Type 2 diabetes (T2D), once considered a disease of adulthood, is increasingly affecting children due to rising rates of obesity, poor dietary habits and physical inactivity. With over 11.1% of adults globally affected and rising childhood prevalence, early prevention has become a public health priority. This review explores the growing burden of T2D in children, particularly in India, and emphasises the pivotal role of schools in health promotion. The school-based interventions offer a strategic, scalable platform to instil lifelong healthy behaviours, addressing the modifiable risk factors. Evidence from global programmes highlights that multicomponent school interventions, combining nutrition education, physical activity, behavioural skills, parental involvement, routine screenings and supportive policy, can improve metabolic outcomes and health literacy, even without significant changes in body mass index. The challenges to implementation include resource constraints, cultural factors and sustainability issues. School-based interventions can represent a powerful opportunity to combat early-onset T2D and promote child health, necessitating continued innovation, collaboration and evaluation for long-term impact.

Core decompression (CD) is an effective method in the management of pre-collapsed stage of osteonecrosis of the femoral head (ONFH). It has been combined with various adjuvants like bone marrow mesenchymal cells, platelet-rich plasma, etc. which are costly methods and not affordable to many. We hypothesized that local instillation of ibandronate along with CD is a cost effective, safe and easily available method to increase efficacy of CD, and gives better results than core decompression alone. 17 patients of age group between 18 and 60 years, diagnosed with atraumatic ONFH (FICAT ARLET stage 1/2) were included and followed up for 6 months post-procedure. The patients were evaluated in terms of radiologic progression (modified Kerboul angle) and functional outcome (modified Harris Hip Score and Visual Analog Scale). A significant improvement was observed postoperatively in MHHS at 6 months (p = 0.048) and VAS score at 3 (p = 0.05) and 6 months (p = 0.009) in CD + ibandronate group when compared to CD-only group, although statistically no significant difference was found radiologically in modified Kerboul angle at 6 months between the groups. Core decompression along with ibandronate instillation is more beneficial than core decompression alone in improving functional outcomes. Radiological assessment by measuring modified Kerboul angle did not show benefits in short term and requires long-term follow-up to show improvement, if any. Instillation of inexpensive and effective alternative like ibandronate can potentially postpone the subchondral collapse by preventing osteoclast function and can be an affordable therapeutic option, particularly in low-resource healthcare settings.

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 Lisfranc injuries are frequently overlooked or underestimated. Treatment of neglected injuries is challenging, and the optimal surgical strategy in delayed presentations remains unclear. Methods A PRISMA-compliant systematic review and meta-analysis were performed. Observational studies reporting surgical outcomes of corrective surgery for neglected Lisfranc injuries were included. Random-effects meta-analyses were conducted for AOFAS scores, complication rates, and return-to-work proportions. Meta-regression evaluated the influence of injury energy, surgical procedure, and treatment delay. Results Ten studies with 262 cases were included. Surgery was associated with a significant improvement in AOFAS scores. Patients with high-energy injuries demonstrated lower preoperative scores but greater absolute postoperative improvement, while postoperative scores remained comparable. The choice of surgical procedure and delay were not associated with functional improvement. The pooled complication rate was 34%, with higher rates observed in high-energy injuries and with longer delays. Conclusions In neglected Lisfranc injuries, functional recovery reflects baseline severity rather than timing alone. Surgical decision-making should prioritize joint viability and reducibility over delay.

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.

