INTRODUCTION:Patellofemoral instability is a multifactorial condition affecting young and active individuals, with anatomical contributors including trochlear dysplasia, patella alta, and lateralization of the tibial tuberosity. Among the anatomical parameters, the tibial tuberosity-trochlear groove (TT-TG) distance is a key indicator used to evaluate patellofemoral alignment and guide realignment procedures. While normative TT-TG values have been reported in Western populations, data from the Indian population remain limited and inconsistent. This study aims to evaluate the TT-TG distance using magnetic resonance imaging (MRI) in a North Indian cohort and to explore its variations across age, gender, and laterality. MATERIALS AND METHODS:This prospective observational study was conducted at the department of orthopedics over 18 months. A total of 80 patients (66 males and 14 females; aged 18-50 years) with non-pathological knees and no history of surgery or deformity were included. The TT-TG distance was measured using axial MRI scans on a 1.5 Tesla scanner, following established protocols. The measurements were performed independently by a consultant radiologist and an orthopedic surgeon. Statistical analyses included descriptive statistics and unpaired Student's t-tests to assess associations with demographic variables. RESULTS:The mean TT-TG distance in the study population was 12.4 ± 2.4 mm. Males had a mean TT-TG distance of 12.09 ± 2.25 mm, whereas females had 13.64 ± 2.52 mm. Although the distance appeared slightly greater in females, the difference was not statistically significant (P = 0.706). Similarly, no significant association was found between TT-TG distance and age group or laterality (right knee vs. left knee). Comparison with prior studies suggests that the TT-TG distance in the Indian population is comparable to Western cohorts but higher than other Asian populations. CONCLUSIONS:The average TT-TG distance in the North Indian population was found to be 12.4 mm, consistent with global reference values. This study provides foundational normative data that may aid in the clinical assessment and surgical decision-making for patellofemoral instability in Indian patients. Future research with larger sample sizes and clinical correlation is recommended to establish population-specific thresholds for surgical intervention.

BACKGROUND:Ipsilateral femoral neck and shaft fractures present a unique challenge due to their complex biomechanics and the need for optimal implant selection. Traditional dual-implant fixation has been widely used, but a single implant approach, such as the Proximal Femoral Nail Antirotation-2 (PFNA2), offers potential advantages, including reduced surgical time, minimized blood loss, and lower implant-related complications. However, the stability provided by PFNA2 and its impact on early functional recovery remain areas of ongoing investigation. MATERIALS AND METHODS:This prospective study analyzed 20 patients (14 males and 6 females) aged 22-44 years (mean: 34.5 years) with ipsilateral femoral neck and shaft fractures managed using PFNA2. Functional outcomes were evaluated using the Harris-Hip Score (HHS) and Friedman-Wyman Scoring System at 3, 6, and 12 months postoperatively. Radiological assessments included time to fracture union for both the neck of femur (NOF) and the shaft of femur (SOF). Additional parameters such as surgical duration and functional weight-bearing status were recorded. Complications, including infections, delayed union, and implant-related failures, were monitored. RESULTS:The mean HHS improved from 54.3 at 3 months to 81.9 at 12 months. Functional weight-bearing scores increased from a mean of 2 at 3 months to 4 at 12 months. Mean fracture union time was 3.5 months for NOF and 5.35 months for SOF. Most patients achieved functional weight-bearing within 4 months. The mean surgical duration was 87.2 min. Complications included superficial infections (10%), delayed union (15%), and mild varus collapse (5%), with no cases of nonunion or implant failure. CONCLUSION:PFNA2 provides biomechanical stability, promotes early mobilization, and minimizes the need for multiple implants in ipsilateral femoral neck and shaft fractures. Proper surgical technique and postoperative care are essential to optimize outcomes and reduce complications.

Vitamin D has immuno-modulatory and potential cartilage-regenerative effects. Therefore, it is of interest to evaluate the association between serum vitamin D levels, pro-inflammatory cytokines (IL-6, TNF-α), and functional status in patients with knee osteoarthritis (OA). In this cross-sectional analysis of 84 patients with bilateral knee OA, serum vitamin D, IL-6, TNF-α levels and WOMAC scores were recorded. Patients with vitamin D deficiency exhibited significantly higher IL-6 and TNF-α levels and worse WOMAC scores. Data shows that vitamin D deficiency is associated with increased inflammation and poorer functional outcomes in knee OA.

