Vol 10 | Issue 2 | July-December 2025 – Page 2 – Journal of Clinical Orthopaedics

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Atypical Venous Malformation of the Volar Wrist Presenting as a Ganglion Cyst: Diagnostic Pitfalls and Surgical Insights – Case Report

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.798

Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 08 Nov 2025, Review Date: 15 Nov 2025, Accepted Date: 25 Nov 2025 & Published Date: 10 Dec 2025

Author: J S R G Saran [1], Varun Devdass [1], Durai Anand [1]

[1] Department of Orthopaedics, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Address of Correspondence
Dr. J S R G Saran,
Department of Orthopaedics, M S Ramaiah University of Applied Sciences Nagar, Bengaluru, Karnataka 560094, India.
E-mail: jsaran868@gmail.com

Abstract

Background: Wrist swellings are most often benign cystic lesions such as ganglion cysts; however, vascular anomalies such as venous malformations (VMs), though rare, can closely mimic these entities and pose diagnostic challenges.
Case Report: A 24-year-old male presented with a painful volar wrist swelling following trauma, radiologically suggestive of a multiloculated ganglion cyst. Conservative management failed, and surgical excision through a modified Henry approach was undertaken. Intraoperatively, an ill-defined, violaceous, non-pulsatile vascular mass was identified and completely excised with assistance from a vascular surgery team. Histopathological examination confirmed a VM.
Results: Post-operative rehabilitation led to significant improvement in pain and wrist function, with no recurrence noted at short-term follow-up.
Conclusion: VMs, though rare, should be considered in persistent wrist swellings unresponsive to conservative treatment. Complete surgical excision with multidisciplinary support and structured rehabilitation can achieve excellent functional recovery and prevent recurrence.
Keywords: Atypical venous malformation, Wrist, ganglion cyst, Surgical excision, Vascular anomaly.

References

1. Cooke-Barber J, Kreimer S, Patel M, Dasgupta R, Jeng M. Venous malformations. Semin Pediatr Surg 2020;29:150976.
2. Behravesh S, Yakes W, Gupta N, Naidu S, Chong BW, Khademhosseini A, et al. Venous malformations: Clinical diagnosis and treatment. Cardiovasc Diagn Ther 2016;6:557-69.
3. Scheer HS, Banz Y, Grobbelaar AO, Vögelin E. Posttraumatic vascular anomalies in hand surgery-a case-based approach. Plast Reconstr Surg Glob Open 2021;9:e3802.
4. Tisetso Morare NM, Baloyi ER. Post-traumatic arteriovenous malformation of the superficial temporal artery. J Vasc Surg Cases Innov Tech 2020;6:50-4.
5. Ota Y, Lee E, Sella E, Agarwal P. Vascular malformations and tumors: A review of classification and imaging features for cardiothoracic radiologists. Radiol Cardiothorac Imaging 2023;5:e220328.
6. Freire V, Guérini H, Campagna R, Moutounet L, Dumontier C, Feydy A, et al. Imaging of hand and wrist cysts: A clinical approach. AJR Am J Roentgenol 2012;199:W618-28.
7. Neto N, Nunnes P. Spectrum of MRI features of ganglion and synovial cysts. Insights Imaging 2016;7:179-86.
8. Sofka CM, Adler RS. Sonography of cubital bursitis. AJR Am J Roentgenol 2004;183:51-3.
9. Wang C, Song RR, Kuang PD, Wang LH, Zhang MM. Giant cell tumor of the tendon sheath: Magnetic resonance imaging findings in 38 patients. Oncol Lett 2017;13:4459-62.
10. Middleton WD, Patel V, Teefey SA, Boyer MI. Giant cell tumors of the tendon sheath: Analysis of sonographic findings. Am J Roentgenol 2004;183:337-9.
11. Dalei TR, Loya VK. Tendon sheath hemangioma. J Hand Microsurg 2019;11 Suppl 1:S22-5.
12. Shrateh ON, Jobran AW, Khatib M, Sulaiman S, Thalji F, Hussein S. Radiological diagnosis of median nerve lipoma: A case report from Palestine. Radiol Case Rep 2023;18:1248-52.
13. Jaovisidha S, Chen C, Ryu KN, Siriwongpairat P, Pekanan P, Sartoris DJ, et al. Tuberculous tenosynovitis and bursitis: Imaging findings in 21 cases. Radiology 1996;201:507-13.
14. Hage AN, Chick JF, Srinivasa RN, Bundy JJ, Chauhan NR, Acord M, et al. Treatment of venous malformations: The data, where we are, and how it is done. Tech Vasc Interv Radiol 2018;21:45-54.
15. Acord M, Srinivasan A. Management of venous malformations. Semin Intervent Radiol 2021;38:215-25.
16. Makhija LK, Bhattacharya S. Management of vascular anomalies: Review of institutional management algorithm. Indian J Plast Surg 2017;50:193-200.
17. Mehta PS, Gohil AR. A case report of rare incidence of benign vascular lesion of hand masquerading magnetic resonance imaging findings. Int J Res Orthop 2025;11:928-30.
18. Corvino A, Catalano O, Tagliati C, Cocco G, Tafuri D, Corvino F, et al. When a lump is not a cyst: A case of superficial venous aneurysm of the Hand diagnosed with high-resolution ultrasound. Diagnostics (Basel) 2025;15:1546.

