Background Vitamin D deficiency is prevalent globally, with potential consequences for bone health and trauma outcomes. This study aimed to assess the prevalence of vitamin D deficiency in orthopedic trauma patients and investigate its correlation with various demographic and injury-related factors. Methodology A cross-sectional investigation was undertaken at a tertiary care center. An evaluation of serum 25-hydroxyvitamin D3 levels was conducted on 124 individuals, aged 20 to 70 years, who were hospitalized with orthopedic injuries. Demographic information, the injury method, the bone involvement pattern, and socioeconomic status were documented. Statistical analysis was employed to evaluate the correlations between vitamin levels D and these variables. Results The overall prevalence of vitamin D deficiency was 54 (43.6%) cases, with nine (7.3%) cases exhibiting severe deficiency and 45 (36.3%) cases exhibiting moderate deficiency. Higher rates of deficiency were associated with lower socioeconomic status (p = 0.044) and low-velocity trauma (p = 0.037). No significant association was found with age, sex, or residence. Interestingly, patients with multiple fractures were more prone to deficiency compared to those with single fractures. Conclusions This survey revealed a significant vitamin D deficiency among orthopedic trauma patients. Factors such as socioeconomic status and the nature of the injury emerged as significant risk factors. While conducting routine vitamin D assessments might pose challenges in developing nations, consistent supplementation could prove advantageous in enhancing fracture healing and overall health outcomes among this demographic. There is a call for future research to delve deeper into the role of vitamin D in trauma management and refine supplementation strategies.

Background: The quadriceps angle, commonly known as the Q-angle, is the angle formed between the vectors of the pull of the quadriceps muscle and the patellar tendon. The literature varies in terms of the values of Q angles measured by various researchers. It is well appreciated that the normal Q-angle should fall between 12° and 20°, with males being at the lower end of this range and females having higher measurements. An increase in Q-angle beyond the normal range has been associated with knee extensor dysfunction leading to patellar instability. Keeping in mind the clinical and biomechanical importance of the Q-angle, the aim of this study was to compare and establish the range of the Q-angle in healthy individuals and evaluate its variations with respect to age, weight, height, gender, dominant side, and femoral bicondylar distance. These observations will be helpful for sports therapists in understanding the evaluation of Q-angle in athletes as a prognostic value for probable knee pathologies that may appear in the future. Methods: The current study was conducted at a tertiary care center, and a total of 100 healthy adults between the ages of 18 and 35 were enrolled in the study (50 males and 50 females), following which their Q-angles, bicondylar distances, and femur lengths were measured. Individuals with any lower limb injury that resulted in a ligamentous, muscular, or bony defect; any spinal or neurological injury; any diagnosed knee disorder, such as a fracture, acute or chronic knee pain, patellar dislocation, or prior orthopaedic surgery in the lower extremities, were excluded from the study. Data were analyzed using paired t-tests, independent sample t-tests, ANOVA, and Pearson correlation coefficients. Result and conclusion: The mean Q-angle in males was found to be 11.14° ± 1.9° on the right side and 10.84° ± 1.86° on the left side. In females, it was found to be 13.68° ± 1.87° on the right side and 13.61° ± 2.04° on the left side. Among males, right and left Q-angles showed significant positive correlations with height, weight, BMI, right femur length, left femur length, right bicondylar distance, and left bicondylar distance (p<0.05). The highest correlation was found between weight and BMI. Among females, the right Q-angle showed significant positive correlations with weight and BMI (p<0.05). The highest correlation was found with weight.

