Background: Squat depth and dynamic knee valgus (DKV) are widely discussed determinants of lower-limb performance and injury risk, yet their independent contribution to jump performance has rarely been examined together, particularly using accessible, application-based tools. This study examined whether squat depth and DKV predict countermovement jump (CMJ) performance in healthy young adults. Methods: In this cross-sectional study, 139 healthy young adults (71 men, 68 women; 18-25 years) underwent smartphone/tablet-based biomechanical assessment. Squat depth was quantified as trochanteric displacement normalised to femur length during a self-selected bodyweight squat; DKV was measured from frontal-plane video as peak medial knee displacement; CMJ, squat jump and horizontal jump performance were assessed using a validated flight-time application. Associations were examined using Spearman correlation, multiple linear regression (adjusted for age, sex and body mass index [BMI]), and squat-depth quartile comparison. Results: Squat depth correlated strongly with CMJ height (r=0.72), squat jump height (r=0.76) and horizontal jump length (r=0.61, all p<0.001), and remained an independent predictor of CMJ height after adjustment (β=6.79 cm per unit depth, p<0.001; model R²=0.879). DKV was not associated with squat depth (r=-0.12, p=0.152) and showed only a borderline association with CMJ height (β=-0.383, p=0.051). A squat-depth×sex interaction on DKV approached but did not reach significance (β=1.44, p=0.078). Conclusions: Squat depth, not DKV, was a strong, independent predictor of CMJ performance. Squat depth showed no meaningful relationship with knee valgus, suggesting the two are largely independent expressions of lower-limb function in healthy young adults.
Background: Varus deformity in osteoarthritic knees causes medial compartment overload, pain, instability, and progressive functional limitation. Total knee arthroplasty (TKA) is an established treatment for advanced disease. This study evaluated the clinical and radiological outcomes of TKA in patients with varus knee deformity. Methods: This prospective observational study was conducted in the Indian tertiary-care teaching hospital, from May 2023 to January 2025. Institutional ethical committee clearance and informed consent from patient was taken. Fifty knees in patients aged 45-80 years with primary or secondary osteoarthritis or rheumatoid arthritis associated with varus deformity underwent posterior-stabilized TKA through a standardized medial parapatellar approach. Results: Mean knee society clinical scores improved from 48.2 to 84.6 and functional scores from 47.1 to 85.3. Alignment correction and outcome categories are to be reported as per final tables. Conclusions: TKA provided significant functional improvement and reliable deformity correction.
Background: Adhesive capsulitis is a painful shoulder disorder causing progressive stiffness and restricted mobility. Despite widespread use of intra-articular corticosteroids, real-world evidence on triamcinolone hexacetonide in India remains limited. This prospective study assessed the effectiveness and safety of a single ultrasound-guided intra-articular injection in routine practice. Methods: This prospective, multicenter, single-arm post-marketing observational study was conducted at four sites in India. Adults with symptomatic adhesive capsulitis received a single ultrasound-guided intra-articular injection of triamcinolone hexacetonide (20-40 mg). Effectiveness was measured by changes in SPADI total and subscale scores over 12 weeks, while safety was assessed through adverse event monitoring. Results: A total of 60 patients (37 males, 23 females) with a mean (SD) age of 46.60 (15.56) years were enrolled, and all completed the study. Compared to the mean (SD) baseline score of 74.14 (14.40), total SPADI score declined significantly (p<0.0001) by 11.15 (8.19) and by 28.70 (27.19) points at week 4 and 12, respectively, with clinically meaningful improvement observed from week 1 and sustained through week 12. Pain and disability subscales demonstrated parallel statistically significant reductions. Treatment was well tolerated; mild, transient adverse events (AEs) were reported in 8.3% of patients and were not treatment-related. Conclusions: In routine clinical practice, a single intra-articular injection of triamcinolone hexacetonide performed with ultrasound guidance was effective in alleviating pain and improving functional outcomes in patients with adhesive capsulitis, while demonstrating a favorable safety profile. These findings support its use as a practical treatment option for frozen shoulder and provide preliminary real-world evidence to inform future prospective studies.