BACKGROUND:Delayed union of long bone fractures presents a significant clinical challenge, often leading to prolonged morbidity and functional limitation. Teriparatide, a recombinant human parathyroid hormone (PTH 1-34), has shown promise as a biological enhancer of bone healing. This study aims to evaluate the efficacy and safety of teriparatide in promoting fracture healing in patients with delayed union. MATERIALS AND METHODS:A prospective interventional study was conducted on 48 adult patients (mean age: 42.6 ± 11.2 years) with delayed union of long bone fractures (tibia, femur, humerus, and radius/ulna) between 3 and 9 months postinjury. All patients received daily subcutaneous teriparatide (20 μg) for 3 months, along with calcium and vitamin D supplementation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and weight-bearing ability; radiological healing was assessed using the Radiographic Union Score for Tibial fractures (RUST) and cortical bridging on serial radiographs at 0, 6, and 12 weeks. RESULTS:The mean VAS score significantly reduced from 7.8 ± 1.1 at baseline to 2.1 ± 0.9 at 12 weeks (P < 0.001). Radiological union was observed in 81.2% of patients at 12 weeks, with the mean RUST score improving from 5.2 ± 1.3 to 10.3 ± 1.2 (P < 0.001). Clinical union was achieved in 87.5% of patients, and 91.7% regained full weight-bearing ability. Metaphyseal fractures and fractures with stable fixation showed better outcomes. No major adverse events were reported. CONCLUSION:Teriparatide is a safe, well-tolerated, and effective adjunct in managing delayed union of long bone fractures. It accelerates both clinical and radiological healing, reducing the need for surgical reintervention. These findings support its inclusion in the orthopedic treatment armamentarium for biologically enhancing fracture repair in selected cases.

INTRODUCTION:Kinesiophobia, which refers to the fear of physical movement and activity due to vulnerability to injury, has been associated with suboptimal outcomes following total knee arthroplasty (TKA). This study aimed to assess the impact of kinesiophobia on early functional outcomes after TKA. MATERIALS AND METHODS:A cohort analysis was conducted on 60 participants aged 18 years and older. Detailed sociodemographic characteristics were recorded, and the Tampa Scale for Kinesiophobia was used to evaluate kinesiophobia. Pain intensity was measured using the Visual Analog Scale, knee flexion was assessed using a goniometer, and functional status was evaluated using the Oxford Knee Score. Data were collected and analyzed accordingly. RESULTS:The mean age of the patients was 56.62 ± 6.28 years, with a higher proportion of male participants in the study. The majority of patients were from the middle class (75.00%), employed (91.67%), graduates (76.67%), and married (93.33%). Positive coping style had a significantly higher mean score compared to negative coping style ( P = 0.0001*). Most patients received moderate social support (61.67%) ( P = 0.0008*). Kinesiophobia, as measured by the Tampa Scale score, demonstrated a decreasing trend with a significant difference ( P < 0.0001*). The highest kinesiophobia score was observed at 2 weeks (58.29 ± 3.51), whereas the lowest was at 6 months (21.48 ± 1.32). Significant differences were noted in pain intensity, flexion, and functional status from 2 weeks to 6 months. Age, educational status, coping style, social support, high pain intensity, and low flexion were identified as significant risk factors for kinesiophobia. CONCLUSION:During the initial postoperative period, most patients exhibit low levels of kinesiophobia. Targeted interventions focusing on positive coping, social support, pain management, and improvement of knee flexion can effectively address kinesiophobia and enhance rehabilitation outcomes.

