Objective: Patient-related pain is commonly observed after surgically treated fractures. Studies have examined pain and function improvements as well as complications after elective implant removal. Outcomes vary based on factors like implant location and patient characteristics. However, most patients with initial pain and dysfunction show improvements in standardized scoring systems. Previous studies relied on subjective pain scores and patient satisfaction, but newer tools like PROMIS offer better assessment. Certain questions remain unanswered, such as outcomes in terms of MCID. The study aims to predict patient-reported outcomes after elective implant removal by analyzing preoperative factors. To determine preoperative factors predictive of improvement in pain and function after elective implant removal. We hypothesized that patients undergoing orthopaedic implant removal to relieve pain would have significant improvements in both pain and function. Methods: Retrospective cohort study. Level I Trauma Center. 36 were enrolled after consenting for orthopaedic implant removal to address residual pain. 30 were available for 3-month follow-up. Results: Preoperative and postoperative outcome measures including Patient Reported Outcomes Measurement Information System (PROMIS) scores were compared. Preoperative scores, surgeon prediction of pain improvement were analyzed as predictors of outcomes. Median PROMIS physical function and pain interference scores and visual analogue scale significantly improved by 6, 8, and 2 points, respectively. Worse preinjury scores predicted improvement in respective postoperative outcomes. Surgeon prediction of improvement was associated with improved PROMIS pain interference, patient subjective assessment of pain improvement, and subjective percent of pain remaining at 3 months. Conclusions: Although the primary indication for implant removal in this population was pain relief, many patients also had a clinically relevant improvement in physical function. In addition, patients who start with worse global indices of pain and function are more likely to improve after implant removal. This suggests that implant-related pain directly contributes to global dysfunction

Background: A proximal femur fracture is the most serious complication of osteoporosis, due to the high mortality and morbidity associated with it. Its risk in the elderly is a function of multiple factors, including bone mineral density, muscle strength, and balance, all of which have been related to Vitamin D status and function. Vitamin D deficiency is common in older adults in Western countries with seasonal winters, when the amount of sunlight is much reduced. There is a paucity of data on the prevalence of vitamin D deficiency in patients with hip fracture in countries such as India where the climate is predominantly tropical. Methods: We prospectively studied 30 patients with hip fracture admitted to the Orthopedic department over a 1-year period. Younger patients (patients < 50 years) were excluded. Data on patient demographics, comorbidities, functional status, and serum 25-hydroxyvitamin D levels were collected. Results: The data of 30 patients (aged between 50 to 73), were analyzed. The prevalence of vitamin D insufficiency (25(OH) D < 30 ng/mL) and deficiency (25(OH) D < 20 ng/mL) was 63.3% and 36.6%, respectively. Age and 25(OH) D levels were found to be correlated, with no correlation between the UV index and the 25(OH) D levels.Conclusions: Supplementation of vitamin D in elderly people with and without fracture might prevent secondary hyperparathyroidism, osteomalacia and fracture.

Background: Floating knee injuries are complex injuries that are generally caused by a high-energy trauma such as a motorcycle or a car accident. Local trauma to the musculoskeletal and the soft tissues is often extensive and life-threatening; associated injuries may also be present, producing a challenging problem to manage. In this study, we presented the outcome of these injuries after surgical management.Patients and Methods: In this prospective study, 30 patients with floating knee injuries were managed over a 1-year period; both fractures of the floating knee injury were fixed surgically by different modalities. Fractures were classified according to the modified Fraser classification, and the outcome was evaluated by the Karlstrom criteria.Results: The main mode of injury was motorcycle accident (70%). The complications presented in 4 (13%) patients. According to the Karlstrom criteria, the end results were as follows: Excellent − 8 (26.6%), good − 17 (20.6%), acceptable − 2 (23.6%), and poor − 2 (11.8%).Conclusion: Surgical fixation is an effective treatment for floating knee injuries worldwide. On long-term follow-up of patients treated surgically, the functional and radiological outcomes were good with few complications rate.

Objective: Intramedullary nailing is a commonly used method for fixing tibia fractures due to its benefits. However, it can lead to complications such as malalignment and knee pain. The traditional infrapatellar approach is associated with higher malalignment rates, while a suprapatellar approach has shown lower rates. Knee pain, particularly at the site of nail insertion, is a common issue reported by patients. Different approaches have been compared, but no significant difference has been found in terms of chronic knee pain. To assess clinical, radiographic, and functional outcomes after intramedullary nail (IMN) fixation of tibia fractures with an infrapatellar approach compared to a suprapatellar approach. Methods: Retrospective study: Level 1 trauma centre. Patients with 30 tibia fractures were treated with intramedullary nailing between 2022 and 2023. A retrospective chart review of tibia fractures was conducted. The clinical and functional outcomes of tibia fractures treated with IMN were compared between groups treated with an infrapatellar approach versus a suprapatellar approach. Multivariate models were created to control for confounding demographic, comorbidity, and injury-related confounders. Results: Outcome measures included non-union, malunion, and infection. Subjective functional patient outcomes were assessed using pain interference (Pi) and physical function (PF) Patient-Reported Outcome Measurements Systems scores (PROMIS). There were 14 patients treated with infrapatellar nailing (46%) and 16 patients treated with suprapatellar nailing (54%). On multivariate analysis, suprapatellar nailing was independently associated with decreased risk of malunion and decreased risk of postoperative knee pain. There was no difference in the rate of non-union infection or Patient Reported Outcome Measurements Systems pain interference or physical function scores. Conclusion: Suprapatellar IMN fixation of tibial shaft fractures is independently associated with a lower risk of malunion and postoperative knee pain compared to the infrapatellar approach. However, there are no functional differences between approaches.