Background: The duration of chemotherapy for the tubercular spine is an unresolved issue. Various drug regimens have been used for various durations. Objectives: (1) To calculate the duration of antitubercular therapy (ATT) for achieving the healed status of the tubercular spine, (2) to report the behavior of kyphotic deformity, and (3) outcome of neurological deficit. Materials and Methods: This longitudinal descriptive study included 76 cases of tubercular spine diagnosed on clinico-imaging and/or on histopathology/molecular tests. They were treated as per the DOTS regime. Surgery was done for predetermined indications. ATT was stopped once healed status was demonstrated on CE-MRI/PET-CT. Kyphotic deformity was measured by modified Konstam’s method, and neurological grading was assessed by Tuli’s grading. Results: The mean duration of healing was 20.08 ± 8.09 months (range 9–48 months) in primary spinal TB with no recurrence after the mean follow-up of 15 months (range 3–108 months). Overall, 92.6% showed good neural outcomes at the final follow-up. Mean kyphotic deformity was found to be 16.75° ± 12.23°, 18.78° ± 12.62°, and 18.78° ± 12.53° at presentation, after stopping ATT and at the final follow-up. Conclusion: It is unscientific to stop ATT in spinal TB till healed status is demonstrated by contrast-enhanced MRI or PET-CT. Although the sample size is small, the data is enough to prove this point that if all patients were treated till healed status was achieved, there would be no recurrence.

Background Acetabulum fracture is one of the most challenging fractures to manage and operate for orthopaedic surgeons; anatomical reduction of fractures and reconstruction of the joint is of utmost importance. These factors in turn are dependent on the appropriate surgical approach used to improve the clinical outcomes and reduce associated complications. Hence, this meta-analysis aims to compare the outcomes of ilioinguinal versus modified Stoppa approach for open reduction and internal fixation (ORIF) of displaced acetabular fractures. Methods Medline (PubMed), Embase, Scopus, and Cochrane Library databases were searched from their inception to 10th of June 2021 for both randomized clinical trials (RCTs) and or non-randomized studies comparing the outcomes of ilioinguinal approach and modified Stoppa approach for the ORIF of acetabular fractures. The estimates of treatment effects were described by mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous variables with corresponding 95% confidence (95% CI) intervals. The risk of bias was assessed by MINORS tool for the non-randomized, and the Cochrane Collaboration's risk of bias tool for RCTs. Result A total of ten studies (717 patients), three RCTs and seven retrospective studies, were included. Modified Stoppa approach showed shorter mean duration of surgery (MD 47.13, 95% CI: 27.30-66.96), lesser number of overall complications (OR 2.14, 95% CI: 1.46-3.13), less intraoperative blood loss (MD 259.65, 95% CI: 152.66-366.64), and lower rates of infection (OR 2.17, 95% CI: 1.14-4.15). However, ilioinguinal approach showed a better quality of fracture reduction (OR 0.59, 95% CI: 0.42-0.82). Results were equivocal in terms of vascular injuries (OR 1.88 (95% CI: 0.86-4.09), nerve injuries (OR 1.77, 95% CI: 0.99-3.17), heterotopic ossification (OR1.74, 95% CI: 0.63-4.82), and clinical outcome (OR 0.81, 95% CI: 0.45-1.47) between the two groups. Conclusion Modified Stoppa approach carries a lesser duration of surgery, lesser intraoperative blood loss, fewer overall complications, and lesser postoperative infection rates compared to ilioinguinal approach. Although a better anatomical reduction is achieved by ilioinguinal approach, however, this does not translate into better clinic functional outcomes which remain comparable between the two approaches. So overall, modified Stoppa approach seems a better alternative for managing these fractures.