Background: Femoral neck fractures are common injuries in older adults and are associated with substantial morbidity and mortality. Arthroplasty is widely used for displaced intracapsular femoral neck fractures in older patients, while the choice of surgical approach and implant fixation remains an important part of perioperative decision-making. Methods: This prospective study included 50 patients with femoral neck fractures treated between March 2023 and February 2025. Patients were followed for 6 months to 1 year. Functional outcomes were assessed using the Harris hip score (HHS). Results: The mean age was 72±8.16 years. Women comprised 60% of the cohort and men 40%. Left-sided fractures accounted for 52% and right-sided fractures for 48%. Most injuries followed low-energy trauma. Uncemented implants were used in 47 patients (94%) and cemented implants in 3 (6%). The mean interval from injury to surgery was 5.5 days. At final follow-up, 72% of patients had good, 18% excellent, 8% fair, and 2% poor functional outcomes. Overall, complications occurred in 20% of patients. Conclusions: Hip hemiarthroplasty through the modified Hardinge approach was associated with favorable functional outcomes in this prospective cohort, with most patients achieving good-to-excellent HHS and a relatively low frequency of major complications.
Background: Tuberculosis (TB) of the spine (Pott's disease) remains one of the most common forms of skeletal tuberculosis and is an important cause of pain, neurological deficits, spinal deformity, and long-term disability, particularly in developing countries. Although antitubercular therapy (ATT) is the cornerstone of treatment, the optimal endpoint for discontinuing therapy remains controversial because clinical recovery, laboratory improvement, and radiological healing often occur at different stages. This study evaluated the clinical, laboratory, and radiological parameters used to determine the endpoint of ATT in patients with spinal TB. Methods: A retrospective observational study was conducted in the Department of Orthopaedics at Padmini Care Hospital, Tangi, Cuttack, Odisha, India, between October 2022 and May 2024. Medical records of 50 patients with spinal TB who completed standard first-line ATT were reviewed. Clinical improvement, neurological status, inflammatory markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), and serial radiological findings were analyzed to identify reliable indicators for treatment completion. Statistical analysis was performed using paired Student's t-test and Chi-square test, with p<0.05 considered statistically significant. Results: The mean age of the patients was 42.8±13.1 years, with males comprising 62.0% of the study population. Significant clinical improvement was observed during treatment, with mean visual analogue scale pain scores decreasing from 7.8±1.1 to 2.1±0.9 (p<0.001). Neurological improvement occurred in 75.0% of patients with baseline neurological deficits. Mean ESR decreased from 63.5±17.2 mm/hour to 18.9±8.4 mm/hour, and mean CRP declined from 31.4±11.8 mg/l to 5.8±3.1 mg/l (both p<0.001). Although complete radiological healing was observed in 38.0% of patients, 94.0% demonstrated radiological stability without disease progression. No clinical relapse was documented during follow-up after discontinuation of ATT. Conclusions: Clinical recovery, normalization of inflammatory markers, and radiological stability together provide a practical and reliable basis for determining the endpoint of antitubercular therapy in spinal TB. Complete radiological resolution should not be considered mandatory before treatment discontinuation. A multidisciplinary assessment may help prevent unnecessary prolongation of therapy while maintaining favorable clinical outcomes.
