[1] Department of Community and Family Medicine, AIIMS Deoghar, Deoghar, Rampur, Jharkhand, India,
[2] Department of Community and Family Medicine, AIIMS Nagpur, Dahegaon, Maharashtra, India,
[3] Department of Community and Family Medicine, PGIMER, Chandigarh, India,
[4] Department of Orthopaedics, D Y Patil School of Medicine and Hospital, Nerul, Navi Mumbai, Maharashtra, India
Address of Correspondence
Dr Sitanshu Barik,
Associate Professor, AIIMS Nagpur, Maharashtra, India.
E-mail: sitanshubarik@gmail.com
Abstract
Orthopaedic trauma care has traditionally operated within the confines of the biomedical model, focusing on physical recovery markers such as bone healing and functional restoration. However, this narrow approach often overlooks the profound influence of psychological and social factors on recovery. Emerging evidence underscores that mental health conditions—including depression, anxiety, PTSD, and substance use disorders—substantially affect rehabilitation outcomes in orthopaedic trauma patients. Psychological distress not only prolongs recovery times but also impairs treatment adherence and functional return. Moreover, patients’ cognitive responses, such as catastrophizing and self-efficacy, play pivotal roles in shaping their rehabilitation trajectories. Catastrophizing magnifies perceived disability and pain, while high self-efficacy fosters resilience and active engagement in recovery.
To address these psychosocial dimensions, the biopsychosocial model of care is gaining traction. Targeted interventions such as cognitive behavioral therapy (CBT), psychoeducation, graded physical exposure, and goal-setting have proven effective in reducing distress and enhancing recovery motivation. Furthermore, injury-specific strategies—for conditions like femoral fractures, ACL tears, and spinal surgeries—can be tailored to address patients’ unique informational and emotional needs through in-hospital counselling, digital resources, and home-based support.
The integration of mental health screening, early referral, and multidisciplinary intervention is essential in orthopaedic practice. Clinical guidelines from leading orthopaedic bodies now recommend psychosocial evaluation as part of trauma care. Ultimately, incorporating structured, time-efficient, and scalable interventions into routine orthopaedic workflows—especially in high-volume settings—can improve both mental health outcomes and physical rehabilitation. This shift toward holistic, patient-centred care is imperative for optimizing outcomes in orthopaedic trauma recovery. Keywords: Orthopedics, Mental health, Caregivers
References
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How to Cite this article: Bhattacharya S, Barik S, Kumar V, Bhati A, Vyasv A, Darvesh M. Unveiling the Layers: Mental Health Dynamics in Orthopedic Trauma Patients and Future Implications. Journal of Clinical Orthopaedics January-June 2025;10(1):61-64.
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 14:14:072025-06-21 14:08:56Unveiling the Layers: Mental Health Dynamics in Orthopedic Trauma Patients and Future Implications
Submitted Date: 11 Jan 2025, Review Date: 08 Mar 2025, Accepted Date: 10 Apr 2025 & Published Date: 30 Jun 2025
Author: Mohd Danish [1], Akhilesh Yadav [1], Ashutosh Karn [2]
[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India,
[2] Department of Orthopaedics, Max Superspeciality Hospital, Saket, Delhi, India
Address of Correspondence
Dr. Mohd Danish,
Department of Othopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
Introduction: Total hip arthroplasty (THA) is considered to be one of the most successful orthopaedic interventions of its generation. Joint replacement (arthroplasty) as a surgical option for end stage arthritis is well established now and millions of patients across the world have benefited. India is a country of 1.4 billion people with significant knee and hip arthritis population. According to Frost and Sullivan research, 70,000 joint replacement surgeries were performed in India in the year 2011. The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease. Aims of Study: To compare post-operative outcome as implant positioning in terms of abduction angle of the cup & rehabilitation based on Harris Hip Score at 2 months and 4 months respectively in different approaches of approach of total hip replacement. Materials and Methods: This study was conducted in the department of Orthopaedics at Max Super specialty hospital, Vaishali, Ghaziabad, UP after receiving clearance from the Ethical Committee of the institution. It was a randomized case control study. Two different groups of 32 patients each were evaluated and inclination of acetabular cup was calculated on plain radiograph, subsequently the rehabilitation was also evaluated on basis of Harris Hip score in these patients. Results: In the present study, it was observed that mean postoperative abduction angle in Group A 47.82 ±6.87 and Group B was 51.19 ±7.21 degree respectively. The mean postoperative abduction angle in Group A was less compared to Group B with statistical significance. (P<0.05) In the present study, it was observed that intergroup comparison of mean Harris hip score post-operative at discharge, at 2 months & 4 months in Group A and Group B showed no statistical significance. (P>0.05) The intragroup comparison of mean Harris hip score post-operative at discharge, 2 months and 4 months in Group A and Group B showed statistical significance. (P<0.05) Conclusion: Present study revealed a significant statistical difference on intragroup comparison of inclination angle and rehabilitation based on Harris Hip Score in both the groups. Keywords: Arthroplasty, Harris Hip Score, Angle of Inclination
References
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14. Ozaki Y, Baba T, Homma Y, Ochi H, Watari T, Banno S, Matsumoto M, Kaneko K. Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12. SICOT-2018; J, 4, 54.
