The femoral neck system (FNS) is a relatively new internal fixation device designed to improve stability in unstable femoral neck fractures. Despite its increasing use, a comprehensive mapping of the research landscape regarding its application in high-shear Pauwels III fractures is lacking. This study aims to provide a bibliometric analysis of the current literature to identify trends, research hotspots, and evidence gaps. A systematic search of the PubMed database was conducted for studies published between 2017 and 2026. Data extraction included publication year, source journals, authorship, institutional affiliations, and country of origin. Bibliometric mapping was performed using the R-package Bibliometrix. Studies were categorized by methodology (Clinical, Biomechanical/Cadaveric, Finite Element Analysis, or Mixed) and level of evidence. Thirty-five studies were identified, with a mean document age of 2.51 years, reflecting a burgeoning interest in the FNS. Research is heavily concentrated in East Asia, with China contributing 88.5% (n=31) of the total output. BMC Musculoskeletal Disorders was the most prolific journal (n=7). The majority of studies utilized computational or experimental designs: 14 FEA, nine biomechanical/cadaveric, and nine clinical studies. Notably, most clinical studies were retrospective cohorts providing Level III evidence, with an absence of Level I or II randomized controlled trials. The evidence base for the FNS in Pauwels III fractures is rapidly expanding but remains in a foundational phase dominated by biomechanical and finite element simulations. While early clinical results from specialized centers in China are promising, there is a critical need for prospective, multicenter international trials to elevate the level of evidence and validate long-term patient outcomes across diverse populations.

Purpose: Femoral neck fractures (FNF) in young and middle-aged adults carry a high risk of avascular necrosis (AVN), non-union, and mechanical failure. We evaluated the clinical and radiographic outcomes of Femoral Neck System (FNS) fixation in this population, compared them with published benchmarks, and identified factors associated with failure. Methods: Prospective single-centre cohort of 47 consecutive patients aged 16–60 years with isolated femoral neck fractures treated with FNS (46 analysed; minimum 2-year follow-up), examined as two groups: under 40 years (n = 15) and a middle-aged "borderline" group aged 40–60 years (n = 31). Outcomes (union, AVN, non-union, malunion [shortening > 10 mm]) were benchmarked against published series; associations were assessed with Fisher and rank-based tests and treated as exploratory. Results: Forty-six patients had complete outcome data and were analysed (mean age 43.3 years; 74% male; 41% Singh index ≤ 3; 68% displaced). Union was achieved in 31/46 (67%); at least one complication occurred in 25/46 (54%; some patients had > 1) — non-union 33% (4 implant failures), AVN 15%, malunion 13% — comparable to the published benchmark. AVN was associated with Pauwels type III, subcapital location and comminution; non-union with displacement and borderline reduction; and malunion with older age and lower Singh index. Conclusion: FNS outcomes were comparable to the published baseline for these fractures; angular stability did not overcome the inherent risk of failure. In the older subgroup, malunion and non-union remained frequent, suggesting implant choice alone is insufficient and that anatomical reduction and, in borderline cases, augmentation of fixation warrant consideration.

External fixators have a limited role in the management of tibial plateau fractures (TPF). They are typically used as an initial management strategy. The Joshi External Stabilisation System (JESS) is a Kirschner wire-based fixator and has been used in TPF where plating may not be feasible due to poor skin conditions or delayed due to other soft tissue complications. This retrospective case series aimed to evaluate the radiological and functional outcomes of TPF managed using the JESS fixator. Records of patients operated on with the JESS fixator for TPF between January 2021 and January 2024 were included in the case series. Data for each follow up at 2 weeks, 6 weeks, 12 weeks and 24 weeks was retrospectively collected. Demographic data, fracture classification using the Schatzker and Gustilo-Anderson and assessment of clinical, radiological union and complications on each follow-up were collected. The Knee Society Score (KSS) and visual analogue scale (VAS) were used for functional assessment of the patients. Twenty-three patients were included, with an average age of 41 ± 11.18 years. The majority of injuries were due to road traffic accidents (69.6

Distal femur fractures in geriatric patients present a significant challenge due to age-related factors, including osteoporosis, comorbidities, and diminished functional reserve. These injuries have high morbidity and require nuanced management strategies to optimize outcomes. In the current chapter, we have reviewed the challenges associated with these intricate injuries and the potential solutions for their favorable outcomes. We reviewed the published literature on epidemiology, pathophysiology, clinical presentation, and current treatment modalities for distal femur fractures in the elderly population, with a focus on advances in surgical techniques, rehabilitation strategies, and outcomes. Operative treatment remains the mainstay, tailored to fracture patterns, patient comorbidities, and bone quality. Locking plates offer strong fixation in osteoporotic bone, while intramedullary nails, especially the newer generation ones, provide better biomechanical stability for unstable fracture types. Total knee replacement and distal femur replacement is a viable option in severe cases with comminution or poor bone quality. Distal femur fractures in the elderly are complex injuries with high morbidity and mortality. Early surgical intervention, optimized postoperative care, and a focus on addressing osteoporosis are key to improving outcomes and minimizing the long-term impact of these fractures on the vulnerable population. Favorable fracture healing can be achieved with plates, nails and their combinations as long as they are judiciously used.

