Understanding the costs of surgical correction of pediatric deformity aids patients and surgeons in making informed decisions about cost-effective management strategies. Therefore, we conducted a study to assess and compare the hospital costs associated with the surgical management of adolescent idiopathic scoliosis and congenital scoliosis. We retrospectively reviewed 100 consecutive patients undergoing posterior spinal fusion from 2019 to 2021 at a tertiary public sector hospital in Northern India. We assessed hospital costs from a payor’s perspective under the following heads: surgical costs, hospitalization costs, and supportive costs. Regression analysis was used to assess the factors associated with higher costs. The mean total cost of surgery was Rs. 6,79,062±1,53,468 (USD 9,177 ± 2,074). The mean surgical costs, hospitalization costs, and supportive costs were Rs. 4,82,070±1,08,476, Rs 1,55,008±95,842, and Rs. 41,983±16,551 (USD 6,514 ± 1,466, USD 2,095 ± 1,295, and USD 567 ± 224), respectively. Implant costs contributed 62
Adolescent idiopathic scoliosis (AIS) is a complex, three-dimensional spinal curvature that develops in 1–3
Computer-assisted and robotic orthopedic oncologic surgery (CAROS) has become a significant development direction in the field of musculoskeletal oncology. However, there is currently a lack of systematic bibliometric synthesis on the knowledge structure, thematic evolution, and international collaboration networks within this domain. This study aims to systematically map the global research landscape, collaboration patterns, and thematic evolution in the CAROS field from 2010 to 2026 using bibliometric and scientometric analysis methods. A total of 540 peer-reviewed articles and reviews (2010–2026) were retrieved and filtered from the Web of Science Core Collection. Quantitative analysis was conducted using Bibliometrix (R 4.3.1), VOSviewer 1.6.19, and CiteSpace 6.4.R1, covering co-citation analysis, co-authorship analysis, bibliographic coupling, keyword co-occurrence, and burst detection analysis. The annual publication output grew at a rate of 10.58
Hip fractures in geriatric population are associated with high morbidity, mortality, and loss of independence. Frailty has emerged as an important predictor of surgical outcomes. The five-item Modified Frailty Index (5-mFI) is a simple, validated tool, but its prognostic role in low- to middle-income countries (LMICs) remains unclear. This retrospective observational study included 138 geriatric patients who underwent surgical management for hip fractures at a tertiary teaching hospital in India. Demographic, clinical, and perioperative data were retrieved from medical records. Frailty was assessed using the 5-mFI. Functional outcomes were evaluated with Harris Hip Score (HHS) and Visual Analogue Scale (VAS), while survival was analyzed using Kaplan–Meier curves and Cox regression. In 138 geriatric hip fracture surgeries, higher 5-mFI was associated with greater perioperative acuity, including ICU admission (ρ = 0.45, p < 0.001), longer ICU stay (ρ = 0.60, p < 0.001), and higher ASA grade (ρ = 0.54, p < 0.001). At 12 months, 1-year mortality was 16.7
The management of complex lower limb conditions such as chronic infection, failed limb salvage procedures, and malignant bone tumors often necessitates a choice between above-knee amputation (AKA) and knee arthrodesis. Although both procedures aim to restore function and improve quality of life, comparative evidence evaluating their functional and patient-reported outcomes remains limited. A retrospective comparative study was conducted at a tertiary care center in North India. Patients who underwent either AKA or knee arthrodesis between 2019 and 2026 with a minimum follow-up of six months were included. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, while health-related quality of life was evaluated using the 36-Item Short Form Health Survey (SF-36). Demographic, clinical, and outcome data were analyzed and compared between groups. Twenty-two patients met the inclusion criteria, including 12 who underwent knee arthrodesis and 10 who underwent AKA. Mean MSTS scores were comparable between the arthrodesis and AKA groups (55.56