Abstract Purpose: There is a paucity of literature on the prevalence and risk factors of kinesiophobia following knee arthroplasty in Indian scenario. In the present study, we evaluated the incidence and risk factors of kinesiophobia following total knee arthroplasty (TKA). Materials and Methods: The study was conducted in the department of orthopedic surgery of our institution. All patients who underwent TKA fulfilling the inclusion criteria were requested to answer written set of questions on their demographic details, kinesiophobia (TAMPA scale), self-efficacy, the intensity of pain, and coping styles and social support, within 24 h after TKA. Patients completed the questionnaires themselves of all questions in the presence of the investigator. A univariate analysis was conducted to establish the correlation between proposed risk factors and kinesiophobia. Results: Out of 50 patients enrolled in the study 34 (68.0%) had TAMPA score ≥37 were diagnosed with kinesiophobia and the rest 16 (32.0%) patients having TAMPA score < 37 were found to have no kinesiophobia. Factors such as age ( P = 0.036), lower education level ( P = 0.039), negative coping style ( P = 0.044), greater pain intensity ( P < 0.001 ) , low self-efficacy ( P < 0.001), and less social support ( P = 0.017) show statistical significance with kinesiophobia. Conclusion: Kinesiophobia is a common entity following TKA with an incidence of 68%. Factors associated with it were elderly age, lack of education, negative coping style, higher pain intensity, low self-efficacy, and low social support. Many of these risk factors are modifiable and should be kept in mind while planning for TKA.

[This corrects the article DOI: 10.7759/cureus.84453.].

BACKGROUND:Primary bone tumors, though rare, impose significant psychological stress due to chronic pain, disfigurement, and functional limitations. In developing countries like India, this burden is compounded by limited access to mental health services, economic strain, and social stigma. However, data focusing on the psychological impact of bone tumors in Indian populations remain sparse. MATERIALS AND METHODS:A cross-sectional observational study was conducted on 80 patients aged 18-50 years with histologically confirmed primary bone tumors between April 2023 and September 2024. Psychological distress was assessed using validated tools: Depression, Anxiety, and Stress Scale-21 (DASS-21), Perceived Stress Scale (PSS), and World Health Organization Quality of Life - Brief Version (WHOQOL-BREF) (quality of life [QoL]). Associations with sociodemographic and clinical variables were statistically analyzed. RESULTS:Among the 80 patients, 58% were male, and the mean age was 31.08 ± 6.69 years. Severe-to-extremely severe psychological distress (DASS-21 score >35) was found in 57.5% of participants. Moderate-to-high perceived stress (PSS score >30) was present in 90% of cases. Poor-to-moderate QoL (WHOQOL-BREF score <45) was observed in 85% of patients. Psychological distress was significantly higher in patients with malignant tumors compared to benign ones (P < 0.005). Other significant risk factors included younger age, lower income, rural background, and nuclear family structure. CONCLUSION:Psychological distress is highly prevalent among patients with primary bone tumors, particularly those with malignant pathology. Routine psychological screening and early psychosocial interventions should be integrated into orthopedic oncology care, especially in resource-limited settings.

Abstract Introduction: The role of anterior cruciate ligament (ACL) in gait balancing and lower limb kinematics is very crucial. It is believed that using the peroneus longus (PL) to reconstruct the ACL will cause ankle instability, which could result in poor gait and postural instability. The stability and biomechanics of lower limb after ACL reconstruction (ACLR) can be measured by foot pressure analysis, gait analysis, and percentage contact area of the foot. Aim: The purpose of this study is to analyze postural stability and the kinematic difference via foot pressure and contact area of the foot after ACLR using two different autologous grafts (PL and hamstring [HM] tendons). Materials and Methods: Quasi-experimental study was conducted in the Department of Sports Medicine from January 15, 2022, to October 31, 2024. Ten patients each in the PL tendon and HM tendon groups were included. Postoperative (at 6 months and 1 year) foot pressure and contact area of the foot were calculated. Data analysis was done using the IBM Statistical Package for Social Science, Version 26. Results: No significant difference was observed postoperatively in the foot pressures (6 months: P = 0.687, and 1 year: P = 0.301) and percentage contact area (6 months: P = 0.159 and 1 year: P = 0.513) between the PL and HM group. Conclusion: There is neither a significant difference in the value of foot pressure and percentage contact area of the foot nor any postural instability or kinematics while running and walking after ACLR groups using PL and HM at 6 months and 1 year.