BACKGROUND:The measurement of the posterior tibial slope (PTS) angle is crucial for various knee surgeries such as total knee replacement, high tibial osteotomy, and anterior cruciate ligament reconstruction. This hospital-based study aimed to determine the average PTS angle in the knee joints of the North Indian population and provided valuable data to aid knee surgeries in this region. METHODS:An analysis of 200 plain X-ray films, specifically the true lateral view of both knees in 20-degree flexion, was conducted on participants who exhibited skeletal maturity with no arthritis, tumours, or previous knee surgeries. The PTS measurements were performed manually. The data were analyzed statistically by matching them with variables such as gender, age, laterality, and body mass index (BMI). RESULTS:The study revealed the following findings for the posterior tibial slope in a section of the North Indian population: there was no significant laterality difference (right knee: 12.76±2.35°, left knee: 12.55±2.46°); no notable sexual dimorphism (males: right knee - 12.79±2.65°, left knee - 12.25±2.65°, females: right knee - 12.73±2.11°, left knee - 12.77±2.30°). However, as age advanced, there were significant differences observed (PTS: 14.27±1.28° and 13.84±1.80° in the 18-40 years age group, 11.36±1.76° and 11.31±1.97° in the 41-60 years age group, 10.32±2.82° and 10.56±3.04° in the >60 years age group for the right and left knee, respectively). No significant correlation was found with BMI (PTS: 13.12±3.13° and 12.59±3.14° for BMI <25, 12.88±2.15° and 12.80±2.34° for BMI 25-30, 12.00±2.09° and 11.66±2.99° for BMI >30 in the right and left knee, respectively). CONCLUSIONS:The study demonstrated significant variations in the posterior tibial slope based on age, emphasizing the need for individualized treatment in knee surgeries. The research provided valuable insights into normal PTS values specific to the North Indian population, offering regional data to inform knee surgery procedures.

A Shear fracture of posterior aspect of femoral condyles in coronal plane is known as Hoffa fracture. This fracture pattern, originally described by Hoffa, is an intra-articular fracture and radiologically and clinically silent most of the times and thus commonly missed. The bicondylar variant of this fracture is a rare injury. We report a case of 38-year old male patient presenting with one day old bicondylar Hoffa fracture managed with headless compression screw and cannulated cancellous screws.

Background: Intertrochanteric femur fractures are one amongst the most common hip fracture presenting to our centre. Clinical efficacy and safety of PFNA and DHS in the treatment of unstable intertrochanteric fractures in elderly patients and found that compared with the control group (DHS), the observation group (PFNA) experienced shorter operation time and fracture healing time and less intraoperative blood loss, and suffered a shorter incision. The purpose of this study was to compare the functional outcomes and related complications between DHS and PFNA in treatment of unstable intertrochanteric femur fracture. Methodology: Total of 60 patients having unstable intertrochanteric femur fracture were included in this study and was equally divided into two groups. Group-P included patients with unstable intertrochanteric femur fracture managed by PFN-A II while Group-D patients managed by DHS. The result was analysed using descriptive statistics and making comparisons among various groups. Categorial data were summarized as in proportions and percentage (%) while discrete as mean ± SD. Results: At final follow-up; it was found that 72.4% of the cases of PFNA have achieved excellent union as compared to 44.4% for DHS group, 24.1% cases of PFNA have good union as compared to 51.9% in DHS group and the difference of mean DHS was significantly higher for PFNA group (p=0.001). Conclusion: PFNA-II have benefits like minimally invasive procedure, less soft tissue dissection, less amount of blood loss and provides better result in terms of union. Therefore PFNA-II is recommended as a better choice as compared to DHS in management of unstable intertrochanteric fractures in terms of functional outcome.