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How to Cite this article: Danish M, Yadav A, Karn A. Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation. Journal of Clinical Orthopaedics January-June 2025;10(1):32-37.
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 14:04:472025-06-21 14:04:03Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation
Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 38-44 | B S Océane Mauffrey, B A Kevin Yu, B S Malvika Choudhari, Ashley Lynn Habig, Vinay Narotam
Submitted Date: 14 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: 28 Apr 2025 & Published Date: 30 Jun 2025
Author: B S Océane Mauffrey [1], B A Kevin Yu [2], B S Malvika Choudhari [1], Ashley Lynn Habig [3], Vinay Narotam [4]
[1] Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
[2] Department of Orthopaedics, University of North Carolina, Gillings School of Public Health, Chapel Hill, North Carolina, United States of America,
[3] Department of Orthopaedics, University of North Carolina, Undergraduate, Chapel Hill, North Carolina, United States of America,
[4] Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States of America
Address of Correspondence
Dr Océane Mauffrey,
Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
E-mail: oceane_mauffrey@med.unc.edu
Abstract
Objective: The Ponseti method is a widely adopted nonsurgical approach for correcting clubfoot deformities, but its success relies heavily on consistent brace usage during the maintenance phase. The present study seeks to analyze whether socioeconomic factors affect brace adherence in clubfoot patients. Study Design: The present study was reviewed and approved by the Institutional Review Board. The charts of 83 patients treated for clubfoot by two providers at a single institution between 2013 and 2022 were reviewed to investigate the impact of various socioeconomic variables on brace adherence and its association with treatment outcomes. Brace adherence was determined based on provider documentation noting self-reported parental accounts of adherence. Annual family income was derived from North Carolina census data based on zip code. Chi-squared tests and two sample t-tests analyses were performed, controlling for clinical factors such as treatment strategy, comorbidities, laterality, and prenatal diagnosis. Results: Patients from families with higher annual income based on zip codes demonstrated higher brace adherence rates. Patients from racial minority backgrounds exhibited reduced adherence with brace usage, likely in the context of greater obstacles to care. No significant correlations were found between brace adherence and distance to the hospital, gender, or language. Conclusion: The findings highlight the multifaceted nature of brace adherence in clubfoot patients undergoing Ponseti treatment, suggesting the importance of addressing specific patient demographics, socioeconomic contexts, and caregiver support structures to optimize treatment outcomes. Further research involving a larger and more diverse cohort is necessary to validate these findings. Keywords: Clubfoot, Social determinants of health, Clinical outcomes, Brace compliance.
References
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How to Cite this article: Mauffrey BSO, Yu BAK, Choudhari BSM, Habig AL, Narotam V. A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method. Journal of Clinical Orthopaedics January-June 2025;10(1):38-44.
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 13:48:522025-06-21 14:04:55A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method
[1] Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India,
[2] Department of Orthopaedics PGIMER, Chandigarh, India,
[3] Department of Orthopaedics, D Y Patil School of Medicine and Hospital Nerul Navi Mumbai, India
Address of Correspondence
Dr Sudip Bhattacharya,
All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
Email: drsudip81@gmail.com
Abstract
The abstract outlines a comprehensive study on the increasing prevalence of osteoarthritis (OA) in India from 1990 to 2019. The number of affected individuals rose from 23.46 million to 62.35 million during this period. Standardized OA prevalence per 100,000 people also saw an increase, along with Disability-Adjusted Life Years (DALYs) attributed to OA, highlighting the growing burden of the condition. Knee OA emerged as the most widespread form, with higher prevalence, incidence, and DALYs observed in females compared to males. The present OA management primarily focuses on symptom alleviation rather than addressing the underlying biomechanical stress. Research indicates that abnormal dynamic loads during walking contribute to joint damage, and reducing these loads can provide relief from symptoms. This opinion emphasizes the significant impact of modern footwear on knee loads, particularly in individuals with symptomatic knee OA. Cheaper, budget-friendly footwear often lacks proper cushioning and ergonomics, potentially worsening knee joint issues over time. To address the issue, a multi-pronged approach is proposed. Government subsidies and incentives, Public-Private Partnerships, indigenous research and development, public awareness campaigns, and community clinics are suggested strategies to make ergonomically designed footwear more affordable and accessible. In addition, offering affordable orthotic inserts and encouraging local shoemakers and small-scale manufacturers can contribute to this effort. We concluded by emphasizing the importance of quality assurance in ensuring that low-cost ergonomic footwear meets essential ergonomic criteria. Overall, the proposed strategies aim to reduce the burden of knee osteoarthritis in India and improve public foot health.
Keywords: Osteoarthritis, Gait, Posture.
References
1. Singh A, Das S, Chopra A, Danda D, Paul BJ, March L, et al. Burden of osteoarthritis in India and its states, 1990-2019: Findings from the global burden of disease study 2019. Osteoarthr Cartil 2022;30:1070-8.
2. Yu SP, Hunter DJ. Managing osteoarthritis. Aust Prescr 2015;38:115-9.
3. Shakoor N, Sengupta M, Foucher KC, Wimmer MA, Fogg LF, Block JA. Effects of common footwear on joint loading in osteoarthritis of the knee. Arthritis Care Res (Hoboken) 2010;62:917-23.
