Introduction: Scapular fractures are rare and usually unite with conservative treatment. Symptomatic non-union of the scapular body is exceptionally uncommon and can lead to chronic pain and functional limitation. Case Report: A 42-year-old female with a right scapular body fracture initially treated non-operatively developed persistent posterior shoulder pain and radiographic non-union at 1 year. She underwent open reduction and internal fixation using a modified posterior midline approach with dual 3.5-mm reconstruction plates and autologous iliac crest cancellous bone grafting. Conclusion: Solid union was achieved in 3 months, and the patient regained full, pain-free shoulder function at 1 year. A modified posterior approach allows dual-border exposure through a single incision with limited soft-tissue disruption, enabling stable fixation and excellent clinical outcome in scapular body non-union.

Study Design:A cross-sectional validation study. Purpose:To translate, culturally adapt, and validate the Hindi version of the AO Spine Patient-Reported Outcome Spine Trauma (PROST) questionnaire among native Hindi-speaking individuals with spinal trauma. Overview of Literature:Patient-reported outcome measures play a crucial role in spine trauma research; however, only a few have been culturally adapted for South Asian populations. The AO Spine PROST has shown excellent reliability and validity in Dutch, English, German, and Nepali cohorts, yet no validated Hindi version currently exists. Considering India's large Hindi-speaking population and significant spinal trauma burden, a Hindi adaptation is required to facilitate standardized evaluation and ensure cross-study comparability. Methods:The AO Spine PROST was translated and culturally adapted into Hindi following international protocols, including forward- backward translation, expert committee review, and pretesting. A total of 101 patients with recent spinal trauma were included. Psychometric evaluation involved assessing internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient [ICC]), and construct validity through correlation with the 36-Item Short-Form Health Survey. Feasibility, along with floor and ceiling effects, was also evaluated. Results:The Hindi AO Spine PROST exhibited excellent internal consistency (Cronbach's α=0.984) and strong test-retest reliability (Spearman's ρ=0.897; ICC=0.658; 95% confidence interval, 0.578-0.729). Correlation with the original English version was high (ρ=0.999), confirming strong conceptual equivalence. Construct validity was supported by strong correlations with EuroQol Visual Analog Scale (ρ=0.897) and relevant EuroQoL 5-Dimension 3-Level domains (e.g., walking vs. mobility; ρ=-0.84). Conclusions:The Hindi version of the AO Spine PROST is a reliable, valid, and culturally suitable tool for assessing functional outcomes following spinal trauma in Hindi-speaking populations. Its implementation promotes standardized, patient-centered outcome evaluation and enhances the inclusion of underrepresented linguistic groups in spine trauma research.

OBJECTIVE:Comminuted intra-articular distal radius fractures (DRFs) present significant treatment challenges due to their complex morphology and tendency for post-traumatic arthritis. Volar plating alone may be insufficient to achieve and maintain reduction in dorsally displaced fractures. This prospective study evaluated the radiological and functional outcomes of dorsal-assisted volar plate fixation in dorsally displaced comminuted intra-articular DRFs. METHODS:A total of 21 patients treated at a tertiary care trauma centre were enrolled. All underwent dorsal-assisted reduction followed by volar plating without dorsal instrumentation and were followed for a minimum of one year (mean follow-up: 19.6 ± 4.7 months). Radiological outcomes were assessed using radial height, radial inclination, volar tilt, and intra-articular step-off, while functional outcomes were measured using the QuickDASH and modified Mayo Wrist scores. The study was prospectively registered in the Department review board in department of Orthopaedic Surgery, PGIMER, under registration number DRB/Ortho/2023/49. RESULTS:The mean patient age was 38 years, with a male predominance (17/21; 80.9%). Most fractures (15/21; 71.4%) were AO type 2R3C3. Postoperative evaluation demonstrated restoration of wrist alignment with a mean radial inclination of 23.35°, radial height of 11.29 mm, and volar tilt of 6.70°, closely approximating the uninjured wrist. Functional outcomes improved significantly from two months postoperatively to the final follow-up (P < 0.001), achieving a mean QuickDASH score of 4.95 and a modified Mayo Wrist Score of 90. Only two patients experienced minor complications related to implant prominence. CONCLUSIONS:Dorsal-assisted volar plating is a safe and effective technique for managing dorsally displaced comminuted intra-articular distal radius fractures, providing excellent anatomical restoration and functional recovery with minimal complications. It offers a valuable surgical option where volar plating alone may be inadequate.