There has been an increased interest in the external and percutaneous fixation of proximal humerus fractures. Numerous advantages of external fixation like less blood loss, ease of application, and rigid fixation provide a promising new avenue for the management of humeral fractures. This retrospective case series aims to assess the radiological and functional outcome of proximal humerus fractures treated with the Joshi External Stabilization system (JESS). A retrospective review of records was performed using hospital records from January 2020 to January 2024. The records of patients more than 18 years of age with proximal humerus fractures who were operated with the JESS fixator were reviewed and a proforma based on each follow-up was filled by the investigators. A total of 28 patients met the inclusion criteria with an average age of 65.17 ± 13.1 years. Neers type 3 injuries were most common (38.3

Background: Glycemic variability (GV) is the third domain of sepsis-induced dysglycemia, after hyperglycemia and hypoglycemia, potentially leading to adverse outcomes. This study analyzed the association of GV with in-hospital mortality and length of stay (LOS) in non-diabetic sepsis patients. Materials and methods: In this prospective observational study, non-diabetic sepsis patients were followed till day 14 of hospital stay, and blood glucose levels were assessed by finger-prick method (seven times per day) daily; clinico-laboratory and GV parameters [standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE)] were assessed on days 1, 3, 5, 7, 10, and 14 of admission. Results: Two hundred thirteen patients were screened and 80 (mean age 45.6 +/- 15.37 years; 50% men) were included in the final analysis. Patients with in-hospital mortality had significantly higher GV when compared to patients without in-hospital mortality [SD: 37.57 vs 25.21, adjusted odds ratio (aOR) 1.13, 95% confidence interval (CI) 1.02-1.24, p = 0.013; CV: 24.91 vs 16.88, aOR 1.19, 95%CI: 1.03-1.38, p = 0.016; MAGE: 73.13 vs 48.03, aOR 1.05, 95% CI: 1.01-1.11, p = 0.014], independent of illness severity (APACHE II), mean blood glucose and hypoglycemia on multivariate regression analysis.There was no significant correlation between GV and LOS. Multivariate analysis showed a significant independent association between CV and ventilator requirement (aOR 1.15, 95% CI: 1.03-1.29, p = 0.017) and between SD and need for renal replacement therapy (aOR 1.04, 95% CI: 1-1.09, p = 0.044). Conclusion: This study demonstrated that GV is independently associated with increased in-hospital mortality in non-diabetic sepsis patients. Further studies are required to investigate whether targeting lower GV in septic patients would translate to better outcomes. Clinical significance: Glycemic variability in sepsis is controversial, with discordant results and a paucity of studies on the Indian population in the literature. Despite blood sugar monitoring being routinely done in sepsis patients, GV is rarely measured and the results of our study indicate that it may be worthwhile to estimate GV in sepsis. This may aid in identifying a subset of patients with increased mortality risk, who may benefit from intensive glucose monitoring and modification of insulin regimen.

Displaced intra-articular calcaneal fractures often pose challenging situations, especially concerning wound-related complications, be it surgical wounds or the associated open wounds. This literature suggests evolving trends favoring less-invasive methods of fixation of these fractures. Joystick methods have been advocated for closed manipulation of calcaneal fractures. However, the less-invasive reduction techniques for articular restoration are still limited and poorly described. In this technical note, we describe a simple percutaneous technique that allows the reduction of articular fragments along the subtalar joint and simultaneously corrects the lateral wall blowout in cases where conventional joystick methods may not help.