Background: Bone tumors remain a formidable challenge for orthopedic surgeons. In developing countries, the challenge is exacerbated by limited diagnostic, therapeutic, and management facilities and ignorance. Patients with upper and lower-extremity muscle and skeletal tumors are candidates for amputation or surgical rescue of the limbs. Traditionally, limb rescue surgery by neo-adjuvant chemotherapy is the preferred surgery method for localized carcinoma. Amputations are usually reserved for patients with increased tumor size. The purpose of this study is to investigate health-related quality of life (HRQOL) and physical disability, focusing on surgical care, gender, and age, in adolescent and young adult survivors of malignant bone tumors treated surgically. Methods: This cross-sectional study consists of 38 long-term survivors who underwent amputation or limb-salvage surgery at King George's Medical University, Lucknow, from 2019 to 2022. After obtaining ethical clearance and informed consent, 38 patients which included 26 patients treated with limb salvage in Group A and 12 patients treated with amputation in Group B were included in the study. The SF-36 and HUI3 scores were used to assess the functional outcome and health-related QoL of these patients. Results: After minimal six months of interventions, we have found a significant improvement in all the following factors: physical functioning (P=0.000), role limitations due to physical health (P=0.000) and emotional problems (P=0.001), energy/fatigue (P=0.000), emotional well-being (P=0.000), social functioning (P=0.000), pain (P=0.000), and general health (P=0.000). Group A showed a higher degree of significance than Group B through SF-36 (Short Form-36, patient-reported outcome), whereas HUI-3 did not show any significant outcomes (P=0.347). Conclusion: The overall quality of life of patients with salvaged limbs appears to be higher than that of the quality of life of amputee patients in tumor survivor patients. Further analyses must be carried out to verify the results and focus on areas that have a major impact on the overall quality of life using other assessment tools. The impact of therapy on the quality of life depends on maintaining the necessary structures for functional functions, adjusting patient expectations to cancer treatments, and designing long-term rehabilitation programs to support functional functions.

Background: Idiopathic clubfoot is one of the most common and complex congenital deformities which are difficult to correct. Aims and Objectives: The present study was designed to assess the effectiveness and results of the Ponseti method’s early use in the treatment of idiopathic congenital talipes equinovarus (CTEV). Materials and Methods: Seventy-six feet in 50 patients of CTEV during the period of May 2019–May 2020 were studied. All the cases were treated by Ponseti technique. Children with idiopathic CTEV and age <1 year were included in our study. The severity of deformity was graded according to Pirani scoring system both at the beginning and at the end of treatment. Results: The mean age at presentation was 2.77 months. The mean initial Pirani score at time of presentation was 4.07, and at last follow-up was 0.13. We observed that 63 feet (82.89%) out of 76 feet required a percutaneous TA tenotomy along with plaster casting to correct the equines deformity. The mean total number of casts required to correct the deformity was 6.4. The mean duration of treatment from 1st plaster cast to cast for equinus correction was 8.4 weeks. About 94% of cases had a good outcome at last follow-up which was evaluated on the basis of Pirani score. The association of duration of treatment (weeks) with age and total number of cast with age has P=0.002 which was found to be significant. Conclusion: The Ponseti technique is a very safe, efficient, and acceptable economical treatment for the correction of CTEV that gives excellent results on conservative treatment and in most of the cases avoid surgical intervention if protocol followed as prescribed. If the age of the patient is higher at time of presentation, it requires a longer casting period and more number of casts to correct the deformity compared to younger children with the early presentation.

Aims and objectives: To measure the additional effect of platelet-rich plasma (PRP) on functional outcome of anterior cruciate ligament tear managed by augmenting anterior cruciate ligament (ACL) reconstruction with PRP. Methods: The present study was conducted on patients with ACL tear admitted in the department of orthopaedics, King George's Medical University, Lucknow wherein a total of 70 subjects were assigned into two groups of 35 patients each randomly, viz Group 1 in which the patients were treated by quadruple hamstring graft alone and Group 2 in which the patients were treated with augmented hamstring graft with PRP. The standardized anterior drawer test, Lachman's test, Lysholm knee score were quantified both preoperatively and postoperatively at different follow-ups and also tibial tunnel widening was measured postoperatively at different follow-ups. Result: The present study had 70 patients with ACL tears. The mean age of patients in non-PRP groups was 29.71 +/- 2.99 years while that in the PRP group was 28.34 +/- 4.32 years. On comparing the improvement in grades at pre-op, immediate postop, 6 weeks, and 3 months follow-ups, there was no statistically significant difference between the two groups. The tibial tunnel widening also showed no significant difference between the two groups. Conclusion: In our study, it was found that both the groups showed improvements in grades of anterior drawer test and Lachman's test postoperatively but the difference between both the groups was not significant. Similarly, while comparing the improvements in Lysholm knee score and tibial tunnel widening among both the groups, the difference was not significant. Follow up of 3 months was a limiting factor in our study. This technique needs further clinical evaluation to assess the long-term results.