Background: Proximal tibia fractures are complex intra-articular injuries often resulting from high-energy trauma. Traditional classification systems like Schatzker and AO/OTA rely on anteroposterior radiographs and may overlook posterior column injuries. The Three-column classification, introduced by Luo et al, utilizes computed tomography (CT) to address multiplanar fractures, particularly those involving the posterior column. Methods: A prospective study was conducted on 80 patients with closed tibial plateau fractures at a tertiary care centre from January 2021 to January 2022. Fractures were classified using the Three-column concept. All patients underwent Open reduction and internal fixation (ORIF) using column-specific approaches. Functional outcomes were assessed after a minimum follow-up of 6 months using the modified Rasmussen clinical score. Results: The mean age was 37.88±8.79 years, with a male preponderance (86.2%). Road traffic accidents were the most common mode of injury (88.7%). Two-column fractures were the most frequent (46.2%), followed by three-column fractures (32.5%). Functional outcomes were excellent in 17.5%, good in 68.7%, fair in 11.3%, and poor in 2.5% of cases. The mean Rasmussen score was significantly higher for one-column medial fractures (28±0) compared to two-column (24.05±1.54) and three-column fractures (24.80±1.35). Complications included superficial infection (11.3%), knee stiffness (8.7%) and screw pull-out (7.5%). Conclusions: The Three-column concept provides a comprehensive understanding of fracture morphology, facilitating precise surgical planning for complex multiplanar injuries. Fixation based on this concept yields satisfactory functional outcomes, although multi-column injuries inherently carry a prognosis of lower functional scores compared to isolated column fractures.
Dislocation after bipolar hemiarthroplasty is a known complication, but dissociation of a fixed (non-modular) cemented bipolar prosthesis during attempted closed reduction is extremely rare. Standard management usually requires stem removal and revision total hip arthroplasty (THA), often necessitating extended trochanteric osteotomy (ETO), which increases morbidity in elderly patients. A 78-year-old male underwent cemented bipolar hemiarthroplasty for fracture neck of femur. Following a fall, he presented with painful hip deformity and inability to bear weight. Closed reduction attempted elsewhere failed and resulted in dissociation of the bipolar prosthesis, with separation of the outer cup from the femoral head. Radiographs confirmed dissociation with the stem well fixed in cement mantle. Considering advanced age and stable cemented stem, a stem-retaining conversion THA was planned. Previous operative records revealed a 32-mm head on a 10–12 mm taper. The acetabulum was prepared and a cemented polyethylene acetabular component implanted. Without removing the cemented stem or performing extended trochanteric osteotomy, the hip was reduced using a compatible femoral head. Stable reduction and satisfactory range of motion were achieved intraoperatively. Post-operative radiographs showed well-positioned acetabular component and stable hip joint. The patient was mobilized with walker support. At follow-up, the patient was ambulatory, pain significantly reduced, and no redislocation occurred. Stem-retaining conversion THA is a viable and less invasive salvage option in selected elderly patients with dissociated bipolar hemiarthroplasty when the cemented femoral stem is stable. This technique avoids extended trochanteric osteotomy and reduces surgical morbidity.
Background: Wrist ganglion cysts are recognized as the most common benign soft-tissue tumors of the hand and wrist. Despite multiple available treatment modalities, there is no consensus regarding the optimal approach, particularly in resource-limited settings. This study aims to evaluate and compare the functional outcomes, complication profiles, and recurrence rates of three common treatments: surgical excision, aspiration, and threading. Methods: This prospective observational comparative study included 91 patients with symptomatic wrist ganglion cysts treated at a rural tertiary care teaching hospital. Based on patient preference and feasibility, participants were categorized into three intervention groups: surgical excision (n=37), aspiration (n=26), and the threading/transfixation technique (n=28). Outcomes were assessed using visual analog scale (VAS) pain scores, a 5-point patient satisfaction scale, recurrence rates, and operative parameters such as procedure time. Results: All treatment modalities achieved a significant reduction in postoperative pain, indicating comparable short-term symptomatic relief. However, long-term efficacy varied significantly; excision demonstrated the lowest recurrence rate at 5.4%, followed by threading at 14.3%, while aspiration showed a highly significant recurrence rate of 65.4%. Patient satisfaction was highest following excision (mean 4.86) and threading (4.68), and comparatively lower for aspiration (4.11). While excision required a longer procedural time (11.2 minutes), threading and aspiration were minimally invasive and faster (4.7 and 4.8 minutes, respectively). Conclusions: Surgical excision provides the highest patient satisfaction and lowest recurrence rate, reaffirming it as the definitive gold standard for treating wrist ganglion cysts. However, the threading technique emerges as a highly practical, minimally invasive alternative that successfully balances low recurrence with feasibility, making it especially valuable in resource-constrained environments. Aspiration, due to its significantly higher recurrence rates, is limited in its role as a definitive long-term treatment.