4. Srinivas MN. A note on sanskritization and westernization. Far East Q 1956;15:481-96.
5. Bhattacharya S, Juyal R, Hossain MM, Singh A. Non-communicable diseases viewed as “collateral damage” of our decisions: Fixing accountabilities and finding solutions in primary care settings. J Family Med Prim Care 2020;9:2176-9.
How to Cite this article: Bhattacharya S, Kumar V, Kale S, Bhati A, Vyas A, Darvesh M. Reducing Joint Loading and Preventing Osteoarthritis with Proper Footwear Choices in India. Journal of Clinical Orthopaedics January-June 2025;10(1):45-47.
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 12:41:592025-06-21 14:05:44Reducing Joint Loading and Preventing Osteoarthritis with Proper Footwear Choices in India
[1] Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
Address of Correspondence
Dr Avik Kumar Naskar
Old Resident Hostel, IGGMC and Mayo Hospital, Nagpur – 440018, Maharashtra, India.
E-mail: avik7933@gmail.com
Abstract
Background: Anatomical variations of the ulnar nerve, particularly involving its course and branching pattern near the distal humerus, are exceedingly rare. Such anomalies may pose significant risks during surgical procedures around the elbow due to their potential for entrapment, mechanical stretch, or iatrogenic injury. Case report: We report a case involving a 59-year-old male with a distal humerus fracture, managed surgically through a posterior paratricipital approach. Pre-operatively, there was no neurological deficit. Intraoperatively, a rare anatomical variant of the ulnar nerve was observed: It exhibited two bifurcations approximately 40 mm and 20 mm proximal to the medial epicondyle. Notably, both aberrant branches pierced the medial intermuscular septum to enter the anterior compartment. In addition, the main trunk of the ulnar nerve was tethered by a dense fascial band extending between the medial intermuscular septum and the medial epicondyle. The fracture was stabilized using bicolumnar plating. Results: Despite meticulous dissection, the patient developed a post-operative ulnar nerve deficit, likely due to traction or compression injury to the aberrant branches. This unusual branching pattern increased the risk of intraoperative nerve compromise. Conclusion: This case underscores the importance of considering rare ulnar nerve anatomical variations during surgical planning for distal humerus fractures. Pre-operative vigilance and careful intraoperative dissection are essential to prevent nerve injury. Keywords: Ulnar nerve, Distal humerus fractures, Peripheral nerves, Nerve compression.
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How to Cite this article: Mehta MA, Naskar AK, Ganwir HP, Atram VA. Unorthodox Ulnar Nerve Arborization at the Distal Metadiaphyseal Humerus: An Insight into the Neuroanatomical Oddity and its Surgical Implication. Journal of Clinical Orthopaedics. January-June 2025;10(1):65-68.
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 12:32:502025-06-21 14:09:44Unorthodox Ulnar Nerve Arborization at the Distal Metadiaphyseal Humerus: An Insight into the Neuroanatomical Oddity and its Surgical Implication
Submitted Date: 25 Jan 2025, Review Date: 13 Feb 2025, Accepted Date: ?? 2025 & Published Date: 30 Jun 2025
Author: Manit Arora [1], Frederick Weitz [2]
[1] Department of Orthopaedics and Sports Medicine, Fortis Hospital Mohali, Punjab, India,
[2] Department of Orthopaedics, Ernst-Mortiz-Arndt-Universitat Greifswald, Pihlajalinna, Finland
Address of Correspondence
Dr Manit Arora,
Department of Orthopaedics, Fortis Hospital Mohali, Mohali – 160 022, Punjab, India.
E-mail: manit_arora@hotmail.com
Abstract
Pediatric ACL injuries are rising, and the ACL tear in an open physis is becoming more common. Traditional ACL reconstruction techniques, whether physeal sparing or transphyseal, are associated with good outcomes but carry the risk of growth arrest due to femoral and tibial bone drilling. We describe a novel technique for ACL repair in pediatric ACL patients, which prevents tibial bone drilling completely and is physeal sparing in the femur. This technique is suitable only for ACL injuries near ACL’s femoral attachment. The technique is well established and documented in adult population. For the femoral fixation Swivelock anchor screw is used. This provides a stable fixation of the ACL in femur with no risk of violating the growth plate through drilling or hardware. This should theoretically minimize the risk of growth plate arrest. Keywords: Pediatriac, ACL, ACL injuries, Physis
References
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8. Pierce TP, Issa K, Festa A, Scillia AJ, McInerney VK. Pediatric anterior cruciate ligament reconstruction: A systematic review of transphyseal versus physeal-sparing techniques. Am J Sports Med 2017;45:488-94.
9. Trivedi V, Mishra P, Verma D. Pediatric ACL injuries: A review of current concepts. Open Orthop J 2017;11:378-88.
10. Faunø P, Rømer L, Nielsen T, Lind M. The risk of transphyseal drilling in skeletally immature patients with anterior cruciate ligament injury. Orthop J Sports Med 2016;4:2325967116664685.