Recurrent equinus remains one of the most common deformities following initial correction of clubfoot. This systematic review and meta-analysis aims to analyse the outcomes and complication rates of anterior distal tibial hemiepiphysiodesis for the treatment of recurrent equinus deformity in children with clubfoot. A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guideline in PubMed, Scopus, and Cochrane Library up to January 10, 2026. Eligible studies included research evaluating distal tibial hemiepiphysiodesis for equinus in skeletally immature children with clubfoot. Risk of bias was assessed using the ROBINS-I tool. A random-effects model was used to conduct the meta-analysis. Seven studies (six retrospective, one prospective; Level IV evidence) involving 102 children (134 feet) were included. Mean age at surgery was 9.1 ± 1.7 years, with a mean follow-up of 27 ± 9.5 months. Pooled data demonstrated a significant improvement in ankle dorsiflexion (mean difference: −8.64°, P = 0.0008) and a significant reduction in ADTA (mean difference: 14.40°, P < 0.00001). The mean rate of angular correction was 0.70 per month. The overall complication rate was 15.7
The optimal fixation method for vertically oriented femoral neck fractures remains controversial because of high rates of mechanical failure and biological complications. This study aimed to compare the classic three-parallel-cannulated screw configuration with a four-screw fixation technique incorporating an additional transverse (alpha) screw in terms of radiological and clinical outcomes. A retrospective cohort study was conducted on patients aged 18–65 years who underwent internal fixation for femoral neck fractures between January 2015 and December 2022. After applying exclusion criteria, 60 patients were included and divided into two groups according to fixation method: Group 1, classic three-screw fixation (n = 40), and Group 2, four-screw fixation with an additional transverse (alpha) screw (n = 20). Demographic characteristics, operative variables, radiological outcomes, and functional outcomes were compared. Femoral neck shortening, nonunion, avascular necrosis (AVN), reoperation rates, Harris hip score (HHS), and visual analog scale (VAS) scores were evaluated during follow-up. No significant differences were observed between the groups regarding demographic or baseline clinical characteristics (p > 0.05). Operative time and fluoroscopy exposure were significantly greater in Group 2 (p < 0.001), whereas intraoperative blood loss was significantly lower (p = 0.03). Fracture healing time was shorter in Group 2 (14.6 ± 2.2 weeks vs. 15.9 ± 2.3 weeks, p = 0.01). Although femoral neck shortening, nonunion, AVN, and reoperation rates were lower in Group 2, these differences did not reach statistical significance (p > 0.05). Early functional outcomes favored Group 2, with significantly higher HHS at 3 months (p = 0.008) and lower VAS scores at 1 and 6 months (p < 0.01). Addition of a fourth transverse (alpha) screw may improve early functional outcomes and enhance mechanical stability in vertically oriented femoral neck fractures without increasing complication rates. Although major complication rates were lower in the four-screw group, larger prospective studies are required to confirm these findings.
Periprosthetic fractures (PPFs) around total knee arthroplasty (TKA) represent a significant complication that is becoming increasingly prevalent and poses considerable technical challenges. Periprosthetic tibial fractures (PTFs) especially possess higher morbidity, with limited management consensus in the literature. In the setting of TKA PTFs, the use of minimally invasive treatment techniques may be more advantageous in terms of reducing potential complications and achieving satisfactory clinical outcomes. We report the case of a 93-year-old woman with a history of diabetes, high body mass index, osteoporosis, and a prior right total knee arthroplasty (TKA) who sustained a right combined lateral tibial plateau and comminuted tibial shaft fracture after a motor vehicle collision. Due to a medial leg contusion and potential cellulitis, we utilized a lateral submuscular proximal tibia locking plate with a photodynamic intramedullary bone stabilization system from the medial side. The fracture healed uneventfully within 6 months, with acceptable alignment and no complications. To our knowledge, published clinical reports describing the use of a photodynamic intramedullary stabilization system for periprosthetic tibial fractures are very limited, even though many surgeons may already be utilizing this technique. This case highlights the potential benefits of combining minimally invasive fixation techniques in managing complex tibial periprosthetic fractures following TKA, particularly in elderly patients with significant comorbidities and poor surgical site skin condition. In indicated cases of tibial periprosthetic fracture, the use of a supplementary intramedullary photodynamic bone stabilization system may help to improve fixation strength and avoid an invasive surgical approach.