Background:Management of neck of femur fractures depend upon the age of presentation and it ranges from internal fixation to arthroplasty. In a relatively young population, anatomical reduction with stable internal fixation is the preferred treatment modality; the choice of implants available are multiple cannulated cancellous screws, dynamic hip screws, and the newly devised femoral neck system. The fracture configuration and pattern dictate the ideal implant to be utilized, with the femoral neck system documented to be apt for all the fracture types, while the cannulated screws are deemed better for stable fractures. Methods:A primary electronic search was conducted on databases of Medline, Scopus, Scopus, Cochrane Library, and Embase, to look for articles published between 1st January 2010 to 22nd November 2021. Studies including adults with femoral neck fractures treated with internal fixation with femoral neck system and comparing them with internal fixation with cannulated cancellous screws in terms of variables like mean surgical duration, loss of blood, length of incision, fluoroscopy time, duration of hospital stay and outcomes like union time, complications, functional outcomes, Visual Analogue Score, and femoral neck shortening, were included. Results:6 retrospective studies with 371 patients (224 males,147 females) (164: FNS; 207: CCS) were included. Our analysis demonstrated no statistically significant difference in terms of duration of surgery, incision length, and length of hospital stay, there was more blood loss in FNS, but less fluoroscopy time. The fracture union time was lesser for the FNS group and also the femoral shortening was lesser in it. There was no difference in terms of complications, pain relief, and functional outcomes. Conclusion:Femoral neck system is a new and effective implant for femoral neck fractures in the young with faster union rates and lesser neck shortening through an incision similar to the conventional multiple cancellous screws. It has additional advantages of lesser fluoroscopy exposure to the patient and the OT personnel. However, the rates of complications like implant failure, non-unions, and avascular necrosis are similar to the cannulated screws and either of the implants do not offer any advantage in the final functional status and pain relief to the patient over each other.

Introduction: Sideswipe injuries are most commonly described in passengers traveling in a car or bus, but here we report an unusual mode of sideswipe injuries, in passengers traveling in a train sitting on window seats with elbow protruding outside the window. Case series: Four patients reported to our Orthopaedic emergency 2 hours after a railway track accident with more or less similar pattern of injury, an open proximal forearm monteggia fracture-dislocation with bone and soft tissue loss along with closed fracture humerus, and with or without radial nerve palsy and intact distal pulses. We followed a multidisciplinary approach with initial wound lavage followed by wound debridement, stabilization of monteggia and humerus fractures with different justifiable modalities of treatment with an exploration of the radial nerve. Discussion and conclusion: Sideswipe injury is a well-known case entity in literature, classically described mode of trauma is when an elbow protruding out of the window of a vehicle struck by a moving or fixed object. However, in our series patients sitting in a train on window seat with elbow protruding outside sustained sideswipe injury which has not been reported in literature. We also explained the mechanism of impact forces caused bony and soft tissue injury in our series presented in diagrammatic representation. Hence, the purpose of this case series is to spread the awareness regarding such kind of preventable injury which can be easily prevented with awareness, and an appropriate preventive measure can be taken by the local administration.

Femoral neck fracture in lower limb amputees poses treatment problems. The altered biomechanics of the hip in amputees, stump length, associated osteoporosis and difficulty in positioning these patients on the operation table are few of the technical challenges faced by an operating surgeon especially while salvaging the native hip joint. We report a case series of two lower limb amputee patients with fracture neck of femur in whom we salvaged the native hip joint by performing osteosynthesis. We observed satisfactory results of osteosynthesis in both of our patients on follow-up, with both achieving pretrauma ambulatory status in 6–8 weeks postoperatively. We concluded that each lower limb amputee patient with fracture neck of femur should be carefully evaluated on presentation and managed individually. These patients can be positioned and managed by osteosynthesis on a standard operating table or fracture table without requiring any special operating theatre set-up (traction devices).

The treatment of pathological femoral neck fracture in children due to osteopetrosis is not clear as only a few cases have been reported to date. We encountered a 7-year-old osteopetrotic girl with asynchronous bilateral femoral neck fractures. Radiographical assessment showed markedly dense bones with loss of corticomedullary differentiation, sandwich vertebrae and increased density of the ribs. Her mother had a similar radiological picture. Genetic testing showed CLCN-7 mutation which confirmed the diagnosis of autosomal dominant osteopetrosis. As the parents opted against operative treatment, the femoral neck fractures were managed conservatively with skin traction. At the 2-year follow-up, both fractures had united, although with coxa vara, and the patient had excellent functional outcome as she could walk without difficulty, had unrestricted motion at both hips, and there was no pain. Lifestyle modifications were suggested to prevent recurrent fractures and genetic counselling was done.

Osteochondroma of the talus is a rare entity that can cause pain, swelling, restriction of movements, synovitis and tarsal tunnel syndrome (TTS). We present three such cases with varying presentation. Case 1 presented with synovitis of the ankle along with a bifocal origin of the talar osteochondroma. Case 2 presented with TTS as a result of compression of the posterior tibial nerve. Case 3 presented with deformity of the foot. In all the three cases, the mass was excised en bloc and histologically proven to be osteochondroma. In case 3, the ankle joint was reconstructed with plate, bone graft and arthrodesis of the inferior tibiofibular joint. All the three cases had good clinical outcomes.

