Displaced lesser trochanter (LT) fragments are common in unstable intertrochanteric fractures and may compromise posteromedial stability. However, the clinical relevance of LT fragment union after intramedullary nailing remains unclear. This prospective observational study included 72 adults with intertrochanteric fractures and displaced LT fragments treated with intramedullary nailing. LT fragment morphology (displacement, rotation, fragment number) was quantified on preoperative CT scans. Outcomes included radiographic healing, assessed using the modified Radiographic Union Score for Hip (mRUSH), and functional recovery, assessed using the modified Harris Hip Score (mHHS) at 1, 3, and 12 months. Patient factors, including serum vitamin D levels, smoking status, and comorbidities, were analysed for association with LT non-union. At 12 months, patients with LT union had significantly higher mHHS (p = 0.003) and mRUSH (p = 0.003) scores, whilst VAS pain scores were similar (p = 0.832). LT non-union was associated with greater displacement (p < 0.001), greater rotation (p < 0.001), multiple fragments (p < 0.001), lower vitamin D levels (p = 0.009), smoking (p = 0.010), and hypertension (p = 0.031). LT fragment union after intramedullary nailing is associated with improved functional recovery and radiographic healing. Preoperative CT-based assessment of LT morphology and optimization of modifiable risk factors (vitamin D, smoking, hypertension) may improve outcomes.

Background: Managing humeral shaft nonunion requires a comprehensive approach. Key factors include infection, prior surgeries, and severe bone loss. Treatment is challenging due to various surgical options, a lack of clear protocols, and limited evidence-based guidelines. Methods: Forty-four adults with humeral shaft nonunion (not caused by infection) were treated over 8 years from January 2012 to December 2020. Seven cases were particularly stubborn. Cases were excluded if they involved open fractures, infections, breaks with big gaps, bone disease, or other upper limb injuries. Treatment included removing unhealthy bone and tissue, correcting bone shape, using the patient’s own bone to help healing, and fixing the bone with a strong plate. Outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score at baseline and at least 24 months later. Results: Patients were followed for an average of 75 months. All patients healed. On average, healing took about 6 months (ranging from 4 to 12 months). Four patients (11.1%) had temporary nerve problems that fully recovered within 6 months. Two patients (5.5%) had mild wound infections. Arm function scores improved from an average of 76 before treatment to 7 at the end, showing excellent recovery. Conclusions: Our study shows that open surgery with a locking plate, supplemented with additional bone when needed, is very effective for healing stubborn humeral shaft fractures. Careful steps, such as gentle tissue handling, maintaining a healthy blood supply, and fully removing the bad tissue, are key to success.

Background: Acromioclavicular joint (ACJ) arthritis is a frequent but often overlooked cause of shoulder pain in older adults. Differentiating symptomatic ACJ degeneration from incidental, age-related changes is challenging, particularly when other conditions such as rotator cuff (RC) tears are present. Methods: Forty-eight patients (mean age 61.6 years) with shoulder pain underwent standardized shoulder MRI. Three independent, blinded radiologists graded ACJ arthritis severity using the Shubin-Stein system. Inter-rater reliability was assessed with Fleiss’ kappa. Associations with RC tears, glenohumeral (GH) arthritis, labral pathology, and biceps tendon pathology were analyzed. Results: ACJ arthritis (grade ≥2) was found in 93.8% of patients, with 54.2% showing moderate-to-severe changes. The prevalence observed was higher than that reported in several asymptomatic cohorts. Inter-rater agreement for the Shubin-Stein classification was almost perfect (κ=0.821). Increasing age was significantly associated with greater arthritis severity (p=0.003). Severe ACJ arthritis was strongly correlated with full-thickness or massive RC tears (p=0.001), but not with GH arthritis, labral pathology, or biceps pathology. Conclusions: MRI-detectable ACJ arthritis is highly prevalent in symptomatic shoulders over age 50 and often coexists with significant RC pathology. The Shubin-Stein classification system shows high inter-rater reliability, supporting its clinical utility. These findings demonstrate the need for comprehensive shoulder evaluation, as concurrent ACJ pathology can affect diagnosis and intervention.