Intermittent teriparatide administration is known to accelerate and promote bone healing. We wanted to investigate if intermittent teriparatide administration could facilitate supraphysiological-rate distraction osteogenesis (DO) in the rabbit tibial lengthening model without compromising on the regenerate quality. 24 New Zealand white rabbits underwent tibial lengthening of 10 mm by distraction osteogenesis and were divided into two groups. Group A (n = 12) underwent DO at the physiological (standard) rate of 0.75 mm per day and Group B (n = 12) underwent DO at the supraphysiological (accelerated) rate of 1.5 mm per day. Subgroups A1 and B1 received intermittent teriparatide, whereas subgroups A2 and B2 received saline as the vector control. The latency period (7 days) was equal in both groups. The consolidation phase was 2.5 times the distraction phase. Outcome parameters included mortality, number of failures of DO, regenerate volume, bone mineral density and strength of the regenerate as determined by the three-point bending test parameters (stiffness, work to failure and ultimate load to failure). There was one mortality in each group. Failure of distraction osteogenesis was noted in one animal in groups A1, A2 and B1, and four animals in Group B2. Kaplan–Meir survival analysis revealed significantly higher failures in Group B2 (log-rank test P value = 0.02). ANOVA revealed significant difference in regenerate stiffness (P = 0.04) among the four groups. However, the total volume, bone mineral density, work to failure and ultimate load to failure parameters were not significantly different among the four groups. This feasibility study provides proof of concept of using teriparatide to accelerate distraction osteogenesis to supraphysiological levels, without compromising on the regenerate quality.

Knowledge and practices related to insulin injections often remain suboptimal among patients even those on insulin therapy. These faulty knowledge and practices can lead to erratic glucose control and higher complications. This study aimed to evaluate insulin injection knowledge and practices, and knowledge related to hypoglycemia management among diabetes patients on insulin therapy at a tertiary care center in North India. A cross-sectional survey was conducted among 200 diabetes patients on insulin therapy. Data were collected on insulin injection techniques, insulin storage, blood glucose monitoring, and hypoglycemia management. Statistical analysis was performed using SPSS version 20. Of the 200 participants, 97.5

Introduction: Pelvic ring injuries lead to significant patient morbidity and mortality. We evaluated long-term (>1 year) functional outcome of these patients using patient-reported outcome measures) using both generic health-specific and disease-specific outcome instruments. Materials and Methods: Pelvic ring injury patients seen between 2015 and 2020 were called for a follow-up visit. Patient’s demographic profile, mode and pattern of injury, associated injuries, management, and complications were recorded. Functional outcome assessment was made using two generic health-specific scores (SF-36 and short musculoskeletal functional assessment [SMFA]) and three disease-specific scores (Majeed pelvic score [MPS], Iowa pelvic score [IPS], and pelvic discomfort index [PDI]). Statistical analysis was performed to find the correlation between the two types of scoring systems. SF-36 scores of the study population were compared with normative data from the general population. Results: Of 56 patients (37 males, 19 females, mean age 32 years), there were 40 Tile B type and 16 Tile C type. 27 patients had other orthopaedic injuries, while 24 had nonorthopaedic injuries (14 – urological). 42 patients were operated and 14 were conservatively managed. The mean follow-up duration was 26.8 months. Mean (standard deviation [SD]) SF-36 physical component summary score was 64.01 (22.89) and mental component summary score was 63.79 (23.31). SMFA dysfunction index and SMFA bother index mean (SD) were 22.41 ± 11.75 and 25.97 ± 14.12, respectively. Mean (SD) MPS came as 85.93 (12.89) with 37 patients graded as ”excellent.” The mean (SD) of IPS and PDI scores were 78.61 (9.40) and 21.70 (16.59), respectively. There was no statistical difference between the two types of scores when assessed using Spearman correlation tests. However, on comparison of study population mean SF-36 subset scores with general population norms, no domain of SF-36 could reach norm values. MPS cutoff of >85 (“excellent” outcome) could not include in itself a sufficient percentage of population with at-par SF-36 scores. Long-term sequelae of trauma were significantly associated with poor quality of life scores. Conclusion: Long-term physical functioning and quality of life in patients with pelvic ring injuries seem to be fair, although they are significantly lower than that of their peers in the general population. Keywords: Pelvic fracture, disease-specific scores, generic health-specific scores, SF-36, Majeed pelvic score.