Introduction: Isolated fracture of the radial diaphysis with dislocation of the radial head is a rare injury, which requires careful evaluation. Combined injuries associated with forearm shaft fractures and elbow dislocations are well recognized. Case Report: A 35-year-old male presented to our emergency department with a history of fall in ditch under influence of alcohol with swelling of her right elbow and deformity of right upper limb. Roentgenograms showed oblique fracture of the radial shaft and dislocation of radial head posteriorly. He underwent open reduction and internal fixation of fracture with limited contact dynamic compression plate and reduction of radial head and fixing with radiocapitellar wire. After 4 months, the fracture healed fully and he had complete full range of elbow movements. Conclusion: Ipsilateral radial head dislocation and radial shaft fracture are extremely rare injury in a child. A good outcome can be achieved by applying principles of the management of proximal forearm fracture-dislocation. Ipsilateral radial head dislocation and radial shaft fracture is extremely rare injury in a child. A good outcome can be achieved by applying principles of management of proximal forearm fracture-dislocation.

The treatment of pathological neck femur in children due to osteopetrosis is not clear. The literature is scanty and only few case reports are present. We encountered such a 8 year old female child, who presented with two asynchronous femoral neck fractures. There was history of trivial trauma first left followed by right hip was involved. His skeletal survey was suggestive of osteopetrosis. Patient presenting symptom was pain and inability to bear weight on his lower limb. Her mother also had such fractures. We managed conservatively in form of bilateral skin traction for bilateral hip. At 2 years follow-up patient had excellent functional outcome(no pain, full weight bearing, full hip ROM) with radiologically fracture united in coxa-vara. The conservative treatment gives good functional outcome.

Tuberculosis is common worldwide and in endemic in India. Musculoskeletal tuberculosis, involving spine and other joints is seen in 1% to 3% of patients with tuberculosis. The disease has varied clinical presentation & lack of charateristic radiographic findings leading to delayed diagnosis and treatment. Early confirmed diagnosis & proper medical treatment are essential for control of the disease. This review article based on the recent literature review discuss the clinical presentation, diagnosis and management of osteoarticular tuberculosis.

Complex distal end of humerus fractures are one of the most challenging cases in orthopedics. There is a paucity of literature on outcomes of parallel reconstruction plates using olecranon osteotomy technique along with large sample size. This study focuses primarily on rate of various complications encountered in intraarticular AO Type C distal humerus fractures. In this prospective study, we included 94 patients with isolated closed intraarticular AO type C distal and humerus injuries. Exclusion criteria were polytrauma, open injuries, and pathological fractures (except osteoporosis). The followup was done immediate postoperatively, 6 weeks, 6 months, 1 year and at 2 years. Range of motion (ROM), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score was recorded at each visit. Assessment of union was done based on X-ray. Patients were classified into two groups; Group 1 – patients without complications (n = 64) and Group 2 – with one or more complications. The average duration of surgery was 2 h and 15 min. The complication rate was 31.9% (30/94), however, a total of 45 complications were noted. The difference between ROM in the two groups was statistically significant (P < 0.05), however, the difference between MEPS and DASH score was not statistically significant. The most common complication found was ulnar nerve neuropathy. Parallel plating using olecranon osteotomy is an acceptable approach for this fracture, but due to inherent nature of this injury, it has its own set of complications which must be counseled before surgery and active participation of patient is required to obtain realistic expectations and goals for the future.