Background: Acromioclavicular (AC) joint fractures and dislocations are common shoulder injuries, particularly among young active males. Despite the widespread use of various fixation techniques, optimal management and implant removal timing remain topics of ongoing debate. This study retrospectively evaluates patient demographics, surgical approaches, postoperative outcomes, and plate removal timing among individuals treated for AC joint fractures at a major trauma center. Methods: A retrospective observational study was conducted at Rashid Hospital, Dubai, including 187 patients aged ≥18 years who underwent operative or conservative management for AC joint fractures between 2018 and 2025. Sociodemographic data, treatment modality, surgical technique, complications, functional outcomes, and implant removal times were extracted from electronic medical records. Descriptive statistics were performed using SPSS v29. Results: The cohort was predominantly male (93%), with most patients aged ≤40 years (69%). Hook plates were the primary fixation method (86.6%). Postoperatively, 47.8% reported pain, while 52.2% remained pain-free. Range-of-motion limitations were noted in 45.2% of patients, with adduction deficits being most common. Reoperation was primarily for implant removal, occurred in 79.7% of cases. Most plate removals occurred between 4–6 months, peaking at 5 months (41 cases). Early removal at 3 months was uncommon, and 37 patients had no removal at the time of review. Conclusions: Hook plate fixation remains the predominant surgical approach for AC joint fractures at our institution, with generally favorable postoperative outcomes. Functional recovery was preserved in over half of the patients, and implant removal most occurred within 4–6 months. These findings highlight the importance of timely postoperative evaluation and individualized decision-making regarding plate removal to optimize long-term outcomes.
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Nerve conduction studies are used to confirm the diagnosis and classify severity. Understanding the distribution of electrodiagnostic severity and its clinical correlates is important for patient management and healthcare planning. Methods: This descriptive cross-sectional study included 100 consecutive adult patients with confirmed CTS and completed nerve conduction studies at Jordan University Hospital. Electrodiagnostic severity was classified as mild, moderate, or severe. Demographic characteristics, symptom duration, and comorbidities were analyzed using descriptive statistics. Cross-tabulation was used to examine severity in relation to selected variables. Results: Severe CTS was the most common category, accounting for 67% of cases. Moderate CTS was observed in 21%, and mild CTS in 12%. Females represented 80% of the study population. Severe disease was proportionally more frequent among females. Patients with moderate and severe CTS were older than those with mild disease. Mean symptom duration increased slightly with greater severity. Hypertension and diabetes mellitus were common in moderate and severe groups. Other comorbidities were less frequent. Conclusions: Severe electrodiagnostic CTS was predominant in this cohort. Female sex, older age, and certain systemic comorbidities were frequently observed in moderate and severe cases. These findings highlight the importance of early evaluation to reduce progression to advanced disease.
Deciding the level of amputation is influenced by healing potential of the stump and preservation of the limb length to optimise the mobility and energy requirement for walking. In 1854, the Russian surgeon Nikolay Ivanovich Pirogoff introduced a technique of foot amputation in which the heel is preserved and used as a base. The forefoot, midfoot, talus, distal part of the calcaneus, and distal tibial articular cartilage are removed. The plantar skin flap is left attached to the calcaneus, which is rotated 90 dorsally to create a sensate weight-bearing surface with minimal loss of leg length. Since the intact heel pad creates the plantar aspect of the stump, the patient is able to bear full weight on the limb, after bone-healing has occurred, with or without a prosthesis. We present a case of a patient who underwent an amputation with the Pirogoff technique following a traumatic compound Lisfranc’s injury and subsequent its progression to osteomyelitis of forefoot and midfoot. Eight months after the procedure, the patient was able to bear weight on the left lower extremity and was fitted with a definitive prosthesis with a long silicon liner. She was able to walk without pain or the aid of crutches. The rating according to the 100-point Taniguchi scale was 75 points, which indicated a very good result. This case adds to the body of evidence supporting the Pirogoff amputation as a valuable reconstructive option in challenging post traumatic severe forefoot injuries with osteomyelitis. The patient was informed and duly consented for publication of the data.