The goal of this study was to assess whether harvesting the peroneus longus tendon (PLT) for anterior cruciate ligament reconstruction (ACLR) affects ankle function over time, using data from a large group of patients with at least 2 yrs of follow-up. We retrospectively reviewed 327 patients who underwent ACLR using a quadrupled PLT graft without distal tenodesis after harvest. Ankle function was evaluated before surgery and at 6 and 24 months postoperatively using three validated tools: the AOFAS Ankle Hindfoot Score, the Foot and Ankle Disability Index (FADI), and the Visual Analogue Scale (VAS) for pain. Activity levels before injury were recorded using the Tegner Activity Scale. Changes in scores over time were analysed using the Friedman test. Patients were followed for an average of 42.17 months. Preoperative Tegner scores suggested most patients had low to moderate activity levels. Ankle pain remained minimal across all time points, with no significant changes in VAS scores (p = 0.097). Both AOFAS and FADI scores remained consistently high from before surgery to two years after, with no significant decline. These findings suggest that harvesting the peroneus longus tendon does not result in clinically significant donor-site ankle morbidity over long-term follow-up. Use of the peroneus longus tendon for anterior cruciate ligament reconstruction appears to be a safe and effective option that does not compromise clinical ankle function in low- to moderate-activity individuals. Our findings, based on a large cohort with minimum 2 year follow up, support PLT autograft as a reliable alternative with minimal donor site morbidity. Level IV.

Existing patient-reported outcome measures (PROMs) for foot and ankle disorders lack cultural relevance for Indian patients. Hence, this study aimed to develop the Indian Foot and Ankle Society (IFAS) score, a PROM tailored to the unique cultural and functional needs of Indian patients. The IFAS score was developed using the Modified Delphi method, involving a panel of experts in foot and ankle surgery. A master list of 123 items was refined through three Delphi rounds, yielding a final set of 17 items. The final IFAS score comprises 17 items across four domains: Pain, Swelling and Stiffness, Activity, and Footwear Orthotics. Each item is scored from 0 to 4, yielding a maximum raw score of 68, which is converted to a 0–100 scale, with higher scores indicating better function. The IFAS score represents a Phase 1, consensus-based PROM developed to address culturally relevant functional outcomes in Indian patients with foot and ankle disorders. Further psychometric validation, including reliability and validity assessments, is required before routine clinical and research use.

Objective:The current study was done to evaluate the impact of a plan-do-check-act (PDCA)-based AMS program implemented at a tertiary trauma center. Setting/Patients:Inpatients admitted to an Advanced Trauma Centre of a tertiary care hospital in North India. Methods:This implementation research study was conducted in four phases from March 2019 to November 2024. The AMS strategies included prospective audits, feedback mechanisms, education, and multidisciplinary collaboration. Descriptive statistics were used for antibiotic prescription practices, adherence to guidelines, and patient outcomes. Metrics for antibiotics utilization and appropriateness of prescription were the key performance indicators analyzed. Results:A total of 767 patients were enrolled during this period. The practice of antibiotic prescription changed from being prophylactic to culture-based-increasing from 0.7% in phase 1 to 21.4% in phase 4. Compliance to feedback increased from 75.8% in phase 3 to 90.7% in phase 4. There was a fall in aggregate defined daily dose to 658.4, from 808.2 per 1000 patient days, and length of therapy also improved. There was a marked increase in the number of culture-based interventions. The educational programs and multidisciplinary team rounds further reinforced the practice of AMS. Conclusions:The PDCA cycle significantly improved the use of antimicrobials, adherence to treatment guidelines, and patient outcomes in a resource-constrained setting. This approach provides a scalable model for implementing AMS in surgical units despite challenges such as limited microbiological resources.

