[1] Department of Orthopaedics, PGIMER, Chandigarh, India, 2Department of Orthopaedics, D Y Patil Medical School and Hospital, Pune, Maharashtra, India
Address of Correspondence
Dr. Parth Bansal,
Spine Fellow, PGIMER, Chandigarh, India.
E-mail: parthbansal93@gmail.com
Abstract
Lumbar Bone Stress Injuries (LBSI) encompass a spectrum ranging from bone stress reactions to lumbar stress fractures (LSF). These injuries are among the most prevalent in cricket players, particularly fast bowlers. This review highlights the epidemiology of LBSIs and explores both modifiable and non-modifiable risk factors associated with their development. Early diagnosis, along with appropriate workload management, plays a crucial role in the effective management of these injuries. Furthermore, structured prevention programs implemented by cricket organizations can significantly reduce the incidence and long-term impact of LBSIs in the sport. Keywords: Cricket, Lumbar, LBSI, Fast bowlers, Stress reaction
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How to Cite this article: Bansal P, Dhatt SS, Kumar V, Kale S, Gehlot O, Gailot A. Lumbar Bone Stress Injuries in Cricket Fast Bowlers: A Review. Journal of Clinical Orthopaedics. January-June 2025;10(1):53-56.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2025-06-10 16:44:322025-06-21 14:07:22Lumbar Bone Stress Injuries in Cricket Fast Bowlers: A Review
Submitted Date: 25 March 2025, Review Date: 26 april 2025, Accepted Date: 16 May 2025 & Published Date: 30 Jun 2025
Author: Clevio Desouza [1,2], Nicholas Antao [1]
[1] Department of Orthopaedics, Holy Spirit Hospital, Mumbai, India,
[2] Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
Address of Correspondence
Dr. Clevio Desouza,
Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
E-mail: ceviod@gmail.com
Abstract
This comprehensive update on shoulder surgery highlights recent advancements in managing shoulder instability, rotator cuff tears, shoulder arthroplasty, and adhesive capsulitis. It highlights the evolution of surgical techniques, non-operative interventions, and biologic augmentation approaches. Innovations in rotator cuff repair include biologic solutions, such as platelet-rich plasma, while advancements in arthroplasty focus on tailored rehabilitation and infection control strategies. Adhesive capsulitis management now incorporates novel injection techniques and surgical options for refractory cases. This summary underscores the ongoing development of individualized treatment protocols, which are essential for optimizing patient outcomes and addressing the diverse challenges in shoulder surgery. Keywords: Shoulder instability, Rotator cuff, Biologic augmentation, Shoulder arthroplasty, Adhesive capsulitis.
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How to Cite this article: Desouza C, Antao N. The Shoulder Surgery Update: Innovations and Insights. Journal of Clinical Orthopaedics January-June 2025;10(1):48-52.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2025-06-10 16:40:022025-06-21 14:06:37The Shoulder Surgery Update: Innovations and Insights
Submitted Date: 13 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: ?? Apr 2025 & Published Date: 30 Jun 2025
Author: Ujjwal Kanti Debnat [1], Shweta Bhyri [2], Biplab Maji [2], Alaaeldin Ahmad [2], Shubhadip Chakraborty [1], Joydeep Das [1]
[1] Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
[2] Department of Paediatrics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
Address of Correspondence
Dr. Ujjwal K Debnath,
Consultant, Orthopaedics & Spine Surgeon, Professor Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
India.