Vitamin D has been widely known for its role in maintenance and repair of skeletal system, where vitamin D deficiency (VDD) led to hindered effect on bone healing after fractures, bone defects and osteon formation in implants. Some studies have shown that increasing serum Vitamin D levels requires a significant period of time after the application of vitamin D for VDD. In addition, VDD at the time of bone (mainly hip) fracture is associated with an inflammatory response after the fracture. Avascular necrosis (AVN) is a serious complication of defective bone healing. VDD may be a potential risk factor for this incidence; however, further studies are required to validate this aspect in orthopedics. The crucial role of vitamin D in upregulating vascular endothelial growth factor on the proliferation of type-H vessels connects osteogenesis and angiogenesis pathways, thereby providing insight into how to tackle AVN. The primary aim of this review is to highlight the importance of vitamin D supplementation in patients with AVN during the bone regeneration phase.
Avascular necrosis (AVN) is a debilitating manifestation of sickle cell disease (SCD) caused due to structural abnormality of the red blood cells and the precarious blood supply of the femoral head. Prompt identification of the condition in susceptible individuals is of utmost importance. Here, we present a case of SCD with bilateral AVN in Ficat-Arlet stages IIb (left hip) and I (right hip) which was managed by core decompression augmented with platelet rich plasma.
Background: The “floating knee,” described by Blake and McBryde in 1975, involves ipsilateral femur and tibia fractures, usually from high-energy trauma like RTAs or falls. Common in young males, presenting with polytrauma and severe soft tissue damage. Management is complex, requiring early surgical fixation and intensive rehabilitation. Classification systems like Fraser’s help guide treatment and predict complications, including vascular, neurological, and ligament injuries. Methods: This retrospective study was conducted at a tertiary care hospital from March 2024-25, including 30 patients with surgically treated floating knee injuries. Fractures were classified using the Fraser system. Fixation methods and anaesthesia were selected based on clinical indications. Patients were followed up at 6 weeks, 6 months, 1 year. Data on demographics, surgical details, and functional outcomes were collected and analysed. Results: Analysis of 30 floating knee injury cases revealed that most patients were young males (76.7%), commonly aged 20-39 years, and predominantly injured in road traffic accidents (RTAs) (66.7%). Pain (80%) and swelling (63.3%) were the most frequent symptoms. Fraser type I fractures (50%) and closed injuries (76.7%) were most common. Spinal anaesthesia (56.7%) and intramedullary nailing (56.7%) were the preferred surgical approaches. Outcomes were excellent in 30% and good in 20%, though 50% experienced some complications, including delayed union, stiffness, or persistent limp. Conclusions: Floating knee injuries predominantly affect young males involved in high-energy trauma. Intramedullary nailing under spinal anaesthesia offers favourable outcomes with early mobilization and reduced morbidity. Despite good recovery in many cases, complications like stiffness and delayed union persist, underscoring the need for precise surgical technique, timely intervention, and comprehensive rehabilitation support.