11. International Olympic Committee Pediatric ACL Injury Consensus Group, Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, et al. 2018 international olympic committee consensus statement on prevention, diagnosis, and management of pediatric anterior cruciate ligament injuries. Orthop J Sports Med 2018;6:2325967118759953.
12. Seil R, Weitz FK, Pape D. Surgical-experimental principles of anterior cruciate ligament (ACL) reconstruction with open growth plates. J Exp Orthop 2015;2:11.
13. Wong SE, Feeley BT, Pandya NK. Complications after pediatric ACL reconstruction: A meta-analysis. J Pediatr Orthop 2019;39:e566-71.
14. Mäkelä EA, Vainionpää S, Vihtonen K, Mero M, Laiho J, Törmälä P, et al. The effect of a penetrating biodegradable implant on the epiphyseal plate: An experimental study on growing rabbits with special regard to polyglactin 910. J Pediatr Orthop 1987;7:415-20.
15. Mäkelä EA, Vainionpää S, Vihtonen K, Mero M, Helevirta P, Törmälä P, et al. The effect of a penetrating biodegradable implant on the growth plate. An experimental study on growing rabbits with special reference to polydioxanone. Clin Orthop Relat Res 1989;241:300-8.
16. Stadelmaier DM, Arnoczky SP, Dodds J, Ross H. The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 1995;23:431-5.
17. Van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: A paradigm shift. Surgeon 2017;15:161-8.
18. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: Early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy 2015;31:2162-71.
19. Taylor SA, Khair MM, Roberts TR, DiFelice GS. Primary repair of the anterior cruciate ligament: A systematic review. Arthroscopy 2015;31:2233-47.
20. Vermeijden HD, van der List JP, O’Brien RJ, DiFelice GS. Primary repair of anterior cruciate ligament injuries: Current level of evidence of available techniques. JBJS Rev 2021;9:e20.00174.
21. Ferretti A. To heal or not to heal: The ACL dilemma. J Orthop Traumatol 2020;21:11.
22. van der List JP, Vermeijden HD, Sierevelt IN, DiFelice GS, van Noort A, Kerkhoffs GM. Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is needed: A systematic review and meta-analysis of recent literature. Knee Surg Sports Traumatol Arthrosc 2020;28:1946-57.
23. Nwachukwu BU, Patel BH, Lu Y, Allen AA, Williams RJ 3rd. Anterior cruciate ligament repair outcomes: An updated systematic review of recent literature. Arthroscopy 2019;35:2233-47.
24. Kandhari V, Vieira TD, Ouanezar H, Praz C, Rosenstiel N, Pioger C, et al. Clinical outcomes of arthroscopic primary anterior cruciate ligament repair: A systematic review from the scientific anterior cruciate ligament network international study group. Arthroscopy 2020;36:594-612.
25. Van der List JP, Mintz DN, DiFelice GS. The locations of anterior cruciate ligament tears in pediatric and adolescent patients: A magnetic resonance study. J Pediatr Orthop 2019;39:441-8.
26. Christino MA, Tepolt FA, Sugimoto D, Micheli LJ, Kocher MS. Revision ACL reconstruction in children and adolescents. J Pediatr Orthop 2020;40:129-34.
27. Thorolfsson B, Svantesson E, Snaebjornsson T, Sansone M, Karlsson J, Samuelsson K, et al. Adolescents have twice the revision rate of young adults after ACL reconstruction with hamstring tendon autograft: A study from the Swedish National Knee Ligament Registry. Orthop J Sports Med 2021;9:23259671211038893.
How to Cite this article: Arora M, Weitz F. Physeal Sparing ACL Repair using Knotless Suture Anchor Technique for Pediatric ACL Injuries. Journal of Clinical Orthopaedics January-June 2025;10(1):57-60.
Unveiling the Layers: Mental Health Dynamics in Orthopedic Trauma Patients and Future Implications
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 61-64 | Sudip Bhattacharya, Sitanshu Barik, Vishal Kumar, Abhishek Bhati, Aditya Vyasv, Moin Darvesh
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.722
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 13 April 2025, Review Date: 28 April 2025, Accepted Date: 29 May 2025 & Published Date: 30 Jun 2025
Author: Sudip Bhattacharya [1], Sitanshu Barik [2], Vishal Kumar [3], Abhishek Bhati [4], Aditya Vyasv [ ], Moin Darvesh [4]
[1] Department of Community and Family Medicine, AIIMS Deoghar, Deoghar, Rampur, Jharkhand, India,
[2] Department of Community and Family Medicine, AIIMS Nagpur, Dahegaon, Maharashtra, India,
[3] Department of Community and Family Medicine, PGIMER, Chandigarh, India,
[4] Department of Orthopaedics, D Y Patil School of Medicine and Hospital, Nerul, Navi Mumbai, Maharashtra, India
Address of Correspondence
Dr Sitanshu Barik,
Associate Professor, AIIMS Nagpur, Maharashtra, India.