E-mail: debs10uk@gmail.com
Abstract
Introduction: Patients with adolescent idiopathic scoliosis (AIS) have a higher prevalence of Vitamin D deficiency compared with healthy peers. Hypothesis: Vitamin D deficiency in AIS patients does not have a good functional outcome after posterior instrumented corrective spinal fusion. Materials and Methods: A prospective consecutive study of 62 children who underwent surgery for AIS had pre-operative measurement of Vitamin D levels [serum 25-hydroxyvitamin D (ng/mL)]. Post-operative AIS patients were followed up for 2 years after surgery. Data on the history of back pain, socioeconomic status, curve magnitude, age, and gender were recorded. Patients were categorized based on Vitamin D level: deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). The correlation between Vitamin D levels and Scoliosis Research Society (SRS)-22 scores was analyzed using multivariable analysis and pair-wise comparisons using Tukey method. Results: Sixty-two AIS patients (47 Females and 15 Males) were enrolled who underwent posterior instrumented spine fusion. The mean age at surgery was 15.24 ± 4.5 years. Major coronal curves had a mean of 68.08 ± 12° preoperatively and 12.19 ± 4.2° postoperatively. It was found that 35 (56.45%) of patients were Vitamin D deficient, 23 (37.09%) were insufficient, and 4 (6.45%) were sufficient. Although there was no correlation between Vitamin D level and pain, mental health, or satisfaction domains (P > 0.05), Vitamin D-deficient patients were found to be younger than 18 years of age (P < 0.001) and had lower SRS-22 function (P = 0.010), Self-image (P = 0.049), and total scores (P = 0.007). Conclusion: AIS patients with Vitamin D deficiency (<20 ng/mL) are more likely to be younger at the time of surgery, and report lower function, self-image, and total SRS-22 scores postoperatively. Keywords: Adolescent Idiopathic Scoliosis, Posterior Spinal Fusion, Vitamin D Deficiency
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How to Cite this article: Debnat UK, Bhyri S, Maji B, Ahmad A, Chakraborty S, Das J. Vitamin D Deficiency and Surgical Outcome in Adolescent Idiopathic Scoliosis in Low Socioeconomic Status in Rural India. Journal of Clinical Orthopaedics January-June 2025;10(1):00-00.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2025-06-10 16:24:002025-06-21 14:00:04Vitamin D Deficiency and Surgical Outcome in Adolescent Idiopathic Scoliosis in Low Socioeconomic Status in Rural India
[1] The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
[2] The University of North Carolina, Gillings School of Public Health 135 Dauer Drive, Chapel Hill, NC, 27599, United States of America
[3] The University of North Carolina, Undergraduate, Chapel Hill, NC, 27599, United State of America
[4] The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC 27514, United States of America Address of Correspondence
Address of Correspondence
Dr. Océane Mauffrey,
The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
E-mail: Oceane_mauffrey@med.unc.edu
Abstract
Background: Clubfoot is a congenital deformity characterized by cavus deformity of the midfoot, adductus of the forefoot and equinus and varus of the hindfoot. The Ponseti method, a series of casting and bracing protocols has become the standard of care as a highly effective non-surgical intervention. Poor adherence with stringent brace wearing protocols has been identified as one of the leading causes of deformity recurrence with the Ponseti method. The present study seeks to uncover the socioeconomic variables which may contribute to brace adherence. Methods: This survey study included 219 patients, 56 responded (25.5% RR). The survey assessed zip code, annual income, number of caregivers and siblings, brace adherence, and recurrence. Adherence was measured categorically (Likert) and continuously (0-100%); recurrence was measured categorically (yes/no). A t-test was used to evaluate the relationship between adherence and deformity recurrence. All other variables were analyzed using chi squared and Fischer’s exact. Results: 23 patients reported an annual income of $100,000 or greater (n=23), and most had received at least a college education (n=37), many had graduate’s degrees (n=20), most reported two caregivers (n=44), and 1 sibling (n=21). 36 patients reported brace wearing All of the time, and 21 patients reported their child needing to repeat serial casting or additional surgery, indicating recurrence. No significant relationship was found between brace adherence and deformity recurrence (p>0.05). No significant relationship was found between annual income, number of caregivers, highest level of education, number of siblings against brace adherence (p>0.05). Conclusion: These findings contrast with the well-documented risk of recurrence with decreased brace adherence; perhaps due to parental overreporting of brace wearing. The expected relationship between social variables and brace adherence was also not supported potentially because of a skew in our population towards patients with higher education and income. Keywords: Clubfoot, Social Determinants of Health, Clinical Outcomes, Brace Compliance