Background: Saving natural head is the primary aim of management in delayed presented intracapsular fracture neck of femur, especially in young population. Anatomical reduction of these fractures is a difficult task. Rather more difficult is to decide the method of fixation which might require additive procedure(s) and one such method is valgus osteotomy and fixation devices which are technically demanding. Aims and Objectives: Our aim is to evaluate the practicality and validity of valgus osteotomy and fixation with Richard screw and double angle barrel plate in delayed presented (more than 3 weeks) fracture neck of femur in young adults. Materials and Methods: We treated 18 patients with mean age of 39 years who presented late with valgus inter-trochanteric osteotomy and fixed with Richard screw and double angle barrel plate. The cases were evaluated radiologically and clinically for Harris hip score, limb length discrepancy, union time, neck-shaft angle and complications such as avascular necrosis and implant cut through. Results: 15 out of 18 patients (83%) united in an average period of 15 weeks (12–28 weeks) clinically as well as radiologically. In more than 70% of patients, the average Harris hip score was “Excellent to Good” (Harris hip score >80). Pre-operative Pauwel’s angle has been corrected from 72.5 to 33. All the patients with united fracture were able to walk with full weight bearing, sit cross legged, squat, and perform SLR and do one-leg stance. Conclusion: Fixation with Richard screw and120° double angle barrel plate provides rigid bony fixation and restore the limb length after valgus inter-trochanteric osteotomy. Valgus inter-trochanteric osteotomy is an effective method to achieve union in neglected fracture neck of femur, as it facilitates added compression at fracture site and stable internal fixation.

The tubercular involvement of the long bones of the extremities is very rare so, tuberculosis as a differential diagnosis is usually missed when a patient present with pain and swelling over long bones. The radiology is usually suggestive of the malignancy. We hereby present a case with pain and swelling over the ulna with a suspicion of malignanacy, but biopsy and per-operative findings were suggestive of tuberculosis.

Introduction: Diabetic autonomic neuropathy (DAN) is among the least recognized and understood complication of diabetes despite its significant negative impact on survival and quality of life in people with diabetes. Various studies showed that there is increased prevalence of gall bladder diseases like gall stones in patients with diabetes. Methods: This study was done to evaluate gall bladder volume in diabetics, it’s comparison with a control group, and correlation of gallbladder volume in diabetics with various parameters like autonomic neuropathy, age, sex, body mass index, hyperlipidaemia and duration of diabetes. 100 proven diabetic patients and 100 healthy controls were recruited for the study. A detailed history and physical examination findings were recorded. Autonomic neuropathy was determined by using simple noninvasive bedside tests. Fasting gallbladder volume was calculated using ellipsoid formula by ultrasonography. Results: The mean fasting gallbladder volume in diabetics was 23.1±7.3 ml as compared to controls i.e 13.0±3.4ml. Conclusion: When type 2 diabetics were sub grouped according to the presence of autonomic neuropathy, higher gallbladder volumes were seen in patients with autonomic neuropathy.

Introduction:Tibial spine fractures are common injuries and various techniques have been described for the fixation. The purpose of the article is to make familiar with thearthroscopic fixation of the anterior cruciate ligament bony avulsion injuries using non absorbable sutures and simple methods and instruments. Adequate reduction, anterior cruciate ligament integrity and regaining the bio-mechanics of the knee are the ultimate goal to be achieved failing which non union and malunion ensues. This technique has resulted in achieving excellent results and thus avoiding complications like joint laxity, flexion deformity&pain. Methods:Twenty one patients underwent arthroscopic suture fixation of the comminutedtibial spine fractures. Mean age of the patient was 24.28 years (range 16 to 38 years). All of the patients belonged to the Meyer type IV. The mean duration of follow up was 15.5 months with a minimum of one year follow-up. Results:All patients showed negative Lachman test except one having grade 1 positive lachman. No patient showed extension loss. 90.4 % (n=19) patients had an IKDC grade A while two patients belonged to grade B. All patients returned to their previous activity level. Conclusion:The above excellent results show that arthroscopic suture fixation of the comminutedtibial spine is promising and reliable technique to achieve the best biomechanics of the knee.