E-mail: sitanshubarik@gmail.com
Abstract
Orthopaedic trauma care has traditionally operated within the confines of the biomedical model, focusing on physical recovery markers such as bone healing and functional restoration. However, this narrow approach often overlooks the profound influence of psychological and social factors on recovery. Emerging evidence underscores that mental health conditions—including depression, anxiety, PTSD, and substance use disorders—substantially affect rehabilitation outcomes in orthopaedic trauma patients. Psychological distress not only prolongs recovery times but also impairs treatment adherence and functional return. Moreover, patients’ cognitive responses, such as catastrophizing and self-efficacy, play pivotal roles in shaping their rehabilitation trajectories. Catastrophizing magnifies perceived disability and pain, while high self-efficacy fosters resilience and active engagement in recovery.
To address these psychosocial dimensions, the biopsychosocial model of care is gaining traction. Targeted interventions such as cognitive behavioral therapy (CBT), psychoeducation, graded physical exposure, and goal-setting have proven effective in reducing distress and enhancing recovery motivation. Furthermore, injury-specific strategies—for conditions like femoral fractures, ACL tears, and spinal surgeries—can be tailored to address patients’ unique informational and emotional needs through in-hospital counselling, digital resources, and home-based support.
The integration of mental health screening, early referral, and multidisciplinary intervention is essential in orthopaedic practice. Clinical guidelines from leading orthopaedic bodies now recommend psychosocial evaluation as part of trauma care. Ultimately, incorporating structured, time-efficient, and scalable interventions into routine orthopaedic workflows—especially in high-volume settings—can improve both mental health outcomes and physical rehabilitation. This shift toward holistic, patient-centred care is imperative for optimizing outcomes in orthopaedic trauma recovery.
Keywords: Orthopedics, Mental health, Caregivers
References
1. Engel GL. The need for a new medical model: A challenge for biomedicine. Science 1977;196:129-36.
2. Kellezi B, Coupland C, Morriss R, Beckett K, Joseph S, Barnes J, et al. The impact of psychological factors on recovery from injury: A multicentre cohort study. Soc Psychiatry Psychiatr Epidemiol 2017;52:855-66.
3. Reichman M, Bakhshaie J, Grunberg VA, Doorley JD, Vranceanu AM. What are orthopaedic healthcare professionals’ attitudes toward addressing patient psychosocial factors? A mixed-methods investigation. Clin Orthop Relat Res 2022;480:248-62.
4. Van der Kolk B. Posttraumatic stress disorder and the nature of trauma. Dialogues Clin Neurosci 2000;2:7-22.
5. Keizer BM, Wegener ST. AAOS/major extremity trauma and rehabilitation consortium clinical practice guideline summary for evaluation of psychosocial factors influencing recovery from orthopaedic trauma. J Am Acad Orthop Surg 2022;30:e307-12.
6. Large J, Naumann DN, Fellows J, Connor C, Ahmed Z. Clinical outcomes following major trauma for patients with a diagnosis of depression: A large UK database analysis. Trauma Surg Acute Care Open 2021;6:e000819.
7. Yang Y, Tang TT, Chen MR, Xiang MY, Li LL, Hou XL. Prevalence and association of anxiety and depression among orthopaedic trauma inpatients: A retrospective analysis of 1994 cases. J Orthop Surg Res 2020;15:587.
8. Vincent HK, Horodyski M, Vincent KR, Brisbane ST, Sadasivan KK. Psychological distress after orthopedic trauma: Prevalence in patients and implications for rehabilitation. PM R 2015;7:978-89.
9. Levy RS, Hebert CK, Munn BG, Barrack RL. Drug and alcohol use in orthopedic trauma patients: A prospective study. J Orthop Trauma 1996;10:21-7.
10. Gosens T, Den Oudsten BL. Psychology in orthopedics and traumatology: An instructional review. EFORT Open Rev 2023;8:245-52.
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Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 32-37 | Mohd Danish, Akhilesh Yadav, Ashutosh Karn
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.710
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: Mohd Danish [1], Akhilesh Yadav [1], Ashutosh Karn [2]
[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India,
[2] Department of Orthopaedics, Max Superspeciality Hospital, Saket, Delhi, India
Address of Correspondence
Dr. Mohd Danish,
Department of Othopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
Introduction: Total hip arthroplasty (THA) is considered to be one of the most successful orthopaedic interventions of its generation. Joint replacement (arthroplasty) as a surgical option for end stage arthritis is well established now and millions of patients across the world have benefited. India is a country of 1.4 billion people with significant knee and hip arthritis population. According to Frost and Sullivan research, 70,000 joint replacement surgeries were performed in India in the year 2011. The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Aims of Study: To compare post-operative outcome as implant positioning in terms of abduction angle of the cup & rehabilitation based on Harris Hip Score at 2 months and 4 months respectively in different approaches of approach of total hip replacement.
Materials and Methods: This study was conducted in the department of Orthopaedics at Max Super specialty hospital, Vaishali, Ghaziabad, UP after receiving clearance from the Ethical Committee of the institution. It was a randomized case control study. Two different groups of 32 patients each were evaluated and inclination of acetabular cup was calculated on plain radiograph, subsequently the rehabilitation was also evaluated on basis of Harris Hip score in these patients.
