DOIUrl":"10.13107/jocr.2026.v16.i10.8274","url":null,"abstract":"<p><strong>Introduction: </strong>Tendon xanthomas are cholesterol-rich deposits associated with disorders of lipid metabolism, most classically familial hypercholesterolemia. Although primarily a dermatological or metabolic finding, they often present to orthopedic surgeons because of functional impairment, cosmetic concerns, or diagnostic uncertainty arising from a mass-like swelling.</p><p><strong>Case report: </strong>A 33-year-old woman presented with a 3-year history of progressive, painful swelling over both Achilles tendons, worse on the right, with difficulty walking and wearing shoes. Examination revealed firm-to-hard masses adherent to the tendons, tender on the right side, with normal ankle range of motion. Total cholesterol was elevated at 228 mg/dL (reference range, 123-200 mg/dL), with low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides within their reference ranges. Magnetic resonance imaging showed bilateral fusiform thickening of the Achilles tendons. The right-sided xanthomatous mass was excised completely, and the resulting 10-cm defect was reconstructed with a gastrosoleus turn-down flap. Histopathology confirmed tendon xanthoma. At 1-year follow-up, pain had improved (Visual Analog Scale 7-2) and the American Orthopaedic Foot and Ankle Society score had increased (52-90), with the ability to perform a single-leg heel raise and no clinical recurrence.</p><p><strong>Conclusion: </strong>Achilles tendon xanthoma, although uncommon, should be considered in the differential diagnosis of heel swelling, and a lipid profile should be obtained. Orthopedic surgeons play a key role in diagnosis and surgical treatment, while collaboration with endocrinology and metabolic specialists helps guide further evaluation and reduce cardiovascular risk.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"302-307"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Clinicoradiological Outcomes of Primary Total Hip Arthroplasty With and Without Intraoperative Fluoroscopic Guidance: A Comparative Prospective Non-randomised Controlled (Quasi-experimental) Study.","authors":"Ranjeet Choudhary, Ramesh Negi, Devender Kasotya, Narvir Singh Chauhan, Anirudh Dwajan, Amber Agarwal","doi":"10.13107/jocr.2026.v16.i10.8342","DOIUrl":"10.13107/jocr.2026.v16.i10.8342","url":null,"abstract":"<p><strong>Introduction: </strong>The long-term success of total hip arthroplasty (THA) requires optimal acetabular component positioning. To improve implant placement, intra-operative fluoroscopy is increasingly used, yet the evidence remains limited in the Indian population and confined to the direct anterior approach. This study compares the clinicoradiological outcomes of primary THA performed through the posterolateral approach with and without intraoperative fluoroscopic guidance at a tertiary care institution.</p><p><strong>Materials and methods: </strong>In this prospective non-randomised controlled (quasi-experimental) study, 70 patients undergoing primary THA between March 2024 and August 2025 were serially allocated, in order of admission, into 2 groups, either fluoroscopy-assisted (n = 35) or freehand technique (n = 35), performed by a single experienced surgeon through the posterolateral approach. Postoperatively, on anteroposterior pelvic radiographs and low-dose computed tomography radiological outcomes (cup inclination, cup anteversion, horizontal femoral offset, distance of cup from teardrop) were measured. Clinical outcomes included operative time, intraoperative blood loss, limb length discrepancy [LLD], dislocation rates and modified Harris Hip score (mHHS) at 6 weeks, 3 months and 6 months follow-up.</p><p><strong>Results: </strong>At baseline, both the study groups were comparable demographically. There was significant improvement in all radiological parameters postoperatively in both study groups. Cup inclination was significantly better in the fluoroscopy group (39.92° ± 3.59° vs. 37.84° ± 4.44°; P = 0.036), with narrow dispersion showing increased consistency. No significant differences were observed in cup anteversion (P = 0.699), horizontal femoral offset (P = 0.066), LLD (P = 0.235), distance from teardrop (P = 0.766), dislocation rate (P = 1.0), operative time (P = 0.147), blood loss (P = 0.987), or mHHS at 6 weeks (P = 0.735) or 3 months (P = 0.204) or 6 months (0.669).</p><p><strong>Conclusion: </strong>Intraoperative fluoroscopic guidance during posterolateral THA provides statistically significant improvement in acetabular cup inclination, but there were no measurable advantages in other radiological parameters, short-term functional outcomes, or complication rates when done by an experienced surgeon. Fluoroscopy functions to enhance precision and increases the consistency of component positioning rather than determining outcome in this context.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"563-570"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Hand-Palm Technique for Localization of the Greater Trochanter Tip During Proximal Femoral Nailing: A Prospective Pilot Validation Study.","authors":"Sharan Mallya, Ashok Puranik","doi":"10.13107/jocr.2026.v16.i10.8354","DOIUrl":"10.13107/jocr.2026.v16.i10.8354","url":null,"abstract":"<p><strong>Introduction: </strong>An accurate localization of the tip of the greater trochanter (GT) is required for proper skin incision placement and correct entry point creation during proximal femoral nailing (PFN) for intertrochanteric femur fractures. Direct palpation of the GT tip may be unreliable in obese or edematous patients, potentially resulting in extended incisions and improper entry points. This study describes the \"hand-palm technique,\" a surface landmarking method for localization of the GT tip.</p><p><strong>Materials and methods: </strong>The technique was applied in two variations based on the surgeon's glove size. For surgeons with glove size ≥7, the width of four medial fingers placed along the iliac crest from the anterior superior iliac spine was used to identify the GT tip. For surgeons with glove size ≤6.5, the entire palm, including the thumb, was used similarly. Fluoroscopic confirmation was performed in all cases. In addition, an observational pilot study involving 41 patients undergoing PFN was conducted to assess localization accuracy, fluoroscopy usage, operative parameters, and reproducibility of the technique. Descriptive statistical analysis and subgroup comparison between obese and non-obese patients were performed. A body mass index-based subgroup analysis was additionally performed to assess localization accuracy, fluoroscopy usage, reproducibility, and operative parameters across different body habitus categories.</p><p><strong>Results: </strong>A total of 41 patients were included in the pilot study. The mean localization error from the fluoroscopically confirmed GT tip was 2.19 ± 1.74 mm, and the mean number of fluoroscopic images required was 1.66 ± 0.62. The mean operative time was 39.90 ± 7.01 min, the mean blood loss was 119.51 ± 49.85 mL, and the mean incision length was 5.61 ± 0.40 cm. Obese patients demonstrated a trend toward higher localization error and fluoroscopy requirement compared with non-obese patients.</p><p><strong>Conclusion: </strong>The hand-palm technique is a simple and practical surface landmarking method with satisfactory localization accuracy in this pilot study. It may reduce repeated fluoroscopic localization attempts and unnecessary incision extension, particularly in obese or edematous patients. However, fluoroscopic confirmation remains essential, and further prospective studies are needed to validate it.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"619-624"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}