INTRODUCTION:Surgical site infections (SSIs) are a significant concern for surgeons and a leading cause of poor patient outcomes, increased morbidity, extended hospital stay, and higher costs. SSIs are of particular concern in orthopedic implant surgeries because biofilms on implants protect bacteria. This study aimed to evaluate the incidence rate of SSIs in orthopedic implant patients, identify associated risk factors, and analyze the types of bacteria causing these infections. METHODS AND MATERIALS:This study was a prospective analysis of 1,282 patients who underwent orthopedic implant surgery at the Orthopedic Department over a period of more than one year. It examined various parameters, including the type of surgery, surgical site, associated risk factors, and duration of surgery. It also explored the correlation between the development of SSIs, the time to development, and the associated risk factors. RESULTS:Of the 1282 orthopedic patients followed up, 98 developed SSI. Thus, the incidence rate was 7.64%. Patients undergoing emergency surgery are more likely to develop infections than those undergoing elective surgery. About 65% of all SSIs were caused by the most prevalent infectious agent, Staphylococcus aureus, which infected 23 subjects (22.54%), followed by Escherichia coli in 16 subjects (15.68%), Klebsiella pneumoniae in 14 subjects (13.72%), and Acinetobacter baumannii in 13 subjects (12.74%). The most important risk factor was diabetes, which affected 26 participants with the highest prevalence (26.5%), followed by 16 subjects who used tobacco (16.3%). A further significant risk factor for higher rates of SSIs was longer operation times. CONCLUSION:Our analysis highlights the urgent need for a comprehensive antibiotic policy for patients undergoing implant surgery, given the prevalence of common bacteria and the significant risk factors associated with SSIs. To address this critical issue, we propose a level 1 multicenter study to develop standardized guidelines for antibiotic administration in these patients. This approach ensures optimal treatment outcomes and enhances patient safety.

BACKGROUND:The patella plays a crucial role in the extensor mechanism of the knee joint, significantly enhancing the efficiency of the quadriceps muscle. The alignment and height of the patella are critical for maintaining knee joint functionality and preventing knee-related disorders. The Patellotrochlear Index (PTI) is a novel measurement method that provides a more accurate assessment of patellar height and its relationship with the femoral trochlea, particularly in the North Indian population. OBJECTIVE:This study aims to establish normal PTI values in the North Indian population and evaluate the PTI as a reliable method for measuring patellar height. MATERIALS AND METHODS:A cross-sectional study was conducted at King Georges Medical University, Lucknow, involving 80 patients with suspected ligamentous knee injuries. Patients underwent magnetic resonance imaging examinations, and PTI measurements were obtained. Data analysis was performed using SPSS version 22, with statistical significance set at P < 0.05. RESULTS:The mean age of the patients was 31.6 years (±5.6), with 66.3% males and 58.7% having the condition on the right side. The mean PTI was 0.52 (±0.12). PI values increased significantly with age ( P = 0.034) and were higher in females (0.56 ± 0.11) compared to males (0.50 ± 0.11) ( P = 0.024). Significant differences in PI values were also observed between the right (0.48 ± 0.10) and left (0.58 ± 0.11) sides ( P < 0.001). CONCLUSION:The PTI is a dependable and repeatable indicator of patellar height, reflecting the true relationship between the patellar and trochlear articular surfaces. This index can be effectively used to diagnose and manage patellofemoral pain syndrome and other knee disorders, emphasizing its clinical relevance in the North Indian population.

BACKGROUND:Total knee arthroplasty (TKA) is a well-established treatment for advanced knee osteoarthritis. While it offers major pain relief and functional improvement, patient satisfaction often depends on how well postoperative outcomes align with preoperative expectations. In culturally diverse settings like India, specific activities such as squatting and sitting cross-legged may influence patient perceptions of success. This study aimed to evaluate the expectations of Indian patients undergoing TKA and assess their fulfillment after one year. METHODS:A cross-sectional observational study was conducted at a tertiary care center in North India from January 2021 to December 2023. There were 300 patients aged ≥ 50 years who had primary osteoarthritis who underwent unilateral or bilateral TKA using either posterior-stabilized or cruciate-retaining implants were included. All patients completed one year of follow-up. Preoperative expectations were assessed using a modified Hospital for Special Surgery Expectation Survey. Postoperative outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale for pain, and a five-point Likert scale for satisfaction. RESULTS:Pain relief (91%), walking (85%), and daily household activities (82%) were the most commonly fulfilled expectations. Expectations for squatting and sitting cross-legged were met in only 36 and 29% of patients, respectively. Overall, 80% of patients reported being satisfied or very satisfied. Fulfillment of expectations related to pain and ambulation showed a significant positive association with higher satisfaction (P < 0.05). There was no significant difference observed between cruciate-retaining and posterior-stabilized implant recipients. CONCLUSIONS:While core functional goals are largely met, cultural expectations often remain unfulfilled after TKA in Indian patients. Preoperative counseling that addresses realistic goals may enhance satisfaction and patient-centered care.