Results: In the present study, it was observed that mean postoperative abduction angle in Group A 47.82 ±6.87 and Group B was 51.19 ±7.21 degree respectively. The mean postoperative abduction angle in Group A was less compared to Group B with statistical significance. (P<0.05) In the present study, it was observed that intergroup comparison of mean Harris hip score post-operative at discharge, at 2 months & 4 months in Group A and Group B showed no statistical significance. (P>0.05) The intragroup comparison of mean Harris hip score post-operative at discharge, 2 months and 4 months in Group A and Group B showed statistical significance. (P<0.05)
Conclusion: Present study revealed a significant statistical difference on intragroup comparison of inclination angle and rehabilitation based on Harris Hip Score in both the groups.
Keywords: Arthroplasty, Harris Hip Score, Angle of Inclination
References
1. Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res 1970;72:7-21.
2. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015;97:1386-97.
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4. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005;87:1487-97.
5. Singh JA. Epidemiology of knee and hip arthroplasty: A systematic review. Open Orthop J 2011;5:80-5.
6. Morrey BF. A historical perspective of hip arthroplasty and reconstructive surgery. In: Cashman J, Goyal N, Parvizi J, editors. The Hip: Preservation, Replacement and Revision. Brooklandville, MD: Data Trace Publishing Company; 2015. p. 1.1-1.19.
7. Dislocations after total hip – replacement arthroplasties G E Lewinnek, J L Lewis, R Tarr, C L Compere, J R Zimmerman 1978 Mar;60(2):217-20 , PMID: 641088.
8. DiGioia A III, Plakseychuk AY, Levison TJ, Jaramaz B. Mini-incision technique for total hip arthroplasty with navigation. J Arthroplasty 2003;18:123–128
9. Chimento G, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP. Minimally invasive total hip arthroplasty. A prospective randomized study. J Arthroplasty 2005; 20:139–144.
10. Sculco TP, Jordan LC, Walter WL. Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthop Clin North Am 2004; 35:137–142.
11. Nakamura S, Matsuda K, Arai N, Wakimoto N, Matsushita T. Mini-incision posterior approach for total hip arthroplasty. Int Orthop 2004; 28:214–217.
12. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O_Brien S, Beverland D. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. J Bone Jt Surg (Am) 2005; 87:701–710.
13. Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Jt Surg (Am) 2004; 86:1353–1358.
14. Ozaki Y, Baba T, Homma Y, Ochi H, Watari T, Banno S, Matsumoto M, Kaneko K. Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12. SICOT-2018; J, 4, 54.
15. Laffosse JM, Chiron P, Molinier F, Bensafi H, Puget J. Prospective and comparative study of the anterolateral mini-invasive approach versus minimally invasive posterior approach for primary total hip replacement. Early results. International orthopaedics. 2007 Oct;31(5):597-603.
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A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 38-44 | B S Océane Mauffrey, B A Kevin Yu, B S Malvika Choudhari, Ashley Lynn Habig, Vinay Narotam
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.712
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 14 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: 28 Apr 2025 & Published Date: 30 Jun 2025
Author: B S Océane Mauffrey [1], B A Kevin Yu [2], B S Malvika Choudhari [1], Ashley Lynn Habig [3], Vinay Narotam [4]
[1] Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
[2] Department of Orthopaedics, University of North Carolina, Gillings School of Public Health, Chapel Hill, North Carolina, United States of America,
[3] Department of Orthopaedics, University of North Carolina, Undergraduate, Chapel Hill, North Carolina, United States of America,
[4] Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States of America
Address of Correspondence
Dr Océane Mauffrey,
Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
E-mail: oceane_mauffrey@med.unc.edu
Abstract
Objective: The Ponseti method is a widely adopted nonsurgical approach for correcting clubfoot deformities, but its success relies heavily on consistent brace usage during the maintenance phase. The present study seeks to analyze whether socioeconomic factors affect brace adherence in clubfoot patients.
Study Design: The present study was reviewed and approved by the Institutional Review Board. The charts of 83 patients treated for clubfoot by two providers at a single institution between 2013 and 2022 were reviewed to investigate the impact of various socioeconomic variables on brace adherence and its association with treatment outcomes. Brace adherence was determined based on provider documentation noting self-reported parental accounts of adherence. Annual family income was derived from North Carolina census data based on zip code. Chi-squared tests and two sample t-tests analyses were performed, controlling for clinical factors such as treatment strategy, comorbidities, laterality, and prenatal diagnosis.
Results: Patients from families with higher annual income based on zip codes demonstrated higher brace adherence rates. Patients from racial minority backgrounds exhibited reduced adherence with brace usage, likely in the context of greater obstacles to care. No significant correlations were found between brace adherence and distance to the hospital, gender, or language.
Conclusion: The findings highlight the multifaceted nature of brace adherence in clubfoot patients undergoing Ponseti treatment, suggesting the importance of addressing specific patient demographics, socioeconomic contexts, and caregiver support structures to optimize treatment outcomes. Further research involving a larger and more diverse cohort is necessary to validate these findings.
Keywords: Clubfoot, Social determinants of health, Clinical outcomes, Brace compliance.