Limited studies have examined the profile of only those primary hyperparathyroidism (PHPT) patients who had parathyroid surgery in the Indian context. This study aimed to analyse the clinical, biochemical, and radiological profile of adult patients with PHPT who underwent parathyroid surgery at a single tertiary care center. In this prospective descriptive study, adult patients who were diagnosed with PHPT and underwent parathyroid surgery were included. Radiological and nuclear imaging to localize abnormal parathyroid was done in all patients preoperatively. All patients underwent ultrasonography (USG) by a single experienced radiologist and were operated by a single endocrine surgeon. A total of 105 patients, 81 females; age 54.9 ± 12.8 years were included. The majority (95.2%) of the patients were symptomatic. The common symptoms were musculoskeletal weakness (62.8%), bone pain (61.9%), fatigue (60.0%), nausea/vomiting (51.4%), and dyspepsia (41.9%). Albumin-corrected serum total calcium and intact parathyroid hormone levels were 12.3 ± 1.3 mg/dL and 153.4 (61.5–1739.4 pg/dL), respectively. USG neck alone could localize the abnormal gland in 92.4% of subjects, and sestamibi scan alone in 72.5% of subjects, whereas when both were combined, the concordance was 95% to correctly localize the abnormal gland. Except two, all other patients had biochemical remission postparathyroid surgery. The most common histological diagnosis was solitary parathyroid adenoma (95.2%). In our study, most patients with PHPT undergoing parathyroid surgery were symptomatic, with a high success rate when performed by a high-volume parathyroid surgeon.

Case: We report a case of a 44-year-old female with intrathoracic displacement of the humeral head, which was not only missed by the initial trauma team while receiving the patient but also missed by multiple senior surgeons during primary management in the operating room. Conclusion: Diagnostic accuracy hinges on clinical presentation and detailed imaging locating fragments of the fractured head. Interdisciplinary collaboration, particularly with thoracic and trauma surgeons, is crucial for early diagnosis and timely recovery. The possibility of intrathoracic dislodged head should not be ruled out in proximal humeral fractures irrespective of pulmonary complaints or velocity of trauma.

Background: Osteonecrosis of the femoral head (ONFH) is the commonest indication for hip replacements in the developing world. Core decompression (CD) has been an effective method in early stages of ONFH with role of various adjuvants like BMAC and PRP widely documented to enhance its efficacy, albeit the associated high. We evaluated the effectiveness of Ibandronate (IB) which is a bisphosphonate as an adjuvant to CD so as to provide a cheaper and effective alternative to the existing adjuvants. Aim: To assess superiority of addition of intraosseous ibandronate to core decompression over core decompression alone in pre-collapse AVN of femoral head in terms of functional outcomes i.e Pain relief and daily activities Methods: A double blinded randomised controlled trial was done and 17 patients between age 18-59 years, with 30 affected hips in the pre-collapse stage, were recruited and divided into 2 groups; CD only and CD + IB groups. Patients were followed up for 1 year and evaluated in terms of visual analogue scale (VAS) and modified Harris hip score (MHHS). Results: The average preoperative MHHS was 67.44 and 75.36 in CD and CD + IB group respectively. In CD only group, MHHS postoperatively at 8 weeks, 3 months, 6 months and one year were 83.4, 80.42, 75.22, 71.71 respectively (p value = 0.165) while VAS score changed from 4.86 preoperatively to 3.60 at 1 year (p value =0.054). In CD + IB group, MHHS Scores were 85.92, 87.92, 87.9, 89.04, 81.75 respectively (p value = 0.050) while VAS score changed from 4.93 preoperatively to 2.33 at 1 year (p value =0.054). In terms of difference between the two groups, at 6 months the MHHS as well as the VAS in the CD + IB group were better significantly (p=0.048 and 0.009 respectively); however, at 1 year, the differences were not significant (p=0.301 and 0.204 respectively) Conclusion: Ibandronate as an intraosseous adjuvant to CD shows promise in terms of significantly improving the functional outcome and pain relief with better results in the early postoperative period (upto 6 months) than CD alone.