Background: Distal radius fractures (DRFs) are some of the most common injuries suffered by the elderly; however, there are varied opinions on management. As there is limited research on patient factors affecting functional outcomes in conservatively managed patients with DRFs, this study aimed to find predictive factors for functional outcomes in such patients. Methods: Patients with DRFs satisfying the inclusion criteria were managed with closed reduction and slab followed by cast application. Radiological parameters (radioulnar angulation, dorsal tilt, radial height, and ulnar variance) and functional scores (patient-rated wrist evaluation [PRWE] score, Short Form 8 questionnaire [SF-8], and QuickDASH [Disabilities of the Arm, Shoulder, and Hand]-9) were recorded prereduction, postreduction, at the time of cast removal, and in follow-up visits. Patient factors such as underlying diseases were also recorded, and correlations were analyzed using appropriate software. Results: Patients with diabetes (43.33% of patients) and those with loss in radial height through the course of treatment were found to have poorer functional outcomes ( P-values less than .05 for all functional scores—PRWE, QuickDASH-9, SF-8—except SF-8 at 12 weeks). Patients younger than 60 years were also found to have better functional outcomes at 24 weeks (for PRWE: P-value = .048, for QuickDASH-9: P-value = .032, and for SF-8: P-value = .026). Conclusion: Conservative management plays a major role in the treatment of DRFs, despite the increasing trend of operative management. Diabetes was found to be a predictor of poorer functional outcomes; however, further research is needed to determine the role of these and other factors in detail.

Deep angiomyxoma (DAM) is a slow-growing benign tumor with high risk of local recurrence after surgical resection. Although DAM in a lower extremity is extremely rare, clinicians must be aware of its possible occurrence. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed on histopathological examination and immunohistochemistry. We intend to present an extremely rare case of DAM in the knee, managed successfully with marginal excision. A 4-year-old male child presented with the complains of a painless, progressively increasing, soft, non-tender, and fluctuant swelling in his right knee. The plain radiograph showed a non-calcified soft-tissue swelling and MRI revealed a multi-loculated cystic lesion with multiple septations. A pre-operative diagnosis of a benign cystic lesion was made. It was managed by marginal excision of the tumor and a histological diagnosis of DAM was made. IHC staining showed positivity for SMA, CD34 and vimentin were focally positive, while desmin and calponin were negative. At 12 months of follow-up, the patient had a normal painless gait and full knee ROM, without any local recurrence. DAM is a rare tumor which is often misdiagnosed. In this report, we present a rare case of benign cystic lesion which turned out to be DAM on HPE of resected specimen. Marginal excision of this lesion revealed good outcomes with no recurrence until 12 months of final follow-up. With this, we conclude that surgical excision should be the gold standard in cases of DAM.

Background The coverage of immunization amongst adults in India remains low; a lack of nationally endorsed guidelines and implementation policies is a contributing factor. There is a paucity of tools available to assess knowledge, attitude, and practices (KAP) regarding adult immunization. Hence, we attempted to develop a KAP questionnaire to evaluate the existing expertise regarding adult immunization among medicine and infectious diseases resident doctors in an apex medical institute in India. Methods A two-stage scheme for the development and validation of the questionnaire was followed. The first step involved an exhaustive literature review, focused group discussion, and in-depth interviews. The prepared draft was reviewed by experts in the field of infectious diseases and adult immunization across the domains of necessity, relevance, and clarity. ‘Item-level content validity indices’ (I-CVI) and ‘Scale-level content validity indices’ (S-CVI) were then calculated. Brennan and Prediger's AC (Agreement Coefficient) and Gwet’s AC (Agreement Coefficient) were used to establish inter-rater agreement on the obtained expert reviews. Results A 57-item KAP questionnaire was developed and was reviewed by a total of 11 experts. The questionnaire had satisfactory I-CVI (>0.6 for all the items) and S-CVI Ave (>0.9 for each of the domains). The questionnaire had a strong inter-rater agreement as assessed by both Brennan and Prediger AC (> 0.6, p<0.001) and Gwet’s AC (>0.8, p<0.001). Conclusions The developed tool was scientifically validated following a staged process. We propose that this questionnaire can hence be used to evaluate the knowledge, attitude, and practices regarding adult immunization amongst medical practitioners across medical colleges and hospitals in India. This may be instrumental in developing programmatic interventions and major policy changes to enhance the practice of adult immunization amongst healthcare providers.

Anterior abdominal wall fibromatosis is a benign soft tissue tumor that is rare, but fast-growing with minimal chances of malignant change. We report a young female with a large abdominal swelling which on evaluation was provisionally diagnosed as anterior abdominal wall fibromatosis on imaging and confirmed by histopathology. She was successfully managed with resection of the tumor with a challenging abdominal wall reconstruction with bilateral inferiorly based external oblique muscle flap followed by a mesh repair. Though rare, these tumors are difficult to miss. The importance of this case report is that it describes the methods of multimodal management of a patient with surgery, reconstruction, and adjuvant therapy leading to better patient outcomes.

Since the authors are not responding to the editor’s requests to fulfil the editorial requirement, therefore, the article has been withdrawn from the journal "Infectious Disorders - Drug Targets" Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused. BENTHAM SCIENCE DISCLAIMER: It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultane-ously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submit-ting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.