How to Cite this Article: Saran JSRG, Devdass V, Anand D. Atypical Venous Malformation of the Volar Wrist Presenting as a Ganglion Cyst: Diagnostic Pitfalls and Surgical Insights – Case Report. Journal of Clinical Orthopaedics. July-December 2025;10(2):119-124.

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Screwdriver Tip Breakage during Removal of 3.5 mm Locking Screw, an Unusual Complication: A Case Report

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.796

Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 19 Jul 2025, Review Date: 12 Aug 2025, Accepted Date: 10 Sep 2025 & Published Date: 10 Dec 2025

Author: Ahmed A. Khalifa [1, 2], Muhammad Khair Al Muhammad [2]

[1] Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
[2] Department of Orthopaedic, Aster Sanad Hospital, Riyadh, Saudi Arabia.

Address of Correspondence
Dr.Ahmed A. Khalifa,
Department of Orthopedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
E-mail: ahmed_adel0391@med.svu.edu.eg

Abstract

Introduction: Hardware removal after orthopedic or fracture fixation surgeries, including locking plates and screws removal after fracture union, is a common practice; however, sometimes it is not as straightforward a procedure as it looks.
Case Report: We present a case of a male patient, 36 years old, who had a right tibial plateau fracture 2 years back, which was treated by open reduction and internal fixation using a locking 3.5 mm lateral proximal tibial plate. During hardware removal, we encountered an unusual complication: A breakage of the screwdriver tip.
Results: The screws were successfully removed after using a new screwdriver with no further complications.
Conclusion: Various unexpected circumstances might occur, such as damage or breakage of the screws heads or screwdriver tip, which hinders the complete removal of the hardware. The surgeon should be prepared with the proper tools to handle potential unusual situations.
Keywords: Hardware removal, Locking plates, Screws, Case report, Breakage.

References

1. Sandriesser S, Rupp M, Greinwald M, Heiss C, Augat P, Alt V. Locking design affects the jamming of screws in locking plates. Injury 2018;49 Suppl 1:S61-5.
2. Hak DJ, McElvany M. Removal of broken hardware. J Am Acad Orthop Surg 2008;16:113-20.
3. Suzuki T, Smith WR, Stahel PF, Morgan SJ, Baron AJ, Hak DJ. Technical problems and complications in the removal of the less invasive stabilization system. J Orthop Trauma 2010;24:369-73.
4. Kumar G, Dunlop C. Case report: A technique to remove a jammed locking screw from a locking plate. Clin Orthop Relat Res 2011;469:613-6.
5. Ehlinger M, Adam P, Simon P, Bonnomet F. Technical difficulties in hardware removal in titanium compression plates with locking screws. Orthop Traumatol Surg Res 2009;95:373-6.
6. Agrawal AC, Chandewar MM, Chandan RK. Technique for the removal of a locking screw from a broken locking plate following cold welding. J Orthop Traumatol Rehabil 2018;10:142-4.
7. Hammad W, Elnikety S. A simple technique to remove a jammed locking screw. J Musculoskelet Surg Res 2025;9:153-6.
8. Hernigou P, Scarlat MM. Implant removal in orthopaedic surgery: Far more than a resident’s simple task. Int Orthop 2025;49:1767-73.
9. Cronier P, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R. The concept of locking plates. Orthop Traumatol Surg Res 2010;96:S17-36.