Posterior hip dislocations with simultaneous femoral head and neck fractures are extremely rare, usually after high-velocity trauma, and demand urgent surgery to prevent complications. A 40-year-old woman sustained a posterior dislocation with femoral head fracture after a low-energy twisting fall. A forceful closed reduction without relaxation caused an iatrogenic femoral neck fracture (Pipkin Type III). She underwent open reduction and internal fixation within six hours of presentation (28 h after injury). Redislocation occurred on day 20 due to unrecognised labral avulsion and acetabular dysplasia, later addressed with labral repair. At two years, she remained pain-free with good functional scores, although the femoral head was not perfectly concentrically reduced on final radiographs, a finding attributed to the underlying dysplasia; she was subsequently lost to follow-up. This case illustrates that good short-term function can be achieved despite imperfect radiographic congruency, while underscoring the importance of recognising dysplasia and labral injury and of considering arthroplasty as an alternative in this fracture pattern.

Background:Heterotopic ossification (HO) is a recognized complication following operative fixation of elbow trauma. While indomethacin prophylaxis is well established in hip and acetabular surgery, evidence for its role in elbow injuries remains limited. This randomized controlled trial evaluated whether oral indomethacin reduces the incidence and severity of HO after surgical treatment of acute elbow fractures and dislocations. Methods:Eighty-six adults with acute elbow injuries requiring surgical fixation were randomized 1:1 to receive either oral indomethacin (25 mg 3 times daily for three weeks) or no prophylaxis. Eighty-four patients completed follow-up. HO was assessed radiographically at scheduled intervals through the final follow-up and graded using the Hastings and Graham system. The Mantel-Haenszel method was used to calculate a pooled odds ratio adjusted for injury severity. Results:HO developed in 21 of 84 patients (25%), occurring in 14.3% of the indomethacin group vs. 35.7% of controls (P = .018), with indomethacin reducing both incidence (absolute risk reduction 21.4%; number needed to treat = 5) and severity (mean grade, 1.33 vs. 2.93, P = .013). All HO in the indomethacin group were low grade (G1-G2A), whereas high-grade HO (G2C-G3) occurred in 8 of 15 (53.3%) control patients. Stratified analysis demonstrated consistent trends across injury severity levels, with Mantel-Haenszel adjustment yielding similar estimates. Patients with HO in the indomethacin group had a greater range of motion compared to controls. Discussion and Conclusion:Indomethacin prophylaxis was associated with reduced incidence and severity of HO following operative fixation of elbow injuries. These findings should be interpreted in the context of baseline differences in injury severity between groups. Indomethacin may be a useful adjunct in patients at risk of HO following elbow trauma given its low cost, ease of administration and favorable safety profile, although further multicenter studies are required.

​Background Minimally invasive lateral column fixation has emerged as an effective technique for displaced extra-articular scapular fractures, reducing soft-tissue morbidity while restoring biomechanical alignment. Whether a single-plate or dual-plate construct is required within this approach remains undefined. This retrospective study applies a post-hoc non-inferiority framework to determine whether single-plate fixation is non-inferior to dual-plate fixation at minimum two-year follow-up.Methods Thirty-five patients with displaced extra-articular scapular fractures underwent minimally invasive lateral column fixation at a level-one trauma centre between 2021 and 2026. Eighteen received single-plate and 17 received dual-plate constructs, allocated by a standardised intraoperative decision algorithm. The primary non-inferiority endpoint was Constant–Murley score at final follow-up; a margin of eight points was defined before data analysis commenced based on published minimal clinically important difference data. Secondary endpoints included DASH score, shoulder range of motion, operative time, blood loss, radiological union, and complications. Minimum follow-up was 24 months (mean 33.6 months, range 24–48).Results Single-plate fixation was non-inferior for Constant–Murley score (96.2 ± 4.8 vs 95.4 ± 5.2; mean difference +0.8 points, 95% CI −2.5 to 4.1; lower bound above non-inferiority margin of −8; p-non-inferiority < 0.001) and DASH score (3.2 ± 4.1 vs 3.8 ± 4.6; mean difference −0.6, 95% CI −3.5 to 2.3; p-non-inferiority < 0.001). Non-inferiority was confirmed at a conservative four-point margin in sensitivity analysis. Operative time was significantly shorter with single-plate fixation (52.3 ± 11.4 vs 71.8 ± 14.2 minutes; p < 0.001) and blood loss was significantly lower (78 ± 32 vs 112 ± 41 mL; p = 0.004). External rotation remained incomplete in both groups at final follow-up (mean approximately 46° versus normative values of 60–90°), with most recovery occurring within six weeks. All 35 patients achieved radiological union. Complication rates were comparable.Conclusions In this post-hoc non-inferiority analysis, single-plate minimally invasive lateral column fixation produced equivalent functional and radiological outcomes to dual-plate fixation at minimum two-year follow-up with significantly shorter operative time and lower blood loss. Non-inferiority was robust in sensitivity analysis. External rotation recovery warrants targeted rehabilitation attention beyond standard intervals. Prospective randomised validation is required.