Haemodynamically unstable pelvic ring injuries represent one of the most time-critical challenges in trauma care, with substantial mortality predominantly driven by uncontrolled haemorrhage. Management has evolved from volume-based resuscitation and delayed intervention toward a physiology-driven strategy prioritising early haemorrhage control. This narrative review synthesises contemporary evidence on the management of haemodynamically unstable pelvic ring injuries, focusing on damage-control resuscitation, tranexamic acid (TXA), massive transfusion protocols (MTP), mechanical pelvic stabilisation, preperitoneal pelvic packing (PPP), and angioembolisation (AE), while integrating recommendations from major international guidelines. Early TXA administration and balanced haemostatic resuscitation form the pharmacological foundation of management, while pelvic binders and external stabilisation address bleeding associated with pelvic instability. PPP has emerged as an effective early haemorrhage-control intervention in the exsanguinating patient because of its rapid deployment and ability to tamponade predominantly venous and bony bleeding. AE remains the definitive intervention for arterial haemorrhage, particularly in patients whose physiology permits transfer to angiography. PPP and AE should therefore be considered complementary rather than competing modalities, with their sequencing determined by haemodynamic status, suspected source of bleeding, and institutional resources. Resuscitative endovascular balloon occlusion of the aorta (REBOA) remains controversial, with recent evidence questioning its routine use. Contemporary management of haemodynamically unstable pelvic ring injuries is best conceptualised as a physiology-driven, multidisciplinary process embedded within clearly defined institutional protocols. Rapid haemostatic resuscitation, mechanical stabilisation, and timely selection and sequencing of PPP and AE are central to effective haemorrhage control. Future research should focus on high-quality comparative studies, optimisation of treatment algorithms, and development of personalised resuscitation strategies.
Work-related musculoskeletal disorders (WRMSDs) in industrial kitchen and catering workers are an understudied area. This study aimed to identify ergonomic risk factors for WRMSDs among industrial kitchen and catering workers, determine the most affected body region, and propose ergonomic recommendations. This qualitative, questionnaire-based, observational, and interactional study used the Nordic Musculoskeletal Questionnaire, the Borg Rating of Perceived Exertion, the Rapid Entire Body Assessment, and the Rodgers Muscle Fatigue Analysis. 25 different work activities were studied among 45 workers. Workers most commonly reported pain or discomfort in the lower back (71.1
Cervicothoracic spine fractures are common in trauma patients and lead to severe spinal cord injuries (SCI), causing long-term disability. CT scans help identify fractures, while MRI is more sensitive to spinal cord injuries and soft-tissue damage. To provide valuable insights into the care and status of patients with acute spinal cord injuries, this study examines the correlation between different types of cervicothoracic spine fractures and acute spinal cord injuries. This retrospective study included 195 trauma patients who underwent both CT and MRI for cervicothoracic spine evaluation at a single trauma center. CT scans classified fractures as compression, burst, or rotational/distraction injuries, while MRI assessed spinal cord injury and compression. Statistical analysis was conducted to determine the correlation between fracture types and spinal cord injury severity. Compression and burst fractures each accounted for 33.6
Core decompression (CD) is an effective method in the management of pre-collapsed stage of osteonecrosis of the femoral head (ONFH). It has been combined with various adjuvants like bone marrow mesenchymal cells, platelet-rich plasma, etc. which are costly methods and not affordable to many. We hypothesized that local instillation of ibandronate along with CD is a cost effective, safe and easily available method to increase efficacy of CD, and gives better results than core decompression alone. 17 patients of age group between 18 and 60 years, diagnosed with atraumatic ONFH (FICAT ARLET stage 1/2) were included and followed up for 6 months post-procedure. The patients were evaluated in terms of radiologic progression (modified Kerboul angle) and functional outcome (modified Harris Hip Score and Visual Analog Scale). A significant improvement was observed postoperatively in MHHS at 6 months (p = 0.048) and VAS score at 3 (p = 0.05) and 6 months (p = 0.009) in CD + ibandronate group when compared to CD-only group, although statistically no significant difference was found radiologically in modified Kerboul angle at 6 months between the groups. Core decompression along with ibandronate instillation is more beneficial than core decompression alone in improving functional outcomes. Radiological assessment by measuring modified Kerboul angle did not show benefits in short term and requires long-term follow-up to show improvement, if any. Instillation of inexpensive and effective alternative like ibandronate can potentially postpone the subchondral collapse by preventing osteoclast function and can be an affordable therapeutic option, particularly in low-resource healthcare settings.