References
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6. Wang YY, Su YC, Tu YK, et al. Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials. J Bone Jt Surg. 2024;106(4):356-367. doi:10.2106/JBJS.22.01210
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9. Abdelgawad AA, Lehman WB, Van Bosse HJP, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007;16(2):98-105. doi:10.1097/BPB.0b013e32801048bb
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11. Jawadi AH, Al-Abbasi EM, Tamim HA. Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method. J Taibah Univ Med Sci. 2015;10(4):444-448. doi:10.1016/j.jtumed.2015.06.003
12. Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Sanliurfa, Turkey, Bozkurt C, Sipahioglu S, Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Sanliurfa, Turkey. Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment. Acta Orthop Traumatol Turc. 2021;55(2):102-106. doi:10.5152/j.aott.2021.20040
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14. Avilucea FR, Szalay EA, Bosch PP, Sweet KR, Schwend RM. Effect of Cultural Factors on Outcome of Ponseti Treatment of Clubfeet in Rural America: J Bone Jt Surg-Am Vol. 2009;91(3):530-540. doi:10.2106/JBJS.H.00580
15. Haft GF, Walker CG, Crawford HA. Early Clubfoot Recurrence After Use of the Ponseti Method in a New Zealand Population: J Bone Jt Surg. 2007;89(3):487-493. doi:10.2106/JBJS.F.00169
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17. Van Schelven H, Moerman S, Van Der Steen M, Besselaar AT, Greve C. Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis. Acta Orthop. Published online October 5, 2021:1-9. doi:10.1080/17453674.2021.1982576
18. Morgenstein A, Davis R, Talwalkar V, Iwinski H, Walker J, Milbrandt TA. A Randomized Clinical Trial Comparing Reported and Measured Wear Rates in Clubfoot Bracing Using a Novel Pressure Sensor. J Pediatr Orthop. 2015;35(2):185-191. doi:10.1097/BPO.0000000000000205
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How to Cite this article: Mauffrey O, Yu K, Choudhari M, Habig AL, Pugh A, Narotam V. Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoo. Journal of Clinical Orthopaedics January-June 2025;10(1):4-7.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2025-06-10 16:12:192025-06-21 13:59:38Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot
Submitted Date: 5 April 2025, Review Date: 26 April 2025, Accepted Date: 12 June 2025 & Published Date: 30 Jun 2025
Author: Javed Iqbal [1], Faaiz Ali Shah [2], Naeem Ullah [3], Rafi Ullah [4], Mian Amjad Ali [5], Shams Rehman [6]
[1] Department of Orthopaedic, Traumatology and Sports Medicine, MTI, LRH, Pakistan.
Address of Correspondence
Dr Faaiz Ali Shah,
Department of Orthopaedic, Traumatology and Sports Medicine, MTI, LRH. Pakistan.
E-mail: faaizalishah@yahoo.com
Abstract
Introduction: OA in its late stages is characterized by serious joint tissue deterioration and possible bone loss and deformities. Non-contained posteromedial bone defect is a challenge in Primary total knee replacement (TKR) due to the issue with implant stability and placement. Each of these defects needs special attention if there is to be a desired outcome. The management plan of TKR in these patient populations is to provide relief from pain, regain the function of the affected joint, and minimize its further degradation. Objectives: To assess the functional and clinical results of Primary TKR in patients with advanced osteoarthritis of the knee presenting with posteromedial bone loss. Materials and Methods: A descriptive case series study of 25 patients with advanced OA and non-contained posteromedial bone defects was included in this study from Jan 2021 to December 2023. For bone defect, an autologous bone graft from a tibial cut was utilized and fixed with two fully threaded cortical 3.5 mm screws. Then, the tibial stem was used for load sharing across the tibial bone to increase stability, and cemented prostheses were used for routine Primary TKR. Quantitative data of pre- and post-operative functional scores were collected and then compared statistically to assess the degree of improvement. Results: With respect to functional outcome, the mean pre-operative knee society score (KSS) was 42.3 ± 5.7, and the mean post-operative KSS was 85.4 ± 6.1 (P < 0.001). Post-operative, mean flexion of 115 ± 8. Mean pain relief and joint stability scores demonstrated statistically significant improved results. Two patients had superficial surgical site infections, which were then resolved with debridement and antibiotics. Conclusion: Surgical reconstruction of bone defect with autologous bone graft with primary TKR in patients with advanced OA with posteromedial bone defects is an approach to lessen the quantity and burden of hardware, resulting in low cost and satisfactory function, pain relief, and overall improvement in the gait. Keywords: Total knee replacement, Osteoarthritis, Non-contained bone defect, Bone reconstruction, Tibial stem, Posteromedial bone defect.