Background Vitamin D deficiency is prevalent globally, with potential consequences for bone health and trauma outcomes. This study aimed to assess the prevalence of vitamin D deficiency in orthopedic trauma patients and investigate its correlation with various demographic and injury-related factors. Methodology A cross-sectional investigation was undertaken at a tertiary care center. An evaluation of serum 25-hydroxyvitamin D3 levels was conducted on 124 individuals, aged 20 to 70 years, who were hospitalized with orthopedic injuries. Demographic information, the injury method, the bone involvement pattern, and socioeconomic status were documented. Statistical analysis was employed to evaluate the correlations between vitamin levels D and these variables. Results The overall prevalence of vitamin D deficiency was 54 (43.6%) cases, with nine (7.3%) cases exhibiting severe deficiency and 45 (36.3%) cases exhibiting moderate deficiency. Higher rates of deficiency were associated with lower socioeconomic status (p = 0.044) and low-velocity trauma (p = 0.037). No significant association was found with age, sex, or residence. Interestingly, patients with multiple fractures were more prone to deficiency compared to those with single fractures. Conclusions This survey revealed a significant vitamin D deficiency among orthopedic trauma patients. Factors such as socioeconomic status and the nature of the injury emerged as significant risk factors. While conducting routine vitamin D assessments might pose challenges in developing nations, consistent supplementation could prove advantageous in enhancing fracture healing and overall health outcomes among this demographic. There is a call for future research to delve deeper into the role of vitamin D in trauma management and refine supplementation strategies.

Background: The quadriceps angle, commonly known as the Q-angle, is the angle formed between the vectors of the pull of the quadriceps muscle and the patellar tendon. The literature varies in terms of the values of Q angles measured by various researchers. It is well appreciated that the normal Q-angle should fall between 12° and 20°, with males being at the lower end of this range and females having higher measurements. An increase in Q-angle beyond the normal range has been associated with knee extensor dysfunction leading to patellar instability. Keeping in mind the clinical and biomechanical importance of the Q-angle, the aim of this study was to compare and establish the range of the Q-angle in healthy individuals and evaluate its variations with respect to age, weight, height, gender, dominant side, and femoral bicondylar distance. These observations will be helpful for sports therapists in understanding the evaluation of Q-angle in athletes as a prognostic value for probable knee pathologies that may appear in the future. Methods: The current study was conducted at a tertiary care center, and a total of 100 healthy adults between the ages of 18 and 35 were enrolled in the study (50 males and 50 females), following which their Q-angles, bicondylar distances, and femur lengths were measured. Individuals with any lower limb injury that resulted in a ligamentous, muscular, or bony defect; any spinal or neurological injury; any diagnosed knee disorder, such as a fracture, acute or chronic knee pain, patellar dislocation, or prior orthopaedic surgery in the lower extremities, were excluded from the study. Data were analyzed using paired t-tests, independent sample t-tests, ANOVA, and Pearson correlation coefficients. Result and conclusion: The mean Q-angle in males was found to be 11.14° ± 1.9° on the right side and 10.84° ± 1.86° on the left side. In females, it was found to be 13.68° ± 1.87° on the right side and 13.61° ± 2.04° on the left side. Among males, right and left Q-angles showed significant positive correlations with height, weight, BMI, right femur length, left femur length, right bicondylar distance, and left bicondylar distance (p<0.05). The highest correlation was found between weight and BMI. Among females, the right Q-angle showed significant positive correlations with weight and BMI (p<0.05). The highest correlation was found with weight.