Background: Distal tibial nonunion presents a significant challenge due to poor vascularity, limited soft tissue coverage, and mechanical instability. Conventional fixation methods often fail in complex cases, particularly when accompanied by bone loss, deformity, or infection. Tibiotalocalcaneal (TTC) arthrodesis using a tarsus nail has emerged as an effective strategy, providing stable fixation and supporting limb preservation. This study aims to evaluate the clinical and radiological outcomes of managing distal tibial nonunion with TTC arthrodesis using a tarsus nail. Methods: This retrospective study included 40 patients with distal tibial nonunion who underwent TTC arthrodesis using a tarsus nail at a speciality hospital between 2024 and 2025. Functional outcomes were evaluated using standardized scoring systems, including the American Orthopaedic Foot and Ankle Society (AOFAS) score, pain intensity was analyzed by VAS and complications were recorded at one-year follow-up. Radiographic assessments were performed at regular intervals to evaluate bone union and alignment. Results: A total of 40 patients (26 males, 14 females) with a mean age of 52.3±11.6 years were included. At one-year follow-up, radiographic union was achieved in all the patients, with satisfactory alignment in all cases. The mean AOFAS score improved significantly from 38.5±7.2 preoperatively to 78.9±6.8 postoperatively. Pain levels, as measured by the VAS, decreased from a preoperative mean of 7.2±1.1 to 2.1±0.9. No Complications were reported; no cases of implant failure were reported. Conclusions: TTC arthrodesis using a tarsus nail is an effective and reliable procedure for distal tibial nonunion, providing high rates of bone union, significant improvement in functional outcomes, while maintaining limb alignment and stability.
Background: Clavicle fractures are commonly seen in young population, notably in those who are more active in sports, on the contrary, in elderly and children they are attributed mostly to falls, accounting for around 2.6% of all the fractures. The most common site of fracture in the clavicle occurs at the middle third and which accounts for almost 80% of all clavicle fractures. To explain the faster pain relief, early return of function and restitution of clavicle length with the help of reduction and internal fixation of clavicle fracture creating an elastic stability at the fracture gap. Methods: 32 patients presenting with mid shaft clavicle fractures in department of orthopaedics, KLEs Dr. Prabhakar Kore Hospital & Medical Research Centre and Charitable Hospital, were included in this study after taking their consent and fracture was stabilized using TENS nail. Results: In this study, it was noted that males were predominantly involved, maximum incidence between 20-30 years. Most of the cases had RTA as a mode of injury with right clavicle fracture predominance. Post operatively, patients were followed up and Oxford Shoulder Score (OSS) was calculated at 4, 8, 16 weeks and the improvement in OSS score was found to be statistically significant. Conclusions: We concluded that intramedullary fixation of displaced mid shaft clavicle fractures is a safe minimally invasive technique and is recommended in view of faster union, lesser morbidity, earlier rehabilitation and fewer complications.
Background: Thoracolumbar fractures are one of the frequent spinal injuries especially in the developing areas where road accidents and occupational trauma are common. Their resource management in resource constrained health care setting is a special challenge. The paper is an evaluation of short-term (6 months) clinic radiological prognoses of patients with thoracolumbar fractures compared to clinical recovery as per radiological parameters in conventional conservative and surgical interventions. Methods: This prospective observational study included 30 patients (26 males, 4 females) with traumatic thoracolumbar fractures treated between January 2023 and June 2024 at Hassan Institute of Medical Sciences. Patients were assessed using the American Spinal Injury Association (ASIA) spine chart, ASIA Impairment Scale (AIS), and radiological tools (X-rays, CT, MRI, and Thoracolumbar Injury Classification and Severity Score – TLICS). Surgical intervention was indicated for TLICS ≥5, progressive neurological deficits, or >50% vertebral height loss, whereas TLICS ≤3 were managed conservatively. Outcomes were followed up at admission, 7 days, 6 weeks, 12 weeks, and 24 weeks. Results: Short-term clinic radiological evaluation demonstrates that individualized management—guided by TLICS and ASIA parameters—achieves satisfactory recovery in thoracolumbar fractures. Conservative management remains effective for stable injuries, while surgical stabilization provides structural benefits in unstable fractures. Larger multicentric studies with extended follow-up are needed to validate these findings. Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.