Talar malunions can cause significant morbidity in the form of hindfoot deformity, pain, and gait abnormalities. Malunion and nonunion may coexist, making treatment more challenging. Reconstruction is feasible in cases where the talar dome cartilage is intact, avascular necrosis is minimal or partial, and no infection. The addition of subtalar fusion during talus reconstruction can improve revascularization and healing without causing significant disability. In cases where the bone has significantly deformed over time, a triple fusion may be a better option to correct the hindfoot deformity while leaving the talus malunited.

Degenerative cervical myelopathy (DCM)– often termed cervical spondylotic myelopathy– is the most common cause of spinal cord injury in adults, arising from age-related degenerative changes in the spine. Genetic susceptibility may modulate which individuals develop myelopathy under these mechanical stresses. Calmodulin-1 (CALM1) is a gene encoding calmodulin, a key calcium-binding protein involved in cartilage maintenance and neural signalling, and CALM1 variants have been implicated in degenerative joint disease. We hypothesized that a CALM1 polymorphism could influence DCM risk. In this pilot case–control study, 48 DCM patients (with imaging-confirmed cervical spondylotic cord compression) males (n = 42, 84.36

Physiotherapy treatment of adhesive capsulitis comprises various exercise and electrotherapeutic interventions including Codman’s regime, diathermy, ultrasound therapy, and shockwave. However, there is no existing meta-analytic research comparing the efficacy of shockwave and ultrasound. In this review article the databases of PubMed, Embase, Web of Science, Cochrane Central Register, and Google Scholar were searched for clinical trials. Quality assessment of included studies was done as per the method described in the Cochran’s Handbook of Systematic Reviews. Continuous data for pain, range of motion (ROM), and function were expressed in terms of mean ± standard deviation and dichotomous data as n (%). Standard mean difference between the experimental and treatment arm was calculated with 95% confidence interval (CI). We obtained Eight-hundred and twenty-six studies, out of which only 4 were incorporated after in-depth exploration. Statistical comparisons were made for Visual Analog Scale present (pooled mean difference: −0.93; 95% CI: −1.86, 0.00), ROM in terms of flexion (pooled mean difference: −14.58; 95% CI: −20.86, −8.30), abduction (pooled mean difference: −6.66; 95% CI: −15.04, 1.72), and rotations (pooled mean difference: −3.36; 95% CI: −3.03, −0.33), Patient-Specific Functional Scale (pooled mean difference: −2.30; 95% CI: −3.06, −1.54), Disabilities of the Arm, Shoulder, and Hand (pooled mean difference: −9.70; 95% CI: −14.47, −4.93). Among the 4 included studies, the results showed shockwave to be superior in terms of reducing pain, increasing ROM and improving function. Our meta-analysis concluded that the shockwave is more efficient than ultrasound therapy. However, the improvements were only clinically significant in terms of flexion ROM.

Osteoporosis is the major cause of fragility fractures in postmenopausal women. It has been aptly termed as the ‘silent disease’, as most women are asymptomatic, and a fragility fracture is often the first presentation. Fragility fractures have significant implications in terms of decreased quality of life, and increased morbidity, mortality, and healthcare cost. This study has showed that a multivariable logistic regression model based on clinic-demographic parameters and speed of sound that can be used to predict osteoporosis using quantitative ultrasonography. The Cross-sectional study done for a period of one year in Departments of Orthopaedics and Radiodiagnosis, PGIMER, Chandigarh with a Sample Size of N=100 subjects. By itself, estimation of osteoporosis using speed of sound, may not be very reliable or accurate, however, a multivariable model taking into account age, body mass index along with speed of sound, can improve the diagnostic accuracy of such estimates. However, these results need to be validated in a larger cohort of patients. The speed of sound measured at the heel by quantitative ultrasonography was found to be significantly lower (mean difference of approximately 20 m/s) in subjects who had a DEXA proven osteoporosis verses who did not have osteoporosis. Using the normative data of speed of sound of the Japanese population as the reference (Strategy 1), QUS was found to have a poor accuracy for diagnosis of osteoporosis. A cut-off value of speed of sound of less than 1536 m/s at the heel was found to have sensitivity of 91.7% for diagnosis of DEXA proven osteoporosis. On the other hand, a cut-off value of speed of sound of less than 1467 m/s at the heel was found to have specificity of 91.5%. For determining the optimal cut-off for diagnosing osteoporosis based on speed of sound, cut-offs obtained from receiver operating curve analysis (strategy 2b) were found to have a lower percentage of misclassification, as compared to cut-offs obtained from normative data of young Indian females (strategy 2b). In the univariate analysis age, body mass index, hip circumference and time since menopause were significantly associated with DEXA proven osteoporosis.