PURPOSE:Lateral compression (LC) injuries account for more than two-thirds of all pelvic fractures. The goal of surgical treatment is to provide adequate stability and early mobilization. The consensus on posterior fixation of such injuries is strong in the literature; however, the necessity of anterior ring fixation is not clear. Therefore, this study was formulated to determine the practicability of posterior-only fixation in LC injuries. METHODS:Between March 2015 and May 2020, all patients with LC type pelvic ring fractures who were admitted and operated upon in a single level 1 trauma center were included in this cross-sectional observational study. Demographic data, co-morbidities, treatment, types of surgical fixation, concomitant injuries and surgeries, surgical complications, length of hospital stay, injury to weight bearing duration, and follow-up period were documented. Functional outcome and quality of life were assessed using Majeed score and SF-36 questionnaire. Non-normally distributed data were presented as median (Q1, Q3) and normally distributed data were presented as mean ± standard deviation (SD). Spearman's rank correlation coefficient was used for correlation analysis. RESULTS:A total of 25 patients were included, with a mean age of 29.8 years. All patients were managed operatively with posterior-only fixation. The median Majeed score was 90 (76, 95). The median physical component summary score was 69.37 (38.75, 85.62). The median mental component summary score was 63.95 (39.25, 87.87). There was no significant difference compared to population norms of both physical component summary and mental component summary. Injury to weight bearing time correlated significantly (p = 0.002) with Majeed score as well as SF-36 score (p = 0.044). No other variable had a significant association with outcomes. CONCLUSION:Posterior-only fixation is sufficient for fixing LC injuries with up to 80% of cases having good to excellent functional outcomes. However, comparative studies with larger sample sizes are needed for further validation.

Hip fractures in the elderly are a significant cause of morbidity and mortality, with 1-month and 1-year mortality rates reaching up to 10

Background:Quadrilateral plate fractures are a persistent challenge to orthopedic surgeons. The last decade has seen the development of novel anatomical plates for fixation of these fractures but they haven't been widely adopted. The aim of this study was to study the literature published on plate fixation of quadrilateral plate fractures and analyse the differences between the time-tested reconstruction plate and anatomical plate. Methods:PRIMSA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and the search was performed on 3 databases - PubMed, SCOPUS, and EMBASE. The study was registered with PROSPERO (International Prospective Register of Systematic Reviews) under the registration number CRD420251017775. 12 studies of which 4 were comparative were chosen after thorough screening and a meta-analysis was performed between reconstruction plates and anatomical plates to study the intra-operative and post-operative results. The studies were conducted between 2007 and 2021. Results:583 patients with an average age of 55.45 years of which 75.8 % were males were studied. Intraoperatively, surgical time and blood loss were found to be significantly less in the anatomical plate group versus the reconstruction plate group. Quality of reduction as per Matta's criteria and long term outcomes reported as per Merle's score were found to be similar in both the groups. The rate of complications was higher in the reconstruction plate group. Conclusion:The anatomical plate is better for fixation of quadrilateral plate fractures in terms of intraoperative blood loss and operative time. However, the long term outcomes are equivocal.

Both trabecular and cortical bone undergo changes at multiple scales. We previously demonstrated the multi-scale changes in trabecular bone quality that contribute to bone fragility in type 2 diabetes (T2D). The link between increased fragility in T2D and multi-scale changes in cortical bone and their interaction with glycation remains unclear. This study presents, first-ever, multi-scale cortical bone quality parameters in T2D patients after their first hip fracture. The study objective was to determine the association between cortical porosity (Ct.Po.), mechanical, material, and bone compositional properties in T2D. Inferomedial femoral neck (FN) bone tissue specimens were collected from patients (n = 10 with T2D, n = 25 age- and sex-matched non-diabetes controls) who underwent hip replacement surgery following the first hip fragility fracture. Bone mineral density at FN was found to be similar between groups. In T2D, Ct.Po was higher (p = 0.038), while ultimate stress (p = 0.021), ultimate strain (p = 0.040), post-yield strain (p = 0.011), toughness (p = 0.005), yield energy (p = 0.003), and post-yield energy (p = 0.004) were notably lower. Tissue compositional differences included lower gravimetric mineral/matrix (p = 0.017), higher non-enzymatic collagen cross-link ratio (NE-xLR) (p = 0.049) and higher sugar/matrix ratio (p = 0.042) in T2D. Fluorescent advanced glycation end-products (fAGEs) content was higher in T2D bone (p = 0.043). At the mesoscale, the fAGEs in the bone matrix are inversely related to the yield- and ultimate strain of T2D bone, and NE-xLR is negatively correlated with yield- and ultimate- stress in the T2D group. In conclusion, study findings demonstrate that elevated glycation weakens the mechanical integrity of cortical bone by reducing its ability to absorb energy and resist deformation, thereby contributing to bone fragility in T2D. The strong association of fAGEs with lower yield strain, along with the association of NE-xLR with lower yield- and ultimate stress, establishes a causal link between AGEs and the deterioration of cortical bone mechanical properties. These findings underscore the need for strategies targeting glycation and collagen quality to mitigate fracture risk in T2D patients.