References
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How to Cite this article: Iqbal J, Shah FA, Ullah N, Ullah R, Ali MA, Rehman S. Outcome of total knee replacement in advanced osteoarthritis knee with posteromedial bone defect. Journal of Clinical Orthopaedics January-June 2025;10(1):26-31.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2025-06-10 14:33:452025-06-21 14:03:10Outcome of total knee replacement in advanced osteoarthritis knee with posteromedial bone defect
[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, V. N. Desai Hospital, Mumbai, Maharashtra, India
Address of Correspondence
Dr Suyog Wagh,
Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India.
E-mail: suyogwagh6159@gmail.com
Abstract
Background: Scapula is a common site for bony and soft tissue lesions. However, due to the vast number of lesions presenting around the scapula and their relatively low incidence, diagnosis is often missed or delayed, thereby affecting the clinical outcome. Common lesions around the scapula are osteochondromas, osteosarcoma, chondrosarcoma, etc. We present a case of a 12-year-old female child with a scapula mass, which was reported ambiguously in multiple radiographic investigations as well as biopsies. Case: A 12-year-old female patient presented to the outpatient department with complaints of swelling in the right scapular region along with difficulty in range of motion (ROM) and chest pain. The mass had irregular margins and was non-tender. A computed tomography scan was suggestive of Parosteal osteosarcoma involving the scapula, serratus anterior, latissimus dorsi, and parietal pleura. Magnetic resonance imaging was suggestive of a primary neoplastic lesion. Blood reports revealed hyperphosphatemia. A J needle biopsy was inconclusive. The patient was managed with In-toto excision of the mass. The inferior angle of the scapula had to be removed as the mass was adhered to it. Histopathological examination (HPE) was suggestive of tumor calcinosis. The patient was started with physiotherapy as per pain tolerance immediately. The patient was followed for 6 months. There was no clinical or radiological evidence of recurrence, and the patient regained her complete ROM without pain. Results: The patient was followed up for six months, during which no clinical or radiological signs of recurrence were observed. She regained full, pain-free range of motion. The patient is able to do activities of daily living. Conclusion: Scapula is often affected by multiple pathologies of varying origins, which have morphological and radiological resemblances leading to confusion and delayed diagnosis. A comprehensive clinical evaluation, along with correlating metabolic and radiological investigations, may suggest a diagnosis; however, definitive confirmation should always be obtained through excision and histopathological examination (HPE). Keywords: Tumour calcinosis, Scapula, Osteosarcoma.
References
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How to Cite this article: Wagh S, Sharan S, Goregaonkar A, Mugutrao A, Panjwani K. Calcinosis mimicking tumor: A rare case report. Journal of Clinical Orthopaedics. January-June 2025;10(1):69-73.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2025-06-10 14:23:132025-06-21 14:10:32Calcinosis mimicking tumor: A rare case report
Lumbar Bone Stress Injuries in Cricket Fast Bowlers: A Review
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 53-56 | Parth Bansal, Sarvdeep Singh Dhatt, Vishal Kumar, Sachin Kale, Ojasv Gehlot, Akhil Gailot
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.718
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 25 March 2025, Review Date: 26 april 2025, Accepted Date: 16 May 2025 & Published Date: 30 Jun 2025
Author: Parth Bansal [1], Sarvdeep Singh Dhatt [1], Vishal Kumar [1], Sachin Kale [2], Ojasv Gehlot [2], Akhil Gailot [2]
[1] Department of Orthopaedics, PGIMER, Chandigarh, India, 2Department of Orthopaedics, D Y Patil Medical School and Hospital, Pune, Maharashtra, India
Address of Correspondence
Dr. Parth Bansal,
Spine Fellow, PGIMER, Chandigarh, India.