Ankle malunion remains a common issue despite advances in imaging and management protocols; it is a challenging problem that occurs after neglect or inadequate treatment. The consequences are pain, difficult gait, and eventual arthritis of the ankle joint, and demands aggressive management. The existing classification systems for ankle malunion are often too basic, and do not provide enough detail to guide specific treatment plans; our understanding of the complex anatomical issues and how they affect ankle mechanics has greatly improved with advanced imaging like CT and weight-bearing CT, and there is a need for a more comprehensive classification. This paper reviews how our understanding of ankle malunion has evolved over time, looking at biomechanics, imaging techniques, and current classifications. A new comprehensive classification system called the Patel-Dhillon Classification was developed, and was used on individual cases to show how this system works in practice, detailing specific anatomical problems, surgical treatments, and outcomes. A step-by-step plan for managing ankle malunion has been suggested. The proposed Patel-Dhillon classification divides malunions into three main types: Type I (Extra-articular), Type II (Intra-articular Malleolar/Plafond), and Type III (Complex with Articular Impaction/Deficiency). To provide a complete picture, we added four modifiers: Arthritis (Ar), Previous Surgery (PS), Soft Tissue Status (ST), and Syndesmotic Status (Sy). A systematic treatment algorithm, based on this classification is also presented, and its usefulness is demonstrated through six illustrative clinical cases. A detailed, patho-anatomy driven classification system, like the one we propose, is essential for accurate diagnosis, planning personalized surgeries, predicting outcomes, and standardizing research in this complex area; this is because every ankle malunion has unique anatomical challenges.

Truenat MTB Plus assay along with dedicated chips for rifampicin and isoniazid can aid in TB elimination efforts by establishing diagnosis of drug-resistant extrapulmonary tuberculosis (EPTB). 600 EPTB samples (125 microbiologically-confirmed, 275 clinically-suspected and 200 controls) processed between January 2019 and June 2023 were subjected to Truenat MTB Plus for detection of Mycobacterium tuberculosis. All samples showing presence of M. tuberculosis were subjected to individual chips for rifampicin and isoniazid detection. They were also subjected to Xpert MTB/RIF Ultra assay (XpertUltra). The sensitivity, specificity, positive and negative predictive value of Truenat MTB Plus for detecting EPTB was 73.5

Avascular necrosis (AVN) of the talus is a perplexing clinical entity with a notoriously unpredictable course. While some patients proceed rapidly to structural collapse and degenerative arthritis, others maintain talar integrity over the years despite imaging evidence of necrosis. This variability challenges existing staging systems and highlights gaps in our understanding of the biomechanical thresholds that govern progression. We propose a novel, biomechanically grounded hypothesis termed the 'Dhillon-Sharma Hypothesis': that the talus comprises three principal structural pillars-medial, central, and lateral-that bear the axial load transmitted through the ankle together. Collapse is unlikely unless two or more of these pillars are affected by AVN. This 'three-pillar model' of talar AVN is consistent with finite element modeling (FEM) studies, imaging findings, and clinical observations, and may explain why many AVN lesions revascularize and remain clinically silent. In contrast, others progress rapidly to joint failure. We propose that this conceptual framework offers an anatomically and mechanically coherent explanation for observed heterogeneity in talar AVN and may guide future imaging strategies, prognostication, and surgical decision-making.