How to Cite this Article: Khalifa AA, Al-Muhammad MK. Screwdriver Tip Breakage During Removal of 3.5 mm Locking Screw, an Unusual Complication: A Case Report. Journal of Clinical Orthopaedics. July-December 2025;10(2):116-118.

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Management of Chronic Osteomyelitis of Shaft of Long Bones with Antibiotic Impregnated Cement Coated Intramedullary Nailing: A Prospective Analysis

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.794

Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 01 Aug 2025, Review Date: 21 Sep 2025, Accepted Date: 14 Oct 2025 & Published Date: 10 Dec 2025

Author: V Sriram [1], L Sachin Patel [2], K K Nrupatunga [3]

[1] Department of Orthopaedics, East Point College of Medical Sciences, Bengaluru, Karnataka, India.
[2] Department of Orthopaedics, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, India.
[3] Department of Orthopaedics, BGS Medical College Hospital, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. L Sachin Patel,
Department of Orthopaedics, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, India.
E-mail: spatel.bl@gmail.com

Abstract

Background/Aim: The aim of this study was to study the outcome of antibiotic impregnated cement coated intramedullay nailing in the management of chronic osteomyelitis of shaft of long bones.
Materials and Methods: In this prospective study, 17 patients admitted in our hospital who were diagnosed with chronic osteomyelitis of long bones and culture-positive infected fractures of long bones were considered in the study and they were evaluated for a period of 12 months.
Results: Bony union was achieved at around 5 months (20 weeks) on average, and duration for control of infection in case of chronic osteomyelitis was around 4 months, complications such as persistent infection and non-union were around 18 % overall.
Conclusion: The main advantage of the antibiotic nail is that both the union and the infection can be addressed at the same surgery. Single-staged antibiotic nailing technique provides good results, lessens the duration of hospital stay, and reduces the morbidity in infected nonunion of long bones with <2 cm defect.
Keywords: Antibiotic impregnated cement-coated intramedullay nailing, Chronic osteomyelitis, Infected non-union, Infection.

References

1. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am 1976;58:453-8.
2. Gustilo RB. Use of antimicrobials in the management of open fractures. Arch Surg 1979;114:805-8.
3. Bertazzoni Minelli E, Benini A, Magnan B, Bartolozzi P. Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty. J Antimicrob Chemother 2004;53:329-34.
4. Kanakaris N, Gudipati S, Tosounidis T, Harwood P, Britten S, Giannoudis PV. The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods. Bone Joint J 2014;96-B:783-8.
5. Wang G, Luo W, Zhou Y, Zhu Z, Zhao Z, Liu S, et al. Custom-made antibiotic cement-coated nail for the treatment of infected bone defect. Biomed Res Int 2021;2021:6693906.
6. Thonse R, Conway JD. Antibiotic cement-coated nails for the treatment of infected nonunions and segmental bone defects. J Bone Joint Surg Am 2008;90 Suppl 4:163-74.
7. Bhatia C, Tiwari AK, Sharma SB, Thalanki S, Rai A. Role of antibiotic cement coated nailing in infected nonunion of tibia. Malays Orthop J 2017;11:6-11.
8. Dhanasekhar R, Jacob P, Francis J. Antibiotic cement impregnated nailing in the management of infected nonunion of femur and tibia. Kerala J Orthop 2013;26:93-7.
9. Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: Preliminary results in nine cases. J Orthop Trauma 2002;16:723-9.
10. Shyam AK, Sancheti PK, Patel SK, Rocha S, Pradhan C, Patil A. Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones. Indian J Orthop 2009;43:396-402.
11. Saravanan A, Raj Ganesh R, Ismail ND, Anandan H. Antibiotic cement impregnated nailing in management of infected non-union of femur and tibia. Int J Sci Stud 2017;5:187-91.

How to Cite this Article: Sriram V, Patel SL, Nrupatunga KK. Management of Chronic Osteomyelitis of Shaft of Long Bones with Antibiotic Impregnated Cement Coated Intramedullary Nailing: A Prospective Analysis. Journal of Clinical Orthopaedics. July-December 2025;10(2):111-115.