E-mail: parthbansal93@gmail.com
Abstract
Lumbar Bone Stress Injuries (LBSI) encompass a spectrum ranging from bone stress reactions to lumbar stress fractures (LSF). These injuries are among the most prevalent in cricket players, particularly fast bowlers. This review highlights the epidemiology of LBSIs and explores both modifiable and non-modifiable risk factors associated with their development. Early diagnosis, along with appropriate workload management, plays a crucial role in the effective management of these injuries. Furthermore, structured prevention programs implemented by cricket organizations can significantly reduce the incidence and long-term impact of LBSIs in the sport.
Keywords: Cricket, Lumbar, LBSI, Fast bowlers, Stress reaction
References
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The Shoulder Surgery Update: Innovations and Insights
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 48-52 | Clevio Desouza, Nicholas Antao
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.716
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 25 March 2025, Review Date: 26 april 2025, Accepted Date: 16 May 2025 & Published Date: 30 Jun 2025
Author: Clevio Desouza [1,2], Nicholas Antao [1]
[1] Department of Orthopaedics, Holy Spirit Hospital, Mumbai, India,
[2] Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
Address of Correspondence
Dr. Clevio Desouza,
Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
E-mail: ceviod@gmail.com
Abstract
This comprehensive update on shoulder surgery highlights recent advancements in managing shoulder instability, rotator cuff tears, shoulder arthroplasty, and adhesive capsulitis. It highlights the evolution of surgical techniques, non-operative interventions, and biologic augmentation approaches. Innovations in rotator cuff repair include biologic solutions, such as platelet-rich plasma, while advancements in arthroplasty focus on tailored rehabilitation and infection control strategies. Adhesive capsulitis management now incorporates novel injection techniques and surgical options for refractory cases. This summary underscores the ongoing development of individualized treatment protocols, which are essential for optimizing patient outcomes and addressing the diverse challenges in shoulder surgery.
Keywords: Shoulder instability, Rotator cuff, Biologic augmentation, Shoulder arthroplasty, Adhesive capsulitis.
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12. Chen H, Wu S, Qiang H, Liu S. Effectiveness of abduction brace versus simple sling rehabilitation following rotator cuff repair: Systematic review and meta-analyses. J Shoulder Elbow Surg 2023;32:1524-33.
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16. Orozco E, Dhillon J, Keeter C, Brown TD, Kraeutler MJ. Rotator cuff repair with patch augmentation is associated with lower retear rates for large tears: A systematic review of randomized controlled trials. Arthroscopy 2024;40:1300-8.
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Vitamin D Deficiency and Surgical Outcome in Adolescent Idiopathic Scoliosis in Low Socioeconomic Status in Rural India
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 8-13 | Ujjwal Kanti Debnat, Shweta Bhyri, Biplab Maji, Alaaeldin Ahmad, Shubhadip Chakraborty, Joydeep Das
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.703
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 13 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: ?? Apr 2025 & Published Date: 30 Jun 2025
Author: Ujjwal Kanti Debnat [1], Shweta Bhyri [2], Biplab Maji [2], Alaaeldin Ahmad [2], Shubhadip Chakraborty [1], Joydeep Das [1]
[1] Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
[2] Department of Paediatrics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
Address of Correspondence
Dr. Ujjwal K Debnath,
Consultant, Orthopaedics & Spine Surgeon, Professor Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
India.
E-mail: debs10uk@gmail.com
Abstract
Introduction: Patients with adolescent idiopathic scoliosis (AIS) have a higher prevalence of Vitamin D deficiency compared with healthy peers. Hypothesis: Vitamin D deficiency in AIS patients does not have a good functional outcome after posterior instrumented corrective spinal fusion.
Materials and Methods: A prospective consecutive study of 62 children who underwent surgery for AIS had pre-operative measurement of Vitamin D levels [serum 25-hydroxyvitamin D (ng/mL)]. Post-operative AIS patients were followed up for 2 years after surgery. Data on the history of back pain, socioeconomic status, curve magnitude, age, and gender were recorded. Patients were categorized based on Vitamin D level: deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). The correlation between Vitamin D levels and Scoliosis Research Society (SRS)-22 scores was analyzed using multivariable analysis and pair-wise comparisons using Tukey method.