Introduction:Acetabular fracture-dislocations are complex injuries that, if misdiagnosed or mismanaged, can lead to avascular necrosis and early total hip arthroplasty (THA) failure. Case Report:A 16-year-old male with a neglected acetabular fracture-dislocation underwent an ill-planned THA, with the cup placed in fracture callus, which was removed the next day. He later presented in a Girdlestone-like state. Imaging and 3D modeling revealed a malunited posterior wall and column fracture. A staged approach - corrective osteotomy with fixation followed by revision THA - was performed. Result:At 10 months, he achieved excellent function and stable radiographic reconstruction. Conclusion:Early recognition, detailed pre-operative planning, and 3D-assisted individualized surgical strategies are vital for successful reconstruction of neglected or failed acetabular fracture-dislocations.

T-condylar fractures of the distal humerus are rare pediatric injuries. There is no consensus regarding ideal management and clinical outcomes for these injuries. The current review was planned to comprehensively review existing evidence regarding these rare pediatric fractures. A literature search was performed to identify the articles on pediatric T-condylar distal humerus fractures (1950-2024). Patient data was categorized under two groups: groups A (≤8 years old) and B (9-18 years). Finally, 32 articles were reviewed. Groups A and B included 25 and 148 patients, respectively. A majority of patients were males (72.3%) in both groups. 100% and 95.3% (141) of patients in groups A and B, respectively, were managed surgically [closed/open reduction and internal fixation (CR/ORIF)]. IF was predominantly done using Kirschner wire (K-wire) in group A. In group B, IF was performed using plate/screw/K-wire. There was no significant difference in complication rates between the groups [3/10 and 39/62 complications were observed in groups A and B, respectively; Mantel-Haenszel odds ratio:0.33 (95% confidence interval (CI): 0.09-1.14; Z = 1.75, P = 0.08; Chi-square = 3.23, P = 0.66; I2 = 0%)]. 87.5% in group A and 91.8% in group B had excellent; and good to excellent outcomes, respectively. The final elbow range of motion was significantly higher in group A (vs. group B; mean difference:13.91°; 95% CI: 6.93°-20.89°; test of overall effect: z = 3.91, P < 0.0001). Surgical management (i.e. ORIF) is the preferred intervention in pediatric T-condylar fractures. K-wire fixation is the most common operative technique. Overall complication rate is 58.3% (irrespective of age and treatment). Postinjury stiffness is more common in older children (>8 years).

A bent intramedullary nail in femur can be extremely difficult to extract when a patient presents after a secondary episode of trauma following the original episode for which nailing was done. These bent nails require utmost precision while extracting them, to prevent injury to the surrounding soft tissues and neurovascular bundle of the limb. We encountered a particularly rare case of a bent Kuntscher nail who presented to us nearly 20 years (post his primary surgery in 2001) after sustaining a secondary trauma. There was a 29-degree bend in the antero-posterior view and a 106-degree procurvatum bend in the k nail on the lateral view. We followed a technique of sequential manual manipulation under radiographic guidance to correct the acute bend of the nail, taking care not to create any additional fractures. Following nail extraction, the fracture was fixed with an interlocking nail and went on to unite uneventfully. At 3-year follow up, patient was walking pain free and exhibited a good knee range of motion.

We read and discussed the study entitled “Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures” with great interest. The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature. However, there are certain aspects of this study that need clarification from the authors.

BACKGROUND:The relationship of inflammatory bowel disease (IBD) with osteonecrosis or avascular necrosis (AVN) is uncertain. METHODS:Systematic review to estimate the frequency of osteonecrosis in IBD was performed. Electronic databases were searched on 12 December 2022 to identify relevant studies. We planned to estimate the pooled prevalence of AVN in IBD, the risk in IBD when compared to the healthy population (without any chronic disease), and the impact of steroid use on osteonecrosis (IBD with and without steroid use). The risk of Bias was assessed with the Joanna Briggs Institute appraisal tool. RESULTS:Fifteen studies including 105 154 individuals were included. The pooled rate AVN was 10.39 per 1000 patients (95% confidence interval, 4.44-24.11, I 2  = 97%). Subgroup analysis suggested that the prevalence was lower in larger studies (>1000 participants) at 3.10, 1.07; 8.98, I 2  = 98% versus 21.03, 8.69; 50.01, I 2  = 83%. The use of steroids did not seem to increase the risk of osteonecrosis in the included studies (pooled odds ratio: 1.88, 0.55-6.41, I 2  = 39%). The systematic review was limited by the absence of comparison with the control population free of chronic disease. CONCLUSION:IBD may be associated with a risk of osteonecrosis. Future studies should assess the risk in comparison to the healthy population and the impact of disease activity and IBD therapies on the risk.