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To Assess the Functional Outcome of the Fibularis Longus Sinew Autograft Versus the Hamstring Sinew Autograft for ACL Reconstruction

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.792

Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 11 Jul 2025, Review Date: 08 Aug 2025, Accepted Date: 10 Sep 2025 & Published Date: 10 Dec 2025

Author: Pankaj Kumar Singh [1], Avinash Kumar Singh [1], Dinesh Kumar Chaturvedi [1], Sachin Kale [2]

[1] Department of Orthopaedic, Heritage Institute of Medical Sciences, Varanasi, U.P., India.
[2] Department of Orthopaedic, Dr. D Y Patil School of Medicine, Nerul, Navi Mumbai, Maharashtra, India

Address of Correspondence
Dr. Avinash Kumar Singh,
Department of Orthopaedic, Heritage Institute of Medical Sciences, Varanasi, U.P., India.
E-mail: avinashsingha@gmail.com

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is widely performed to restore knee stability following ligament rupture. The choice of autograft remains pivotal in determining long-term functional outcomes. While hamstring tendon (HT) autografts are commonly used, they are associated with donor site morbidity and variable graft diameter. Fibularis longus tendon (PLT) has emerged as a promising alternative due to its favourable biomechanical properties and potential to preserve hamstring function.
Objectives: To assess and compare the functional outcomes, knee stability, and donor site morbidity associated with PLT versus HT autografts in patients undergoing ACL reconstruction.
Methods: A prospective comparative clinical study was conducted between August 2023 and March 2025 at a tertiary care institute in Varanasi. Fifty patients with isolated ACL tears were randomly assigned to undergo reconstruction using either HT or PLT autografts (25 per group). All underwent standardized arthroscopic techniques and a uniform rehabilitation protocol. Functional outcomes were assessed using IKDC, Lysholm, and Cincinnati scores; donor site morbidity using AOFAS and FADI scores; and knee stability via Lachman, pivot shift, and anterior drawer tests.
Results: Both groups showed significant improvement in IKDC scores postoperatively. The PLT group had a slightly higher mean IKDC at 1 year (90.90 vs 89.52; p=0.068), greater graft diameter, and better preservation of thigh muscle mass. No significant differences in knee stability tests or major complications were observed.
Conclusion: PLT is a reliable and effective autograft, showing comparable if not slightly superior functional outcomes to HT in ACL reconstruction, with minimal donor site morbidity.
Keywords: Anterior Cruciate Ligament, Autografts, Fibularis Longus Tendon, Hamstring Tendon, Functional Outcome.