BACKGROUND:The measurement of the posterior tibial slope (PTS) angle is crucial for various knee surgeries such as total knee replacement, high tibial osteotomy, and anterior cruciate ligament reconstruction. This hospital-based study aimed to determine the average PTS angle in the knee joints of the North Indian population and provided valuable data to aid knee surgeries in this region. METHODS:An analysis of 200 plain X-ray films, specifically the true lateral view of both knees in 20-degree flexion, was conducted on participants who exhibited skeletal maturity with no arthritis, tumours, or previous knee surgeries. The PTS measurements were performed manually. The data were analyzed statistically by matching them with variables such as gender, age, laterality, and body mass index (BMI). RESULTS:The study revealed the following findings for the posterior tibial slope in a section of the North Indian population: there was no significant laterality difference (right knee: 12.76±2.35°, left knee: 12.55±2.46°); no notable sexual dimorphism (males: right knee - 12.79±2.65°, left knee - 12.25±2.65°, females: right knee - 12.73±2.11°, left knee - 12.77±2.30°). However, as age advanced, there were significant differences observed (PTS: 14.27±1.28° and 13.84±1.80° in the 18-40 years age group, 11.36±1.76° and 11.31±1.97° in the 41-60 years age group, 10.32±2.82° and 10.56±3.04° in the >60 years age group for the right and left knee, respectively). No significant correlation was found with BMI (PTS: 13.12±3.13° and 12.59±3.14° for BMI <25, 12.88±2.15° and 12.80±2.34° for BMI 25-30, 12.00±2.09° and 11.66±2.99° for BMI >30 in the right and left knee, respectively). CONCLUSIONS:The study demonstrated significant variations in the posterior tibial slope based on age, emphasizing the need for individualized treatment in knee surgeries. The research provided valuable insights into normal PTS values specific to the North Indian population, offering regional data to inform knee surgery procedures.

A Shear fracture of posterior aspect of femoral condyles in coronal plane is known as Hoffa fracture. This fracture pattern, originally described by Hoffa, is an intra-articular fracture and radiologically and clinically silent most of the times and thus commonly missed. The bicondylar variant of this fracture is a rare injury. We report a case of 38-year old male patient presenting with one day old bicondylar Hoffa fracture managed with headless compression screw and cannulated cancellous screws.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has devastated the mankind globally, and countless lives have been lost all around the world. This disease has been linked to various extrapulmonary symptoms and consequences in addition to typical respiratory illness. This case highlights a probable neurological complication of SARS-CoV-2 infection. A 28-year-old healthy man, sustained wedge compression of D12 vertebra following road traffic accident, presented with paraplegia. One week following admission, the patient had a progressive neurological deterioration and developed high grade fever with weakness in both upper limbs. The patient developed quadriplegia 10 days after admission. Magnetic resonance imaging (MRI) brain and spine were done. MRI brain was normal, whereas MRI spine showed D11-D12 anterolisthesis with cord compression with T2 hyperintensity of cervical cord. His SARS-CoV-2 reverse transcriptase polymerase chain reaction turned out to be positive. We hereby report a case of posttraumatic long-segment myelitis with coronavirus disease 2019 as a probable etiology.

Introduction Open fractures remain one of the true orthopedic emergencies. Despite recent advances in orthopedic surgery, the management of compound fractures is still a challenge to an orthopedic surgeon. Open fractures are a result of high-speed injuries and are associated with several complications such as infections, non-unions, or sometimes an eventual amputation. Infection is the major problem associated with open fractures due to soft tissue damage, contamination, and neurovascular compromise. Presently, management of open fractures requires early aggressive debridement followed by limb salvage by definitive reconstruction or amputation, depending upon the extent and location of the injury. Early aggressive debridement of open fractures has always been the rule. However, it has been observed that open fractures managed even after six hours of injury fare well, and there are no definite guidelines available to decide the safe period of debridement following open fractures so as to prevent infection. The "six-hour rule" is a hotly debated topic with fervent perseverance of this dogma despite a gross lack of support from the literature. Objective The objective of this study was to analyze the relationship between the timing of operation/debridement on infection rates in open fractures, particularly if surgery is performed after six hours. Methods This is a prospective study of 124 patients (R=5-75 years) presenting with open fractures to the outpatient department (OPD) and emergency section of a tertiary care hospital from January 2019 to November 2020. Patients were divided into four groups based on the time to operation/debridement: groups A, B, C, and D, with patients operated within six hours, six to 12 hours, 12-24 hours, and 24-72 hours after injury, respectively. Infection rates were obtained based on the above data. ANOVA was applied using SPSS 20 software (IBM Inc., Armonk, New York). Results This study concludes that the infection rate for fractures treated in less than six hours was 18.75%; in the six to 12 hours group, it was 18.50%, and in the 12-24 hours group, it was 14.28%. The infection rate increased to 38.8% if surgery was performed after 24 hours of injury. On statistical analysis, the time to debridement was not found to be a significant factor. The infection rate in Gustilo-Anderson classification compound grade I was 2.7%, grade II 9.8%, grade IIIA 45%, and grade IIIB 61%. Also, in this study, the union rate in grade I was 97.22%, grade II 96.07%, grade IIIA 85%, and grade IIIB 66.66%. Thus, the degree of wound contamination and compounding gives a prognostic indication regarding the final outcome of the compound fracture. Conclusion Time to debridement is not a significant factor in the management of compound fractures, and these fractures can be safely debrided up to 24 hours after injury. Gustilo and Anderson's classification provides a prognostic indicator of the outcome of a compound fracture. Infection rates and non-union rates increase with increasing grades of compound fractures.