Introduction Orthopaedic surgeons are among the most frequent users of radiation and are often exposed to X-Ray radiation regularly. There is an overall unsatisfactory level of knowledge, attitude, and practices regarding the same among surgeons. This study aimed to assess the practices among orthopaedic surgeons regarding radiation and its hazards in India. Methodology This questionnaire-based survey was conducted between March and September 2022. The questionnaire broadly assessed the knowledge, awareness, and practices among orthopaedic surgeons regularly exposed to X-ray radiation. The questionnaire consisted of objective and Likert scale questions which were distributed to the respondents electronically using publicly available contact information. A qualitative review of interpretations obtained from the responses and available evidence in the literature was then performed. Results The response rate for the survey was 36.4%. 65.9% reported using trunk protection all the time during procedures. 57.1% of respondents reported not using thyroid protection during procedures. 92.3% reported not using protective goggles and 100% did not use appropriate gloves. 76.9% were not issued dosimeters, and only 5.5% of those who had been issued one wore it during radiation procedures. 58.2% reported having a dedicated employee to operate the machine. 86.8% of respondents did not have formal training and 81.3% were not aware of institutes offering formal training. Conclusion There is very high compliance with the use of protection aprons among the respondents however, the use of other apparel like thyroid shields, protection goggles and gloves was poor. The awareness regarding radiation exposure was also poor as most respondents were not issued dosimeters, however, those issued with one were well aware of their exposure. It is imperative to prioritize both surgeons’ and patients’ safety where radiation exposure is concerned.

Background: The coronavirus disease 2019 (COVID-19) pandemic has reached a staggering number of almost 280 million cases worldwide, with over 5.4 million deaths as of 29 December 2021. A further understanding of the factors related to the household spread of the infection might help to bring about specific protocols to curb such transmission. Objective: This study aims to find the secondary attack rate (SAR) and factors affecting SAR among the households of mild COVID-19 cases. Methods: An observational study was designed where data of patients admitted at All India Institute of Medical Sciences, New Delhi due to mild COVID-19 were collected, and outcome was noted after the discharge of the patient. Index cases who were the first in the household to have a positive infection only were included. Based on these data, the overall household SAR, factors related to the index case and contacts that affected transmissibility were noted. Results: A total of 60 index cases having contacts with 184 household members were included in the present study. The household SAR was measured to be 41.85%. At least one positive case was present in 51.67% households. Children below 18 years old had lower odds of getting a secondary infection compared to adults and elderly [odds ratio (OR) = 0.46, 95%CI = 0.22-0.94, p = 0.0383). An exposure period of more than a week was significantly associated with a higher risk of infection (p = 0.029). The rate of transmissibility drastically declined with effective quarantine measures adopted by the index case (OR = 0.13, 95%CI = 0.06-0.26, p < 0.00001). Symptomatic index cases contributed more to the SAR than asymptomatic primaries (OR = 4.74, 95%CI = 1.03-21.82, P = 0.045). Healthcare worker index cases had lower rates of spread (OR = 0.29, 95%CI = 0.15-0.58, P = 0.0003). Conclusion: The high SAR shows the household is a potential high-risk unit for transmissibility of COVID-19. Proper quarantine measures of all those exposed to the index case can mitigate such spread and lead to reduction of risk of COVID-19 within a household.

The pandemic of coronavirus is still a major public health problem worldwide.It was started from Wuhan (a city of China), the individuals start reporting the clinical manifestations.Common are fever (moderate to high), dry cough, body ache, diarrhea, headache.In most cases, disease manifestation is mild to moderate with recovery in 6-8 weeks.Mild disease may be accompanied by dyspnea and hypoxia with/without radiological evidence in the lungs.Moderate cases usually have dyspnea with hypoxia and usually, show an altered cytokine pattern.Severe cases of Covid-19 exhibit acute respiratory distress syndrome (ARDS), septic shock, and cytokine storm which may lead to multiple organ failures and eventually death.Therefore, we undertook this case-control study to determine the immune pathogenesis of COVID-19.The objective of the study was to determine T cell subtypes and cytokines in COVID-19 patients with mild to severe disease and compare them between patients who had recovered and those who had progressed to moderate-severe disease.