References

1. Chia L, De Oliveira Silva D, Whalan M, McKay MJ, Sullivan J, Fuller CW, Pappas E. Non-contact anterior cruciate ligament injury epidemiology in team-ball sports: a systematic review with meta-analysis by sex, age, sport, participation level, and exposure type. Sports medicine. 2022 Oct;52(10):2447-67.
2. Mlv SK, Mahmood A, Vatsya P, Garika SS, Mittal R, Nagar M. Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India. World Journal of Clinical Cases. 2023 May 26;11(15):3464.
3. Gokeler A, Grassi A, Hoogeslag R, van Houten A, Lehman T, Bolling C, Buckthorpe M, Norte G, Benjaminse A, Heuvelmans P, Di Paolo S. Return to sports after ACL injury 5 years from now: 10 things we must do. Journal of experimental orthopaedics. 2022 Jul 30;9(1):73.
4. Rovere G, Stramazzo L, Romeo M, D’Arienzo A, Maccauro G, Camarda L. Hamstring graft preparation for ACL reconstruction. Orthopedic Reviews. 2022 Dec 17;14(5):38408.
5. Giusti S, Susca M, Cerulli S, De Fenu E, Adriani E. Donor‐Site Morbidity in Anterior Cruciate Ligament (ACL) Reconstruction With All‐Soft Tissue Quadriceps Tendon Autograft vs. Hamstring Tendon Autograft: A Retrospective Monocentric Observational Study. Advances in Orthopedics. 2025;2025(1):8833546.
6. Keyhani S, Qoreishi M, Mousavi M, Ronaghi H, Soleymanha M. Peroneus longus tendon autograft versus hamstring tendon autograft in anterior cruciate ligament reconstruction: a comparative study with a mean follow-up of two years. Archives of Bone and Joint Surgery. 2022 Aug;10(8):695.
7. Gök B, Kanar M, Tutak Y. Peroneus longus vs hamstring tendon autografts in ACL reconstruction: A comparative study of 106 patients’ outcomes. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2024 Oct 26;30:e945626.
8. Rhatomy S, Hartoko L, Setyawan R, Soekarno NR, Asikin AI, Pridianto D, Mustamsir E. Single bundle ACL reconstruction with peroneus longus tendon graft: 2-years follow-up. Journal of clinical orthopaedics and trauma. 2020 May 1;11:S332-6.
9. Liu CT, Lu YC, Huang CH. Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction. Journal of Orthopaedic Science. 2015 Sep;20(5):854-60.
10. Angthong C, Chernchujit B, Apivatgaroon A, Chaijenkit K, Nualon P, Suchao-in K. The anterior cruciate ligament reconstruction with the peroneus longus tendon: a biomechanical and clinical evaluation of the donor ankle morbidity. J Med Assoc Thai. 2015 Jun 1;98(6):555-60.
11. Wiradiputra AE, Aryana GN. Peroneus longus tendon graft for anterior cruciate ligament reconstruction: a case report and review of literature. International Journal of Surgery Case Reports. 2021 Jun 1;83:106028.
12. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M. A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. The American journal of sports medicine. 2005 Sep;33(9):1337-45.
13. Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH. Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 May;21(5):1111-8.
14. Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. The American journal of sports medicine. 2003 Jul;31(4):564-73.
15. He J, Tang Q, Ernst S, Linde MA, Smolinski P, Wu S, Fu F. Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2021 Sep;29(9):2869-79.
16. Khalil MH, Zawam SH. Comparative study of Peroneus longus tendon autograft versus Hamstring tendon autograft in arthroscopic anterior cruciate ligament reconstruction. International Orthopaedics. 2025 Jun;49(6):1365-72.
17. Kerimoglu S, Aynaci O, Saracoglu M, Aydin H, Turhan A. Anterior cruciate ligament reconstruction with the peroneus longus tendon. Acta orthopaedica et traumatologica turcica. 2008 Jan 1;42(1):38-43.

How to Cite this Article: Singh PK, Singh AK, Chaturvedi DK, Kale S. To Assess the Functional Outcome of the Fibularis Longus Sinew Autograft Versus the Hamstring Sinew Autograft for ACL Reconstruction. Journal of Clinical Orthopaedics. July-December 2025;10(2):105-110.

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Total Hip Arthroplasty for Osteonecrosis in Patients Under 50 years old is Associated with an Increased risk of post-surgical Complications

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.790

Open Access License: CC BY-NC 4.0

Submitted Date: 22 Aug 2025, Review Date: 17 Sep 2025, Accepted Date: 28 Oct 2025 & Published Date: 10 Dec 2025

Author: Pradip Ramamurti [1], Corinne Vennitti [1], Shivam Gandhi [1], Quanjun Cui [1], Tracy Borsinger [1]

[1] University of Virginia, Department of Orthopaedic Surgery, 2280 Ivy Road, Charlottesville, VA 22903.

Address of Correspondence

Dr. Corinne Vennitti
University of Virginia, Department of Orthopaedic Surgery, 2280 Ivy Road, Charlottesville, VA 22903.
E-mail: CV3AJ@uvahealth.org