Results: Sixty-two AIS patients (47 Females and 15 Males) were enrolled who underwent posterior instrumented spine fusion. The mean age at surgery was 15.24 ± 4.5 years. Major coronal curves had a mean of 68.08 ± 12° preoperatively and 12.19 ± 4.2° postoperatively. It was found that 35 (56.45%) of patients were Vitamin D deficient, 23 (37.09%) were insufficient, and 4 (6.45%) were sufficient. Although there was no correlation between Vitamin D level and pain, mental health, or satisfaction domains (P > 0.05), Vitamin D-deficient patients were found to be younger than 18 years of age (P < 0.001) and had lower SRS-22 function (P = 0.010), Self-image (P = 0.049), and total scores (P = 0.007).
Conclusion: AIS patients with Vitamin D deficiency (<20 ng/mL) are more likely to be younger at the time of surgery, and report lower function, self-image, and total SRS-22 scores postoperatively.
Keywords: Adolescent Idiopathic Scoliosis, Posterior Spinal Fusion, Vitamin D Deficiency
References
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Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 4-7 | Océane Mauffrey, Kevin Yu, Malvika Choudhari, Ashley Lynn Habig, Alec Pugh, Vinay Narotam
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.702
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 11 Jan 2025, Review Date: 08 Mar 2025, Accepted Date: 10 Apr 2025 & Published Date: 30 Jun 2025
Author: Océane Mauffrey [1], Kevin Yu [2], Malvika Choudhari [1], Ashley Lynn Habig [3], Alec Pugh [1], Vinay Narotam [4]
[1] The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
[2] The University of North Carolina, Gillings School of Public Health 135 Dauer Drive, Chapel Hill, NC, 27599, United States of America
[3] The University of North Carolina, Undergraduate, Chapel Hill, NC, 27599, United State of America
[4] The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC 27514, United States of America Address of Correspondence
Address of Correspondence
Dr. Océane Mauffrey,
The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
E-mail: Oceane_mauffrey@med.unc.edu
Abstract
Background: Clubfoot is a congenital deformity characterized by cavus deformity of the midfoot, adductus of the forefoot and equinus and varus of the hindfoot. The Ponseti method, a series of casting and bracing protocols has become the standard of care as a highly effective non-surgical intervention. Poor adherence with stringent brace wearing protocols has been identified as one of the leading causes of deformity recurrence with the Ponseti method. The present study seeks to uncover the socioeconomic variables which may contribute to brace adherence.
Methods: This survey study included 219 patients, 56 responded (25.5% RR). The survey assessed zip code, annual income, number of caregivers and siblings, brace adherence, and recurrence. Adherence was measured categorically (Likert) and continuously (0-100%); recurrence was measured categorically (yes/no). A t-test was used to evaluate the relationship between adherence and deformity recurrence. All other variables were analyzed using chi squared and Fischer’s exact.
Results: 23 patients reported an annual income of $100,000 or greater (n=23), and most had received at least a college education (n=37), many had graduate’s degrees (n=20), most reported two caregivers (n=44), and 1 sibling (n=21). 36 patients reported brace wearing All of the time, and 21 patients reported their child needing to repeat serial casting or additional surgery, indicating recurrence. No significant relationship was found between brace adherence and deformity recurrence (p>0.05). No significant relationship was found between annual income, number of caregivers, highest level of education, number of siblings against brace adherence (p>0.05).
Conclusion: These findings contrast with the well-documented risk of recurrence with decreased brace adherence; perhaps due to parental overreporting of brace wearing. The expected relationship between social variables and brace adherence was also not supported potentially because of a skew in our population towards patients with higher education and income.