Objectives:A human being is a social animal, and social interactions are pivotal in his life. After traumatic amputation, a normal and able human being becomes disabled for the rest of his entire life. Despite affecting all aspects of life, this unanticipated disability results in undeniable effects on the social relationships and social behaviour of the person. This qualitative study was conducted to explore the aftermath of traumatic amputation on the social lives of lower limb amputees. Materials and Methods:A qualitative approach with a phenomenological research design was employed. The study was conducted at an amputee clinic of a leading tertiary care hospital in North India. A purposive sampling technique was used to recruit the participants who had undergone lower limb amputation due to trauma and were attending an amputee clinic for their follow-ups. We conducted 16 in-depth, face-to-face interviews using a pre-validated interview guide until we reached data saturation. Results:Data were analysed using the Colaizzi method of thematic analysis, and three main themes emerged: (a) self-isolation (perceived social isolation); (b) support - the core of rehabilitation and (c) spirituality - a major factor in Indian culture. Conclusion:The findings highlighted that there is a perceived social isolation in amputees instead of actual social isolation by others in society. The study revealed spiritual support as a substantial supportive factor for the holistic rehabilitation of lower limb amputees, specifically in countries with spiritually rich traditions like India. Need-based counselling in the acute stage, family-centred care and support group intervention are the key factors for the comprehensive rehabilitation of lower limb amputees.

Despite increasing gender diversity in medicine, orthopedic surgery remains male-dominated, especially in India. This study aimed to explore male orthopedic surgeons’ perspectives on the competence of female colleagues, their intraoperative preferences, and training experiences. A cross-sectional survey was conducted among 226 male orthopedic surgeons in India. Data on age, years of experience, type of practice, and training history were collected. Respondents shared their perceptions regarding gender-based competence, surgical assistance preferences, and challenges in training women. Statistical analysis (chi-square and t tests) was performed to assess associations between demographic variables, perceptions, and preferences. Most respondents worked in the private sector (69.9

BackgroundDespite gender parity in medical school enrolment, women remain underrepresented in orthopaedic surgery in India. Whilst structural barriers and implicit biases are increasingly acknowledged, less is known about the lived experiences and priorities of women navigating this field. This study seeks to capture the perspectives of female orthopaedic surgeons in India-their challenges, choices, and what they value in training and practice.Materials and MethodsA cross-sectional survey was conducted amongst 102 female orthopaedic surgeons across India, ranging from residents to senior consultants. A 43-item questionnaire assessed demographics, residency experience, intraoperative ergonomics, occupational health, psychosocial challenges, and perceived gender bias. Quantitative data were analysed descriptively; qualitative responses were thematically coded. Agreement between self- and peer-perceived difficulty in trauma procedures was evaluated using Cohen's Kappa.ResultsOnly 24.5% reported no gender-based differences during training, whilst 71.8% felt seniors and peers lacked confidence in their surgical ability. Intraoperative difficulties such as poorly fitting lead aprons (64.7%) and radiation exposure (27%) were common. Occupational health issues like back (31.7%) and neck pain (27.6%) were frequently reported. Although trauma was of interest to many, 91.2% reported being discouraged from pursuing it, with key deterrents including work-life imbalance, radiation concerns, and lack of mentorship. Respondents also expressed a need for equitable surgical opportunities, institutional support, and gender-sensitive design in equipment and training environments.ConclusionThe findings reveal what female orthopaedic surgeons value in their professional journeys-supportive mentorship, equal access to operative roles, safe working conditions, and recognition as capable surgeons. Addressing these needs is critical to creating a more inclusive and forward-looking orthopaedic community.