References
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Reducing Joint Loading and Preventing Osteoarthritis with Proper Footwear Choices in India
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 45-47 | Sudip Bhattacharya, Vishal Kumar, Sachin Kale, Abhishek Bhati, Aditya Vyas, Moin Darvesh
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.714
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 15 March 2025, Review Date: 24 April 2025, Accepted Date: 29 May 2025 & Published Date: 30 Jun 2025
Author: Sudip Bhattacharya [1], Vishal Kumar [2], Sachin Kale [3], Abhishek Bhati [3], Aditya Vyas [3], Moin Darvesh [3]
[1] Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India,
[2] Department of Orthopaedics PGIMER, Chandigarh, India,
[3] Department of Orthopaedics, D Y Patil School of Medicine and Hospital Nerul Navi Mumbai, India
Address of Correspondence
Dr Sudip Bhattacharya,
All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
Email: drsudip81@gmail.com
Abstract
The abstract outlines a comprehensive study on the increasing prevalence of osteoarthritis (OA) in India from 1990 to 2019. The number of affected individuals rose from 23.46 million to 62.35 million during this period. Standardized OA prevalence per 100,000 people also saw an increase, along with Disability-Adjusted Life Years (DALYs) attributed to OA, highlighting the growing burden of the condition. Knee OA emerged as the most widespread form, with higher prevalence, incidence, and DALYs observed in females compared to males. The present OA management primarily focuses on symptom alleviation rather than addressing the underlying biomechanical stress. Research indicates that abnormal dynamic loads during walking contribute to joint damage, and reducing these loads can provide relief from symptoms. This opinion emphasizes the significant impact of modern footwear on knee loads, particularly in individuals with symptomatic knee OA. Cheaper, budget-friendly footwear often lacks proper cushioning and ergonomics, potentially worsening knee joint issues over time. To address the issue, a multi-pronged approach is proposed. Government subsidies and incentives, Public-Private Partnerships, indigenous research and development, public awareness campaigns, and community clinics are suggested strategies to make ergonomically designed footwear more affordable and accessible. In addition, offering affordable orthotic inserts and encouraging local shoemakers and small-scale manufacturers can contribute to this effort. We concluded by emphasizing the importance of quality assurance in ensuring that low-cost ergonomic footwear meets essential ergonomic criteria. Overall, the proposed strategies aim to reduce the burden of knee osteoarthritis in India and improve public foot health.
Keywords: Osteoarthritis, Gait, Posture.
References
1. Singh A, Das S, Chopra A, Danda D, Paul BJ, March L, et al. Burden of osteoarthritis in India and its states, 1990-2019: Findings from the global burden of disease study 2019. Osteoarthr Cartil 2022;30:1070-8.
2. Yu SP, Hunter DJ. Managing osteoarthritis. Aust Prescr 2015;38:115-9.
3. Shakoor N, Sengupta M, Foucher KC, Wimmer MA, Fogg LF, Block JA. Effects of common footwear on joint loading in osteoarthritis of the knee. Arthritis Care Res (Hoboken) 2010;62:917-23.
4. Srinivas MN. A note on sanskritization and westernization. Far East Q 1956;15:481-96.
5. Bhattacharya S, Juyal R, Hossain MM, Singh A. Non-communicable diseases viewed as “collateral damage” of our decisions: Fixing accountabilities and finding solutions in primary care settings. J Family Med Prim Care 2020;9:2176-9.
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Unorthodox Ulnar Nerve Arborization at the Distal Metadiaphyseal Humerus: An Insight into the Neuroanatomical Oddity and its Surgical Implication
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 65-68 | Meet Ajay Mehta, Avik Kumar Naskar, Himanshu Pradeep Ganwir, Vikas Anandrao Atram
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.724
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 25 March 2025, Review Date: 29 April 2025, Accepted Date: May 2025 & Published Date: 30 June 2025
Author: Meet Ajay Mehta [1], Avik Kumar Naskar [1], Himanshu Pradeep Ganwir [1], Vikas Anandrao Atram [1]
[1] Department of Orthopaedics, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
Address of Correspondence
Dr Avik Kumar Naskar
Old Resident Hostel, IGGMC and Mayo Hospital, Nagpur – 440018, Maharashtra, India.
E-mail: avik7933@gmail.com
Abstract
Background: Anatomical variations of the ulnar nerve, particularly involving its course and branching pattern near the distal humerus, are exceedingly rare. Such anomalies may pose significant risks during surgical procedures around the elbow due to their potential for entrapment, mechanical stretch, or iatrogenic injury.
Case report: We report a case involving a 59-year-old male with a distal humerus fracture, managed surgically through a posterior paratricipital approach. Pre-operatively, there was no neurological deficit. Intraoperatively, a rare anatomical variant of the ulnar nerve was observed: It exhibited two bifurcations approximately 40 mm and 20 mm proximal to the medial epicondyle. Notably, both aberrant branches pierced the medial intermuscular septum to enter the anterior compartment. In addition, the main trunk of the ulnar nerve was tethered by a dense fascial band extending between the medial intermuscular septum and the medial epicondyle. The fracture was stabilized using bicolumnar plating.
Results: Despite meticulous dissection, the patient developed a post-operative ulnar nerve deficit, likely due to traction or compression injury to the aberrant branches. This unusual branching pattern increased the risk of intraoperative nerve compromise.