Introduction:Delayed union, non-union, and unstable fixation can lead to fatigue fractures of orthopedic implants. Breakages typically occur at the fracture site or locking screw insertion, acting as stress concentration foci. This case report highlights a rare instance of a 3-part broken proximal femoral nail (PFN), extracted using a corticotomy-assisted method without knee joint violation. Case Report:A 45-year-old male patient with a subtrochanteric femur fracture, initially fixed with a short PFN, presented with non-union and a broken implant a year post-surgery. Radiographs revealed breakage at two sites, creating three nail pieces. During revision surgery, the proximal nail part was removed through standard extraction. The middle fragment was accessed and removed at the fracture site, and the distal part was extracted through a lateral cortical window using a beaded guidewire in a retrograde fashion, avoiding the knee joint. A long PFNA was subsequently inserted, and bone grafting was performed. Conclusion:This case underscores a rare PFN failure pattern, with fractures at three sites. The corticotomy-assisted extraction technique preserved medullary canal integrity, minimized tissue damage, and maintained biomechanical stability. This approach offers a viable alternative to traditional methods, reducing complications and improving surgical outcomes.

Generative Artificial Intelligence (AI), characterized by its ability to generate diverse forms of content including text, images, video and audio, has revolutionized many fields, including medical education. Generative AI leverages machine learning to create diverse content, enabling personalized learning, enhancing resource accessibility, and facilitating interactive case studies. This narrative review explores the integration of generative artificial intelligence (AI) into orthopedic education and training, highlighting its potential, current challenges, and future trajectory. A review of recent literature was conducted to evaluate the current applications, identify potential benefits, and outline limitations of integrating generative AI in orthopedic education. Key findings indicate that generative AI holds substantial promise in enhancing orthopedic training through its various applications such as providing real-time explanations, adaptive learning materials tailored to individual student’s specific needs, and immersive virtual simulations. However, despite its potential, the integration of generative AI into orthopedic education faces significant issues such as accuracy, bias, inconsistent outputs, ethical and regulatory concerns and the critical need for human oversight. Although generative AI models such as ChatGPT and others have shown impressive capabilities, their current performance on orthopedic exams remains suboptimal, highlighting the need for further development to match the complexity of clinical reasoning and knowledge application. Future research should focus on addressing these challenges through ongoing research, optimizing generative AI models for medical content, exploring best practices for ethical AI usage, curriculum integration and evaluating the long-term impact of these technologies on learning outcomes. By expanding AI’s knowledge base, refining its ability to interpret clinical images, and ensuring reliable, unbiased outputs, generative AI holds the potential to revolutionize orthopedic education. This work aims to provides a framework for incorporating generative AI into orthopedic curricula to create a more effective, engaging, and adaptive learning environment for future orthopedic practitioners.

A 30-year-old male sustained a road traffic accident and presented to our trauma centre with injuries to his pelvis and right knee. Radiology showed closed fractures of the right posterior wall and posterior column of the acetabulum and PCL bony avulsion with posteromedial tibial plateau osteochondral fracture, without any distal neurovascular deficit. He was managed with surgical intervention for both injuries. His hip and knee healed well with a good functional range of motion at 12 months of follow-up. The aim of highlighting this case is that it underscores the rarity of concurrent PCL and semimembranosus (SM) avulsion injuries, emphasizing the importance of comprehensive evaluation and tailored surgical management. Utilizing CT imaging proves instrumental in identifying the associated posteromedial osteochondral fragment. Successful reduction and posterior buttressing of the fragment are crucial for stability against vertical shear forces and subsequent union.