Preoperative bone mineral density (BMD) may influence postoperative structural stability following transforaminal endoscopic lumbar discectomy (TELD), yet its clinical significance remains underexplored. This study investigated the impact of BMD on disc height collapse, same-segment recurrence, and functional recovery after TELD. A single-center retrospective cohort study was conducted on 125 patients with single-segment lumbar disc herniation who underwent TELD between January 2023 and June 2025. BMD was measured using dual-energy X-ray absorptiometry and classified as normal, osteopenia, or osteoporosis. Disc height collapse, same-segment recurrence, and functional outcomes (ODI, VAS-leg) were assessed during a minimum 6-month follow-up. Multivariable logistic regression, Cox proportional hazards models, ROC analysis, and subgroup analyses were performed. Disc height collapse occurred in 28.8
Conservative manual therapies, including myofascial release and manipulation, show significant clinical potential for managing piriformis syndrome. However, profound methodological heterogeneity and a reliance on isolated treatment paradigms hinder the establishment of standardized evidence-based guidelines. This systematic review synthesizes current literature on MFR and manipulation, emphasizing their integration into multimodal rehabilitation programs, to provide a rigorous framework for optimizing therapeutic decision-making. Adhering to PRISMA and SWiM guidelines, four databases were systematically searched (2015–2025) for studies evaluating myofascial release and manipulation in clinically confirmed piriformis syndrome. Risk of bias was rigorously appraised using RoB2 and ROBINS-I tools. Clinical heterogeneity necessitated a comprehensive qualitative synthesis. Eleven studies (465 participants; 8 RCTs) met the inclusion criteria. Methodological quality was predominantly robust, although inherent blinding challenges introduced some risk of bias. Qualitative synthesis across three clinical domains suggested that manual therapies, particularly myofascial release, active release technique, and manipulation, may provide greater improvements than conventional stretching in several clinical outcomes. Current evidence suggests that these interventions may improve pain intensity, hip range of motion, and functional capacity. Evidence from the included studies suggests that combining manual therapies with targeted strengthening exercises may provide greater clinical benefits than isolated interventions. Myofascial release and manual manipulation appear to be valuable conservative strategies for managing piriformis syndrome and may provide greater clinical benefits when integrated into multimodal rehabilitation programs alongside targeted exercises. However, significant methodological heterogeneity and diagnostic overlap with non-specific low back pain necessitate cautious interpretation.