Keywords: Clubfoot, Social Determinants of Health, Clinical Outcomes, Brace Compliance
References
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3. Cady R, Hennessey TA, Schwend RM. Diagnosis and Treatment of Idiopathic Congenital Clubfoot. Pediatrics. 2022;149(2):e2021055555. doi:10.1542/peds.2021-055555
4. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet: J Bone Jt Surg-Am Vol. 2004;86(1):22-27. doi:10.2106/00004623-200401000-00005
5. Švehlík M, Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in clubfoot – Long-term, randomized, prospective trial. Gait Posture. 2017;58:346-351. doi:10.1016/j.gaitpost.2017.08.010
6. Wang YY, Su YC, Tu YK, et al. Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials. J Bone Jt Surg. 2024;106(4):356-367. doi:10.2106/JBJS.22.01210
7. Recordon JAF, Halanski MA, Boocock MG, McNair PJ, Stott NS, Crawford HA. A Prospective, Median 15-Year Comparison of Ponseti Casting and Surgical Treatment of Clubfoot. J Bone Jt Surg. 2021;103(21):1986-1995. doi:10.2106/JBJS.20.02014
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10. Ramírez N, Flynn JM, Fernández S, Seda W, Macchiavelli RE. Orthosis Noncompliance After the Ponseti Method for the Treatment of Idiopathic Clubfeet: A Relevant Problem That Needs Reevaluation. J Pediatr Orthop. 2011;31(6):710-715. doi:10.1097/BPO.0b013e318221eaa1
11. Jawadi AH, Al-Abbasi EM, Tamim HA. Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method. J Taibah Univ Med Sci. 2015;10(4):444-448. doi:10.1016/j.jtumed.2015.06.003
12. Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Sanliurfa, Turkey, Bozkurt C, Sipahioglu S, Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Sanliurfa, Turkey. Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment. Acta Orthop Traumatol Turc. 2021;55(2):102-106. doi:10.5152/j.aott.2021.20040
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14. Avilucea FR, Szalay EA, Bosch PP, Sweet KR, Schwend RM. Effect of Cultural Factors on Outcome of Ponseti Treatment of Clubfeet in Rural America: J Bone Jt Surg-Am Vol. 2009;91(3):530-540. doi:10.2106/JBJS.H.00580
15. Haft GF, Walker CG, Crawford HA. Early Clubfoot Recurrence After Use of the Ponseti Method in a New Zealand Population: J Bone Jt Surg. 2007;89(3):487-493. doi:10.2106/JBJS.F.00169
16. Hu W, Ke B, Niansu X, et al. Factors associated with the relapse in Ponseti treated congenital clubfoot. BMC Musculoskelet Disord. 2022;23(1):88. doi:10.1186/s12891-022-05039-9
17. Van Schelven H, Moerman S, Van Der Steen M, Besselaar AT, Greve C. Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis. Acta Orthop. Published online October 5, 2021:1-9. doi:10.1080/17453674.2021.1982576
18. Morgenstein A, Davis R, Talwalkar V, Iwinski H, Walker J, Milbrandt TA. A Randomized Clinical Trial Comparing Reported and Measured Wear Rates in Clubfoot Bracing Using a Novel Pressure Sensor. J Pediatr Orthop. 2015;35(2):185-191. doi:10.1097/BPO.0000000000000205
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Outcome of total knee replacement in advanced osteoarthritis knee with posteromedial bone defect
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 26-31 | Javed Iqbal, Faaiz Ali Shah, Naeem Ullah, Rafi Ullah, Mian Amjad Ali, Shams Rehman
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.708
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 5 April 2025, Review Date: 26 April 2025, Accepted Date: 12 June 2025 & Published Date: 30 Jun 2025
Author: Javed Iqbal [1], Faaiz Ali Shah [2], Naeem Ullah [3], Rafi Ullah [4], Mian Amjad Ali [5], Shams Rehman [6]
[1] Department of Orthopaedic, Traumatology and Sports Medicine, MTI, LRH, Pakistan.
Address of Correspondence
Dr Faaiz Ali Shah,
Department of Orthopaedic, Traumatology and Sports Medicine, MTI, LRH. Pakistan.
E-mail: faaizalishah@yahoo.com
Abstract
Introduction: OA in its late stages is characterized by serious joint tissue deterioration and possible bone loss and deformities. Non-contained posteromedial bone defect is a challenge in Primary total knee replacement (TKR) due to the issue with implant stability and placement. Each of these defects needs special attention if there is to be a desired outcome. The management plan of TKR in these patient populations is to provide relief from pain, regain the function of the affected joint, and minimize its further degradation.
