Despite significant advances in cross-sectional imaging, the plain radiograph remains the cornerstone and first-line investigation for evaluation of wrist pathology. Owing to the complex anatomy of the wrist, with eight closely packed carpal bones, interpretation of wrist radiographs can be challenging but is an essential skill for orthopaedic surgeons and trainees. A systematic understanding of wrist anatomy, biomechanics, standardized positioning, and radiological parameters allows accurate diagnosis of a wide spectrum of traumatic and non-traumatic conditions while minimizing the need for expensive advanced imaging. This article provides a practical, step-by-step approach to reading wrist X-rays, emphasizing correct positioning, interpretation of standard posteroanterior and lateral views, and assessment of key parameters such as radial inclination, radial height, ulnar variance, carpal alignment, Gilula’s arcs, and scapholunate relationships. The clinical relevance of lateral view parameters, including volar tilt, teardrop angle, scapholunate angle, and wrist column alignment, is discussed. Common pitfalls, normal variants, and radiographic signs of instability and dislocation are highlighted. In addition, the role and indications of special views for suspected scaphoid fractures and specific carpal bone injuries are reviewed. Mastery of these principles enables clinicians to extract maximum diagnostic information from minimal radiographs, ensuring timely and cost-effective patient care.
Background/Aim: The aim of this study was to study the outcome of antibiotic impregnated cement coated intramedullay nailing in the management of chronic osteomyelitis of shaft of long bones. Materials and Methods: In this prospective study, 17 patients admitted in our hospital who were diagnosed with chronic osteomyelitis of long bones and culture-positive infected fractures of long bones were considered in the study and they were evaluated for a period of 12 months. Results: Bony union was achieved at around 5 months (20 weeks) on average, and duration for control of infection in case of chronic osteomyelitis was around 4 months, complications such as persistent infection and non-union were around 18 % overall. Conclusion: The main advantage of the antibiotic nail is that both the union and the infection can be addressed at the same surgery. Single-staged antibiotic nailing technique provides good results, lessens the duration of hospital stay, and reduces the morbidity in infected nonunion of long bones with <2 cm defect.
Background: Femur fractures are often associated with substantial blood loss, necessitating timely transfusion support. Optimizing the use of whole blood (WB) and packed red blood cells (PRBC) is essential for effective management in tertiary care settings. Materials and Methods: This retrospective observational study was conducted at a tertiary care center and included 45 patients aged ≥18 years with radiologically confirmed femur fractures admitted between July 2022 and June 2023. Data were obtained from hospital records, and the blood bank registers. Data include demographics, blood group, and transfusion details. Results: The study included 27 males (60.0%) and 18 females (40.0%), with a mean age of 46.1 ± 17.9 years. The most common blood groups were B+ (35.6%), O+ (31.1%), and A+ (24.4%). A total of 25 patients (55.6%) received WB and 27 (60.0%) received PRBC; of these, 20 (44.4%) received only PRBC, 18 (40.0%) only WB, and 7 (15.6%) both components. WB transfusions totaled 46 units (mean 1.67 ± 0.95/patient), while PRBC accounted for 50 units (mean 2.05 ± 1.12/patient). The highest WB utilization was in B+ patients (14 units), whereas O+ patients required the most PRBC (18 units). All patients (100%) required transfusion during hospitalization. Conclusion: PRBC was the predominant transfusion modality in femur fracture patients, with higher utilization than WB. The predominance of B+ and O+ groups underscores the need for targeted inventory management. These findings support evidence-based transfusion protocols and optimized resource planning in orthopedic emergencies.
Background: Femoral shaft fractures in limbs affected by post-polio residual paralysis (PPRP) are prone to non-union and implant failure due to altered biomechanics, deformities and compromised bone quality. Case Report: A 36-year-old male with PPRP presented with painful inability to bear weight following implant failure of a previously nailed femoral fracture. Radiographs showed hypertrophic non-union with a bent retrograde nail and screw back-out. Exchange nailing was performed using modified positioning to accommodate severe PPRP-related deformities. Results: The distorted nail was successfully removed, deformity corrected gently, and a larger, longer nail implanted. At 1-year follow-up, radiographs confirmed complete union. The patient achieved pain-free full weight-bearing and functional knee motion with tailored rehabilitation. Conclusion: Exchange nailing is an effective solution for hypertrophic non-union with implant failure, even in complex PPRP-affected limbs, when individualized surgical planning and rehabilitation are employed.
Background: We intend to determine the difference in outcome of core decompression with autologous iliac crest bone graft versus bone marrow infiltration in avascular necrosis (AVN) of femoral head. Materials and Methods: Stage II, III of Ficat and Arlet of AVN of femoral head evaluated clinically and radiologically before getting included into this study. A minimum of 20 cases were studied after clearance from the Ethics committee. Results: In our study, the mean HHS were statistically significant differences between the groups at 3 months and 6 months (P <0.05). At 3 months, the mean Visual Analog Scale (VAS) was 5.7 in Group A and 4.3 in Group B. At the end of the study (6 months), the mean VAS was 4.9 in group A and 2.7 in Group B. However, there were statistically significant differences between the groups at 3 months and 6 months (P < 0.05). Stage III X-ray finding was most common in Group a (63.6%) at pre-operative, and Stage II was most common in Group B (63.6%) at pre-operative. A similar finding was found at 6 months post-operative. Stage III magnetic resonance imaging (MRI) finding was most common in Group a (63.6%) at pre-operative and Stage II was most common in Group B (63.6%) at pre-operative. There was no significant difference (P > 0.05) in MRI and X-ray findings at pre-operative and 6 months between the groups. Conclusion: We conclude that core decompression with bone marrow infiltration is better to iliac crest bone graft because of better HHS and VAS at 6 months in Stage II, III of Ficat and Arlet of AVN of femoral head.