CASE:Neglected elbow dislocation and radial neck malunion frequently result in chronic pain, instability, and early arthrosis. These complications are best prevented by early treatment with open reduction, corrective osteotomy, and ligament reconstruction, followed by early supervised physiotherapy. We present a peculiar case with neglected complex elbow dislocation and radial head malunion. In this case, we performed an open reduction of the elbow joint and radial neck corrective osteotomy, medial collateral ligament, annular ligament reconstruction, and lateral collateral ligament repair. CONCLUSION:Neglected complex elbow dislocations require reconstruction of both ligamentous and osseous structures to achieve a good functional outcome.

Introduction:There is no standard protocol for managing non-union of diaphyseal humerus bone, with several authors reporting their results using various techniques and methods for its management. No meta-analysis has reported the results of managing these cases with non-vascularized fibula grafting as an adjuvant for osteosynthesis. Materials and methods:This meta-analysis was performed to estimate the pooled data for calculating the union rates in diaphyseal humerus fractures managed with non-vascularized fibula grafting. Risk of Bias was computed using the Joanna Briggs Institute appraisal tool. Results:A total of 5 studies, comprising 102 patients, were included. The pooled estimate demonstrated that 94 patients achieved bone union with intramedullary fibular strut grafting. The pooled union rate (per 100 events) was 90.59 (95 % CI, 82.86-95.04, I2 = 0). The present meta-analysis also showed a significant improvement in DASH scores following the use of a non-vascularized fibula graft with a common effects model (SMD = 4.08; 95%CI: 3.44; 4.72; p < 0.01 I2 = 19 %, p-value for Q test = 0.29). Conclusion:Non-vascularized fibula grafting is an excellent adjuvant for the internal fixation of non-union diaphyseal humerus fractures. Although there is limited literature, further studies should highlight and assess the treatment of these uncommon but disabling conditions.

Complex distal humerus coronal shear fractures are rare injuries. These fractures involve small articular fragments and are challenging to fix. Aprospective case series of 10 patients was done at a level 1 trauma centre between February 2017 and July 2021. Dubberley type 3 fractures were included in the study. All patients underwent ORIF using posterior approach with olecranon osteotomy by a single surgeon. Patients were followed up for a minimum of 12 months postoperatively. The primary outcome measures were radiographic union and functional status of the limb (DASH score and MEPI score). All patients achieved radiographic union of fracture as well as the osteotomy. The mean DASH score as measured on the final follow-up was 12.6 ± 10.2 and the mean MEPI score was 90 ± 8.2. None of the cases needed reoperation. Consistently good functional outcomes can be obtained in complex coronal shear fractures by posterior approach with olecranon osteotomy. Dubberley type 3b patients should undergo additional plate fixation.

Introduction: Intramedullary nailing is a commonly performed surgery for tibia diaphysis fractures. However, in selected cases, this procedure can get complicated with rotational malalignment if not checked carefully intra-operatively. Case Report: A 29 year-old male sustained polytrauma and was treated with intramedullary nailing for bilateral femur and right-side tibia fractures. Postoperatively, the patient noticed extreme in-toeing suggesting an internal rotation deformity, which caused great difficulty in walking. The patient was planned for a revision surgery to correct the internal rotation deformity, 6 months after the index surgery. A minimally invasive metaphyseal osteotomy was performed, away from his fracture site by drilling multiple holes. The distal locking bolts of the interlocking nail were removed, and two K wires used to achieve the desired correction angle. After rotating the distal fragment, locking bolts were reinserted in new holes. We kept the patient on our regular follow-up till he achieved sound union at the osteotomy site, after which we allowed him unrestricted activities. Conclusion: The presence of an intramedullary nail can hence help the surgeon in correcting such isolated rotational deformities without getting into the hassle of implant removal to achieve the same. Keywords: Minimally invasive osteotomy, tibia malrotation deformity, polytrauma.