Abstract

Introduction: Osteonecrosis (ON) of the femoral head is responsible for roughly 2 to 10% of total hip arthroplasty (THA) indications. The purpose of this study is to compare complication rates for patients under 50 years old undergoing THA for ON versus osteoarthritis (OA).
Methods: Patients between the ages of 18- and 50-years old undergoing THA for ipsilateral osteonecrosis were identified in the PearlDiver database. A control cohort of patients between the same age thresholds were identified who underwent THA for osteoarthritis. Any patient with a history of proximal femur fracture or prior operative fixation of a proximal femur fracture was excluded. Patients were included if they had a 5-year postoperative database followed up after THA. The 90-day rates of post-operative medical and 5-year surgical complications were recorded. Multivariate analysis was conducted to account for confounding variables and covariates. Subgroup analyses were also performed stratified by age (<30, 30–40, and 40–50 years) to assess revision outcomes.
Results: A final cohort of 6,955 patients met inclusion criteria, 1,769 (25.4%) underwent THA for osteonecrosis while 5,186 (74.6%) underwent THA for OA. Patients undergoing THA for ON had a higher incidence of 5-year post-surgical instability (3.1% vs. 2.2%, OR 1.51, P=0.025) when compared to THA for OA. Similarly, those undergoing THA for OA had a higher incidence of 5-year revision (4.4% vs. 3.0%, OR 1.45, P=0.018) and 90-day readmission (8.0% vs. 4.4%, OR 1.41, P=0.006), and emergency department visits (18.4% vs. 11.1%, OR 1.33, P=0.001) when compared to those undergoing THA for OA.
Conclusion: Patients younger than 50 years old undergoing THA for ON experience increased post-surgical complications such as revision, dislocation, hospital readmission and emergency department visits compared to patients under 50 years old undergoing THA for OA. These findings provide insight for preoperative considerations for arthroplasty surgeons in this patient population.
Keywords: Hip osteoarthritis, Hip osteonecrosis, Total hip arthroplasty, Avascular necrosis, Implant survival, Clinical outcomes, Revision total hip arthroplasty