Conclusion: This case underscores the importance of considering rare ulnar nerve anatomical variations during surgical planning for distal humerus fractures. Pre-operative vigilance and careful intraoperative dissection are essential to prevent nerve injury.
Keywords: Ulnar nerve, Distal humerus fractures, Peripheral nerves, Nerve compression.
References
1. Spinner RJ, Carmichael SW, Spinner M. Ulnar nerve anomalies: Clinical relevance in entrapment syndromes. J Neurosurg 1996;84:725-32.
2. Sunderland S. Nerves and Nerve Injuries. 2nd ed. Edinburgh: Churchill Livingstone; 1978.
3. Dellon AL. Review of treatment results for ulnar nerve entrapment at the elbow. J Hand Surg Am 1986;11:688-700.
4. Capek L, Kunc V. Anatomical variations of the ulnar nerve in the elbow region. Acta Chir Plast 1984;26:209-16.
5. Wright TW, Glowczewskie F Jr., Cowin D, Wheeler DL. Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion. J Hand Surg Am 2001;26:655-62.
6. Karatas A, Basarir K, Ercin E. Anatomic variations of the ulnar nerve at the elbow. Clin Anat 2012;25:498-503.
7. Chow JC, Papachristos AA, Ojeda A. An aberrant anatomic variation along the course of the ulnar nerve above the elbow with coexistent cubital tunnel syndrome. Clin Anat 2006;19:661-4.
8. Ferre-Martinez A, Miguel-Pérez M, Möller I, Ortiz-Miguel S, Pérez-Bellmunt A, Ruiz N, Sanjuan X, Agullo J, Ortiz-Sagristà J, Martinoli C. Possible Points of Ulnar Nerve Entrapment in the Arm and Forearm: An Ultrasound, Anatomical, and Histological Study. Diagnostics. 2023; 13(7):1332.
9. Roy TS, Sharma M, Sharma A. Martin-Gruber anastomosis in human cadavers and its clinical implications. Clin Anat 2004;17:63-6.
10. Paul S, Das S, Chaudhary S, Mishra P, Nayak BS. Marinacci communication: A rare anomaly of the forearm. Singapore Med J 2007;48:e231-3.
11. Roy TS, Gupta V. Berrettini anastomosis in the human hand. Clin Anat 1997;10:165-8.
12. Posner MA. Compressive neuropathies of the ulnar nerve at the elbow and wrist. Instr Course Lect 2000;49:305-17.
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Physeal Sparing ACL Repair using Knotless Suture Anchor Technique for Pediatric ACL Injuries
/in Vol 10 | Issue 1 | January-June 2025 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 57-60 | Manit Arora, Frederick Weitz
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.720
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 25 Jan 2025, Review Date: 13 Feb 2025, Accepted Date: ?? 2025 & Published Date: 30 Jun 2025
Author: Manit Arora [1], Frederick Weitz [2]
[1] Department of Orthopaedics and Sports Medicine, Fortis Hospital Mohali, Punjab, India,
[2] Department of Orthopaedics, Ernst-Mortiz-Arndt-Universitat Greifswald, Pihlajalinna, Finland
Address of Correspondence
Dr Manit Arora,
Department of Orthopaedics, Fortis Hospital Mohali, Mohali – 160 022, Punjab, India.
E-mail: manit_arora@hotmail.com
Abstract
Pediatric ACL injuries are rising, and the ACL tear in an open physis is becoming more common. Traditional ACL reconstruction techniques, whether physeal sparing or transphyseal, are associated with good outcomes but carry the risk of growth arrest due to femoral and tibial bone drilling. We describe a novel technique for ACL repair in pediatric ACL patients, which prevents tibial bone drilling completely and is physeal sparing in the femur. This technique is suitable only for ACL injuries near ACL’s femoral attachment. The technique is well established and documented in adult population. For the femoral fixation Swivelock anchor screw is used. This provides a stable fixation of the ACL in femur with no risk of violating the growth plate through drilling or hardware. This should theoretically minimize the risk of growth plate arrest.
Keywords: Pediatriac, ACL, ACL injuries, Physis
References
1. Shaw L, Finch CF. Trends in pediatric and adolescent anterior cruciate ligament injuries in Victoria, Australia 2005-2015. Int J Environ Res Public Health 2017;14:599.
2. Werner BC, Yang S, Looney AM, Gwathmey FW Jr. Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop 2016;36:447-52.
3. Weitz FK, Sillanpää PJ, Mattila VM. The incidence of paediatric ACL injury is increasing in Finland. Knee Surg Sports Traumatol Arthrosc 2020;28:363-8.
4. Dunn KL, Lam KC, Valovich McLeod TC. Early operative versus delayed or nonoperative treatment of anterior cruciate ligament injuries in pediatric patients. J Athl Train 2016;51:425-7.
5. Smith ID, Irfan A, Huntley JS, Spencer SJ. What is the best treatment for a child with an acute tear of the anterior cruciate ligament? J Paediatr Child Health 2018;54:1037-41.
6. Mouton C, Moksnes H, Janssen R, Fink C, Zaffagnini S, Monllau JC, et al. Preliminary experience of an international orthopaedic registry: The ESSKA paediatric anterior cruciate ligament initiative (PAMI) registry. J Exp Orthop 2021;8:45.
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