Objectives: To assess the functional and clinical results of Primary TKR in patients with advanced osteoarthritis of the knee presenting with posteromedial bone loss.
Materials and Methods: A descriptive case series study of 25 patients with advanced OA and non-contained posteromedial bone defects was included in this study from Jan 2021 to December 2023. For bone defect, an autologous bone graft from a tibial cut was utilized and fixed with two fully threaded cortical 3.5 mm screws. Then, the tibial stem was used for load sharing across the tibial bone to increase stability, and cemented prostheses were used for routine Primary TKR. Quantitative data of pre- and post-operative functional scores were collected and then compared statistically to assess the degree of improvement.
Results: With respect to functional outcome, the mean pre-operative knee society score (KSS) was 42.3 ± 5.7, and the mean post-operative KSS was 85.4 ± 6.1 (P < 0.001). Post-operative, mean flexion of 115 ± 8. Mean pain relief and joint stability scores demonstrated statistically significant improved results. Two patients had superficial surgical site infections, which were then resolved with debridement and antibiotics.
Conclusion: Surgical reconstruction of bone defect with autologous bone graft with primary TKR in patients with advanced OA with posteromedial bone defects is an approach to lessen the quantity and burden of hardware, resulting in low cost and satisfactory function, pain relief, and overall improvement in the gait.
Keywords: Total knee replacement, Osteoarthritis, Non-contained bone defect, Bone reconstruction, Tibial stem, Posteromedial bone defect.
References
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Calcinosis mimicking tumor: A rare case report
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 69-73 | Suyog Wagh, Sudhir Sharan, Arvind Goregaonkar, Aditya Mugutrao, Kishan Panjwani
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.726
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 10 April 2025, Review Date: 28 May 2025, Accepted Date: 19 May 2025 & Published Date: 30 Jun 2025
Author: Suyog Wagh [1], Sudhir Sharan [1], Arvind Goregaonkar [1], Aditya Mugutrao [1], Kishan Panjwani [2]
[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, V. N. Desai Hospital, Mumbai, Maharashtra, India
Address of Correspondence
Dr Suyog Wagh,
Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, Maharashtra, India.
E-mail: suyogwagh6159@gmail.com
Abstract
Background: Scapula is a common site for bony and soft tissue lesions. However, due to the vast number of lesions presenting around the scapula and their relatively low incidence, diagnosis is often missed or delayed, thereby affecting the clinical outcome. Common lesions around the scapula are osteochondromas, osteosarcoma, chondrosarcoma, etc. We present a case of a 12-year-old female child with a scapula mass, which was reported ambiguously in multiple radiographic investigations as well as biopsies.
Case: A 12-year-old female patient presented to the outpatient department with complaints of swelling in the right scapular region along with difficulty in range of motion (ROM) and chest pain. The mass had irregular margins and was non-tender. A computed tomography scan was suggestive of Parosteal osteosarcoma involving the scapula, serratus anterior, latissimus dorsi, and parietal pleura. Magnetic resonance imaging was suggestive of a primary neoplastic lesion. Blood reports revealed hyperphosphatemia. A J needle biopsy was inconclusive. The patient was managed with In-toto excision of the mass. The inferior angle of the scapula had to be removed as the mass was adhered to it. Histopathological examination (HPE) was suggestive of tumor calcinosis. The patient was started with physiotherapy as per pain tolerance immediately. The patient was followed for 6 months. There was no clinical or radiological evidence of recurrence, and the patient regained her complete ROM without pain.
Results: The patient was followed up for six months, during which no clinical or radiological signs of recurrence were observed. She regained full, pain-free range of motion. The patient is able to do activities of daily living.
Conclusion: Scapula is often affected by multiple pathologies of varying origins, which have morphological and radiological resemblances leading to confusion and delayed diagnosis. A comprehensive clinical evaluation, along with correlating metabolic and radiological investigations, may suggest a diagnosis; however, definitive confirmation should always be obtained through excision and histopathological examination (HPE).
Keywords: Tumour calcinosis, Scapula, Osteosarcoma.
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