Introduction YouTube is one of the top-searched online video streaming platforms. However, the content of YouTube may not match the standards required for clinical skills learning. Therefore, we investigated the quality of top-viewed YouTube videos related to three basic surgical procedures that need to be performed by general surgery residents in their first year of training in our institute. Methods We searched YouTube for the top 10 viewed demonstration videos related to ultrasound-guided abscess drainage, chest tube insertion, and central line insertion. For the eligible videos, we calculated the likes ratio, view ratio, and video power index. The videos' quality was assessed using LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) scores. The videos were categorized into high-quality (LAP-VEGaS score ≥ 11) and low-quality videos (LAP-VEGaS score < 11). The different descriptive (view counts, duration, and likes-dislikes) and calculated parameters stated above were compared between the two video quality-based groups. Results The selected videos were uploaded between July 2008 and March 2022. Their mean view counts were 460391.13±373760.19. Their mean video duration was 8.12±4.26 minutes. Their mean likes and dislikes were 2578.38±2977.43 and 144.10±129.80, respectively. The mean like ratio and the mean view ratio were 93.42±13.53 and 317.76±827.79, respectively. The mean video power index was 310.67±827.96. The mean LAP-VEGaS scores for ultrasound-guided abscess drainage, chest tube insertion, and central line insertion-related videos were 6.80, 11.10, and 11.20, respectively. The numbers of likes and dislikes were significantly higher for high-quality videos. Conversely, the view counts, the view ratio, and the video power index were significantly lower for high-quality videos. Conclusion Top-viewed videos related to general surgery procedural demonstrations are of low quality. The video view counts, popularity, and likes-dislikes are highly unreliable indicators of surgical video's usefulness. There is a need for regulatory mechanisms to screen the YouTube content suitable for general surgery residents learning. The residents should therefore be cautious while making inferences based on YouTube videos.

PurposeThe orthopaedic surgeons, especially the young budding surgeons should have a well-balanced knowledge of the past evidence as well the current evidence in the literature for the appropriate as well as optimum management of tibial plateau fractures. Bibliometric analysis of the top-cited papers on tibial plateau fracture management can help know their concurrent interests, deficiencies and conflicting issues regarding their management. This study aimed to identify the 50 most cited research articles in tibial plateau research and analyse their characteristics.MethodsWe searched the Thompson Reuters Web of Science database for articles relevant to tibial plateau fracture and prepared a list of top 50 cited articles that included original articles and review articles concerning tibial plateau fractures. The included articles were analysed for contributing journals, corresponding author's country, publication year, cumulative citations, annual citations, citation trends over time, level of evidence and a qualitative review.ResultsThe search strategy resulted in 2263 articles. The top 50 cited articles were published from 1974 to 2014 and belonged to 12 journal sources. There were 47 original articles and 3 review articles. The average citations per article were 126.2, and the annual citations per article were 6.478 per year. The top-cited articles were relevant to the strategies in the management, classification, fracture reduction, articular restoration, types and number of fixation devices, surgical approaches, associated menisco-ligamentous injuries and applicability of bone grafts/substitutes in tibial plateau fractures.ConclusionThe current bibliometric analysis summarises the top-cited evidence concerning tibial plateau fractures and can be a potential resource for reviewing and locating the same. The analysis shows that most top-cited evidence belongs to the year 2000 onwards. Also, recent articles have a higher annual citation rate. A limited number of journals and mostly, western countries have contributed to the top-cited evidence. Whilst the top-cited evidence has touched several aspects of tibial plateau fractures, it is in the form of level IV case series. It needs better prospective evidence to establish sound recommendations.

We present a case of a 16-year-old male with a Salter-Harris type II physeal slip of the distal femur managed with closed reduction and K wire and clamp-based external fixator. Knee range of motion exercises were initiated after one week. The union was observed at 10 weeks, and implant removal was done on an outpatient basis. At one year follow-up, the patient had good clinical and radiological outcomes. The K-wire-based external fixator frame is an effective fixation method for distal femur physeal slips in older children, providing favorable radiological and functional outcomes.

Introduction: Patients with partial meniscectomy for MMPRTs still develop early osteoarthritis, have poor clinical outcomes, and have a high arthroplasty rate at a follow-up of 8 more than 5 years. Aim: The aim of this study was to evaluate the clinical outcome of medial meniscal posterior root tears treated with arthroscopic transtibial pull-through technique in a middle-aged population. Materials and Methods: Patients with medial meniscus posterior root tears admitted to our facility between 2020 and 2022 were included in this study. The patients were subjected to radiological evaluation of X-rays preoperatively. All the patients were followed for 1 year and assessed using the Tegner Lysholm score. Results: Ten patients with medial meniscal posterior root tears were included in this study. We observed that eight patients who underwent posterior meniscal root repair had excellent results, and two patients had good results. Conclusion: Arthroscopic repair of posterior meniscal root tear shows a significant improvement in clinical outcome.