Background Avascular necrosis (AVN) of the femoral head usually occurs in the third to fifth decade. The treatment options depend on the stage of disease varying from nonoperative treatment to surgical procedure including core decompression (CD) with or without nonvascularized or vascularized fibular graft, muscle pedicle bone grafting, osteotomies, and arthroplasty. Finite life of the total hip arthroplasty (THA) prosthesis limits its use in young adults or in middle aged. In this study, we envisage to evaluate the clinicoradiological outcomes of CD and nonvascularized fibular grafting in early stages of AVN femoral head. Materials and Methods Our study is longitudinal observational study including 76 hips (46 patients) in the age group of 18–48 years (mean 30.07 years). Ficat and Arlet staging system was used and only early stages, that is, Stage 1 ( n = 36 hips) and Stage 2 ( n = 40 hips) were included in the study. The cases with traumatic AVN were excluded. All patients in Stage 1 underwent CD (Group 1) and those in Stage 2 underwent CD and fibular grafting (Group 2). Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs, and MRI taken at different intervals. Results Average period of followup was 53.5 months (44–63 months). Radiological progression was not seen in 55 hips out of 76 hips (72.3%), whereas 21 hips (27.6%) demonstrated signs of progression and collapse. Failure of surgery was defined as progression of the disease, which was 25% ( n = 9) in Group 1 and 30% ( n = 12) Group 2. Median values of HHS at the end of the followup in Group 1 was 77 and in Group 2 was 71.5 compared to the preoperative HHS of 48 and 62 in Group 1 and 2, respectively. Median values of VAS at the end of the followup in Stage 1 was 0 and in Stage 2 was 2 compared to the preoperative VAS of 6 and 8 in Group 1 and Group 2, respectively. Conclusion CD with or without fibular grafting is effective in preserving the sphericity of the femoral head and to delay the progression of the AVN of femoral head in the early stages, that is, Stage 1 and Stage 2 and aids in the early revascularization of ischemic femoral head and is a useful modality to negate or delay the requirement of THA.

Introduction: Platelet-rich plasma (PRP) is promoted nowadays as an ideal autologous biological blood-derived product. It enhances wound healing, bone healing, tendon healing and is currently being widely used. Aims and Objectives: A prospective cohort study was conducted to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in the treatment of plantar fasciitis (PF). Materials and Methods: Fifty patients were included in the study and divided into two groups. Group I (25 patients) received PRP injection and Group II (25 patients) were given steroid injection. Patients were clinically assessed at different intervals. Functional outcome was evaluated on the basis of the visual analog scale (VAS) and foot and ankle ability measure (FAAM) scores. Plantar fascia thickness was assessed pre- and post-injection by ultrasound. Results: PRP and corticosteroid injection groups at the initial visit had VAS score of 8.86 and 8.60, respectively, which was reduced to 1.52 and 3.10 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.2 and 30.8, respectively, which increased to 84.2 and 68.3 at the end of 6 months. After injection, the PRP group had a significant reduction (34.80%) in the thickness of plantar fascia as compared to corticosteroid group (29.54%). Conclusion: Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up.

Reporting a rare scenario of hypoglossal nerve palsy in craniovertebral tuberculosis. Two patients presented in outpatient department with chief complaints of pain in neck, restricted neck movements, gait changes, difficulty in speech and weakness in all the extremities. On the basis of clinicoradiological correlation, the patients were diagnosedwithtuberculosis of C1–C2 spine. They were started on antituberculosis therapy Category 1. The patients improved clinically and there was no worsening of symptoms, but they noticed tongue deviation and hypotrophy on one side of the tongue. C1–C2 tuberculosis along with cranial nerve palsy, especially hypoglossal nerve is one of the rarest presentations. Hypoglossal nerve arises from the medulla, exits through hypoglossal canal in the base of the skull and traverses neck to supply tongue musculature. Prevertebral fascia extends from superior mediastinum to base of the skull. Abscess in this area can cause either actual compression of the hypoglossal canal or C1 and base of the skull dissociation which can lead to compression of the canal.

All researchers want their work published. Unfortunately, this is easier said than done. Manuscript rejection is a common occurrence.1,2 A study by Hall and Wilcox concluded that 62% of the published papers have been rejected at least once.3 The rejection rate is higher in better quality journals.4 The rejection rate of Indian Journal of Orthopaedics (IJO) in the last 5 years has ranged from 57% to 86%. This editorial discusses the common reasons because of which manuscripts are rejected and the ways and means to deal with them [Table 1].

Osteoblastoma is a rare tumor and represents about 0.8% of all bone tumors. The aggressive variant is even rarer and difficult to diagnose. We present a case of a 17year old male with a tumor of the acetabulum with characteristic epithelioid osteoblasts and other features of an aggressive osteoblastoma. It is important to recognize this entity as it can be clinically confused with an osteosarcoma. Our case not only showed epithelioid morphology but also had vacuolated cytoplasm, which simulated a mucin secreting adenocarcinoma. Since treatment and prognosis for these entities is strikingly different, an accurate diagnosis becomes all the more important. This case emphasizes the need for better co-ordination between the clinician and pathologist and use of histochemical stains and immunohistochemistry apart from routine histopathology for arriving at a final diagnosis. It is essential to have a close follow-up of the patient to look for recurrence of the tumor.