To describe a customized “blade-plate” construct using a readily available low-profile plate for paediatric subtrochanteric femur fractures (ages 4–10 years) and to evaluate union, alignment maintenance, reoperation/implant failure, and prespecified complications in this retrospective series. Retrospective single-centre case series (January 2018–December 2023) including children aged 4–10 years with closed traumatic subtrochanteric fractures located ≤ 10
Adolescent Idiopathic Scoliosis (AIS) is a complex spinal condition that involves the three dimensions of scoliosis, affecting postural alignment, symmetry, and health-related quality of life. Although physiotherapy-specific exercises (PSSE) for AIS have been commonly practiced, evidence on adjunct strategies and technology-enhanced delivery (e.g., digital apps, telerehabilitation, gamification) is still scattered and lacks comprehensive evidence mapping. This scoping review was designed to systematically map out current evidence regarding the use of physiotherapeutic interventions and technological innovations in the PSSE approach for AIS patients. We conducted a scoping review guided by the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR, a comprehensive search of PubMed, Ovid, and PEDro (2005–2025) identified studies involving adolescents with AIS receiving physiotherapy-based or adjunct interventions. Eligible designs included randomized controlled trials, quasi-experiments, cohort studies, and case series. Twelve studies met inclusion criteria. The data were charted on study characteristics, intervention type, outcomes, and methodological quality using JBI appraisal tools. Physiotherapeutic Scoliosis-Specific Exercises (PSSE), particularly Schroth and Scientific Exercise Approach to Scoliosis (SEAS), were most frequently investigated and demonstrated improvements in Cobb angle, trunk symmetry, back extensor endurance, and quality of life. Combined approaches PSSE with bracing, core stabilization, or manual therapy showed enhanced structural and functional benefits. Technology-supported strategies, including digital PSSE programs, telerehabilitation, video-game-assisted exercise, and app-guided home programs, improved adherence, exercise precision, and in several studies, Cobb angle reduction. However, heterogeneity in protocols, supervision, and measured outcomes limited comparability. Physiotherapy-based and technology-supported interventions show promising benefits for adolescents with AIS, particularly when structured and adherence-focused. However, the current evidence base remains limited and heterogeneous. Standardized protocols, longer follow-up, and comparative trials are required to strengthen evidence and optimize conservative AIS management.
Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty used predominantly in younger, active patients who are more likely to require future revision surgery. As the population of individuals living long term with HRA implants increases, previously uncommon late complications are being observed. One such complication is the periprosthetic intertrochanteric fracture, a rare event that has been described only sporadically in the literature. This case series describes three patients: a 76-year-old female, an 88-year-old male, and a 63-year-old male who sustained periprosthetic intertrochanteric fractures around hip resurfacing implants. All patients underwent closed reduction and internal fixation with intramedullary nails, two using trochanteric fixation nail advanced (TFNA, DePuy Synthes) and one using Gamma3 hip fracture nail (Stryker). Postoperatively, weight-bearing was allowed as tolerated, and all patients were followed for 18 months with serial clinical and radiographic assessments. Radiographs demonstrated fracture union in all three cases without loss of reduction, hardware failure, or radiographic loosening of the resurfacing components, and no reoperations were required. At final follow-up, functional outcomes assessed using the Modified Harris Hip Score and Oxford Hip Score ranged from 60 to 95 and 42 to 44, respectively, reflecting excellent recovery in two patients and satisfactory function in one. It should be noted that the 18-month follow-up limits the assessment of late implant-related complications and long-term survivorship of intramedullary fixation in this population. In conclusion, this series suggests that intramedullary nailing is a feasible, bone-preserving option for periprosthetic intertrochanteric fractures following HRA when the resurfacing implant is radiographically stable, provided that careful attention is paid to lag-screw trajectory and length around the femoral component dome.
Vitamin D deficiency (VDD) is a highly prevalent among hip fracture patients. Although hypovitaminosis D has negative effects on bone health, infections, and frailty, its effect on postoperative outcomes after hip fracture surgery remains incompletely and inconsistently described in the literature. This review will help demonstrate the impact of VDD on patients sustaining hip fractures. The search was conducted using OVID Medline, Embase, SCOPUS, Cochrane, PubMed, and clinicaltrials.gov. Included studies compared postoperative outcomes between VDD (mostly < 20 ng/mL) and control (≥ 20 ng/mL) groups. Fracture morphology included femoral neck fractures as well as intertrochanteric and subtrochanteric femur fractures. The primary outcome of interest was mortality while secondary outcomes included complications and length of stay. Random-effects meta-analysis was conducted and reported as odds ratios (OR) and effect sizes (ES). Eighteen studies met the inclusion criteria. A total of 10,407/20,544 (51