The distal radioulnar joint (DRUJ) is the wrist joint that allows rotation of forearm. It involves two bones-The Ulna and the Radius. The distal radioulnar joint is stabilised by ligaments, muscles and bones. The wrist or the forearm joint allows 180 degrees of pronation and supination of forearm by 4 components namely the Radio capitellar joint, the proximal radioulnar joint, interosseous membrane and DRUJ. The triangular Fibrocartilage complex (TFCC) is the primary structure for intrinsic stability of DRUJ with predominantly radioulnar ligaments. Both superficial and deep radioulnar fibres of TFCC plays role in DRUJ stability. The triangular fibrocartilage complex being an essential stabiliser biomechanically furnishes unrestricted range of motion of forearm. In the tears of radioulnar ligaments, the ulnar sided ligament tears are detected to cause DRUJ instability more common. This article discusses a case of DRUJ instability of both right and left wrists in same patient due to trauma with symptoms at varied time period. The advanced tight rope implant was placed in the wrists to regain the function. This case report compares and discusses the efficacy, recovery and range of motion of two different orientations (straight and oblique) of the advanced tight rope implant in DRUJ instability.
Background: Proximal humerus fractures account for 4-6% of all fractures and may result in significant functional impairment when displaced and inadequately treated.1 Locking plate fixation offers angular stability and improved fixation, particularly in osteoporotic bone.2,3 Methods: This prospective hospital-based study was conducted from June 2023 to July 2024. Thirty patients aged 18–65 years with acute displaced Neer two-part and three-part proximal humerus fractures were treated with open reduction and internal fixation using proximal humerus locking plates through a deltopectoral approach. Functional outcome was assessed using the Constant-Murley score and DASH score. Radiological union and complications were documented. Statistical analysis was performed using chi-square tests. Results: The mean age was 44 years, with female predominance (60%). Two-part fractures constituted 60% and three-part fractures 40%. Radiological union was achieved in all cases. Functional outcomes were excellent in 20%, good in 50%, moderate in 20%, and poor in 10% of patients. Early surgery (≤5 days) and two-part fractures were significantly associated with better outcomes (p<0.05). Late complications such as stiffness and malunion negatively influenced outcomes (p=0.002). Conclusions: Open reduction and internal fixation using proximal humerus locking plates provides reliable union and satisfactory functional outcomes in displaced proximal humerus fractures when performed early and with appropriate patient selection.
Non-prosthetic peri-implant femoral fractures (NP-PIFFs) are an increasingly recognised complication of fracture fixation, particularly in elderly and osteoporotic patients. These fractures occur in femora containing retained fixation hardware and present unique biomechanical and surgical challenges. Despite their growing prevalence, current literature lacks consensus on classification systems and optimal management. This systematic review aimed to summarise existing classification systems, treatment strategies, and reported outcomes in NP-PIFFs. This review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251102564). Searches of Medline and Google Scholar were performed using the keywords peri-implant fracture, femur, classification, and treatment algorithm. Studies were included if they reported on NP-PIFF classification, management, and at least one outcome measure (union rate, one-year mortality, or complications). Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) tool, and data were synthesised narratively due to heterogeneity. Nineteen studies published between 2016 and 2025 met inclusion criteria, encompassing 984 patients (mean age 82 years). Seven distinct classification systems were identified, with Videla-Cés et al and Chan (NPPIF) being most commonly used. Reported treatment strategies consistently emphasised constructs spanning the entire femur, minimisation of stress risers, and preservation of stable implants to reduce operative trauma. Union rates were high (95-100%), but one-year mortality ranged from 2.7% to 36%, largely reflecting patient frailty. Complications included mechanical failure, loss of fixation, varus collapse, and medical issues such as pneumonia, delirium, and thromboembolic events. NP-PIFFs are complex injuries that remain inconsistently classified and managed across studies. Although union rates are favourable when biological fixation principles are respected, patient outcomes are significantly influenced by age, comorbidity, and systemic complications. Future research should focus on standardising classification systems, validating treatment algorithms, and developing multidisciplinary strategies to optimise both surgical and medical care.