Background Sacroiliac joint dysfunction is a major cause of axial low back pain which can masquerade as pain from lumbar disc diseases. Treatment of axial back pain arising due to sacroiliac joint dysfunction remains a challenge. This study was conducted to evaluate the long and short-term effects of intra-articular corticosteroid injection in the relief of pain and disability caused by sacroiliac joint dysfunction. Methodology A total of 83 patients with sacroiliac joint dysfunction were included in this prospective randomized control study. Patients were randomized into two groups by a computer-generated randomization table. These two groups were treated with fluoroscopy-guided corticosteroid and local anesthetic injection (group A) and distilled water and local anesthetic injection (group B). Pre and post-intervention assessment of all patients was done based on the Numeric Pain Rating Scale (NPRS) for pain and Oswestry Disability Index (ODI) for disability. The outcome measures of the study were the NPRS and ODI assessed at the initial visit one (pre-injection), two weeks post-injection (visit 2), and four weeks post-injection (visit 3). Results Demographic data were comparable in both groups. There was no significant difference in pre-injection NPRS and ODI values in both groups. The changes in NPRS and ODI values were significant from pre-injection to two weeks to four weeks. Group A patients performed better in terms of a decrease in the perception of pain and a decrease in the perception of disability compared to group B patients in the second and fourth weeks of follow-up. Conclusions Fluoroscopy-guided corticosteroid injection is an effective measure for reducing pain and disability in patients with sacroiliac joint dysfunction.

Background: Idiopathic clubfoot is one of the most common and complex congenital deformities which are difficult to correct. Aims and Objectives: The present study was designed to assess the effectiveness and results of the Ponseti method’s early use in the treatment of idiopathic congenital talipes equinovarus (CTEV). Materials and Methods: Seventy-six feet in 50 patients of CTEV during the period of May 2019–May 2020 were studied. All the cases were treated by Ponseti technique. Children with idiopathic CTEV and age <1 year were included in our study. The severity of deformity was graded according to Pirani scoring system both at the beginning and at the end of treatment. Results: The mean age at presentation was 2.77 months. The mean initial Pirani score at time of presentation was 4.07, and at last follow-up was 0.13. We observed that 63 feet (82.89%) out of 76 feet required a percutaneous TA tenotomy along with plaster casting to correct the equines deformity. The mean total number of casts required to correct the deformity was 6.4. The mean duration of treatment from 1st plaster cast to cast for equinus correction was 8.4 weeks. About 94% of cases had a good outcome at last follow-up which was evaluated on the basis of Pirani score. The association of duration of treatment (weeks) with age and total number of cast with age has P=0.002 which was found to be significant. Conclusion: The Ponseti technique is a very safe, efficient, and acceptable economical treatment for the correction of CTEV that gives excellent results on conservative treatment and in most of the cases avoid surgical intervention if protocol followed as prescribed. If the age of the patient is higher at time of presentation, it requires a longer casting period and more number of casts to correct the deformity compared to younger children with the early presentation.