References

[1] Fontalis, Andreas et al. “Advances and innovations in total hip arthroplasty.” SICOT-J vol. 7 (2021): 26. doi:10.1051/sicotj/2021025
[2] Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007 Oct 27;370(9597):1508-19. doi: 10.1016/S0140-6736(07)60457-7. PMID: 17964352.
[3] Tripathy, Sujit Kumar et al. “Management of femoral head osteonecrosis: Current concepts.” Indian journal of orthopaedics vol. 49,1 (2015): 28-45. doi:10.4103/0019-5413.143911
[4] Hines, Jeremy T et al. “Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment.” Journal of Korean medical science vol. 36,24 e177. 21 Jun. 2021, doi:10.3346/jkms.2021.36.e177
[5] Mont, Michael A. MD1; Cherian, Jeffrey J. DO1; Sierra, Rafael J. MD2; Jones, Lynne C. PhD3; Lieberman, Jay R. MD4. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A Ten-Year Update. The Journal of Bone and Joint Surgery 97(19):p 1604-1627, October 7, 2015. | DOI: 10.2106/JBJS.O.00071
[6] Birla, Vikas et al. “Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head – A scoping review.” Journal of clinical orthopaedics and trauma vol. 23 101643. 13 Oct. 2021, doi:10.1016/j.jcot.2021.101643
[7] Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol. 2007 Jul;63(1):16-28. doi: 10.1016/j.ejrad.2007.03.019. Epub 2007 Jun 6. PMID: 17555906.
[8] Konarski, Wojciech et al. “Avascular Necrosis of Femoral Head-Overview and Current State of the Art.” International journal of environmental research and public health vol. 19,12 7348. 15 Jun. 2022, doi:10.3390/ijerph19127348
[9] Wen, Zeqin et al. “Global Trends and Current Status in Osteonecrosis of the Femoral Head: A Bibliometric Analysis of Publications in the Last 30 Years.” Frontiers in endocrinology vol. 13 897439. 15 Jun. 2022, doi:10.3389/fendo.2022.897439
[10] Cardín-Pereda, Adrián et al. “Osteonecrosis of the Femoral Head: A Multidisciplinary Approach in Diagnostic Accuracy.” Diagnostics (Basel, Switzerland) vol. 12,7 1731. 16 Jul. 2022, doi:10.3390/diagnostics12071731
[11] Zhang, Z., Chi, J., Driskill, E., Mont, M., Jones, L. C., & Cui, Q. (2023). Effect of Patient Age on Total Hip Arthroplasty Outcomes in Patients Who Have Osteonecrosis of the Femoral Head Compared to Patients Who Have Hip Osteoarthritis. In The Journal of Arthroplasty. Elsevier BV. https://doi.org/10.1016/j.arth.2023.12.029
[12] Lavernia, Carlos J, and Jesus M Villa. “Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: then and now.” Current reviews in musculoskeletal medicine vol. 8,3 (2015): 260-4. doi:10.1007/s12178-015-9290-y
[13] Mont, Michael A et al. “The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review.” The Journal of bone and joint surgery. American volume vol. 92,12 (2010): 2165-70. doi:10.2106/JBJS.I.00575
[14] Dima, Alina et al. “Association of common comorbidities with osteonecrosis: a nationwide population-based case-control study in Denmark.” BMJ open vol. 8,2 e020680. 8 Feb. 2018, doi:10.1136/bmjopen-2017-020680
[15] George, Gary, and Joseph M Lane. “Osteonecrosis of the Femoral Head.” Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews vol. 6,5 e21.00176. 1 May. 2022, doi:10.5435/JAAOSGlobal-D-21-00176
[16] Wei, Qijiao et al. “Symptomatic femoral head necrosis in patients with rheumatoid arthritis: A retrospective case-control study.” Immunity, inflammation and disease vol. 10,6 (2022): e633. doi:10.1002/iid3.633
[17] van Vollenhoven, Ronald F. “Sex differences in rheumatoid arthritis: more than meets the eye…” BMC medicine vol. 7 12. 30 Mar. 2009, doi:10.1186/1741-7015-7-12
[18] Goemaere, S et al. “Onset of symptoms of rheumatoid arthritis in relation to age, sex and menopausal transition.” The Journal of rheumatology vol. 17,12 (1990): 1620-2.
[19] Dargel, Jens et al. “Dislocation following total hip replacement.” Deutsches Arzteblatt international vol. 111,51-52 (2014): 884-90. doi:10.3238/arztebl.2014.0884
[20] Salman, Loay A et al. “The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis.” International orthopaedics vol. 47,12 (2023): 3043-3052. doi:10.1007/s00264-023-05761-6
[21] Yang, Scott et al. “Does osteonecrosis of the femoral head increase surgical and medical complication rates after total hip arthroplasty? A comprehensive analysis in the United States.” Hip international : the journal of clinical and experimental research on hip pathology and therapy vol. 25,3 (2015): 237-44. doi:10.5301/hipint.5000224
[22] Mallon, Charlotte et al. “Surgeons are deeply affected when patients are diagnosed with prosthetic joint infection.” PloS one vol. 13,11 e0207260. 28 Nov. 2018, doi:10.1371/journal.pone.0207260
[23] Cherian, Jeffrey J et al. “What Host Factors Affect Aseptic Loosening After THA and TKA?.” Clinical orthopaedics and related research vol. 473,8 (2015): 2700-9. doi:10.1007/s11999-015-4220-2
[24] Sax, Oliver C et al. “Osteoarthritis and Osteonecrosis in Total Hip Arthroplasty: 90-Day Postoperative Costs and Outcomes.” The Journal of arthroplasty vol. 36,7 (2021): 2343-2347. doi:10.1016/j.arth.2020.10.039
[25] Hoggard, Timothy M et al. “Outcomes Following Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Patients on Hemodialysis.” The Journal of bone and joint surgery. American volume vol. 104,Suppl 2 (2022): 90-94. doi:10.2106/JBJS.20.00352
[26] Alluri, Ram K et al. “Surgical research using national databases.” Annals of translational medicine vol. 4,20 (2016): 393. doi:10.21037/atm.2016.10.49
[27] Bolognesi MP, Habermann EB. Commercial Claims Data Sources: PearlDiver and Individual Payer Databases. JBJS 2022;104:15. https://doi.org/10.2106/JBJS.22.00607.

How to Cite this Article: Ramamurti P, Vennitti C, Gandhi S, Cui Q, Borsinger T. Total Hip Arthroplasty for Osteonecrosis in Patients Under 50 years old is Associated with an Increased risk of post-surgical Complications. Journal of Clinical Orthopaedics. July-December 2025;10(2):99-104.

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A Novel Technique of Talo-Cuneiform Arthrodesis Using Metallic Cage in Navicular Avascular Necrosis: A Short-term Retrospective Cohort Study of Three Cases

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.788

Open Access License: CC BY-NC 4.0

Submitted Date: 25 Jul 2025, Review Date:18 Aug 2025, Accepted Date: 05 Sep 2025 & Published Date: 10 Dec 2025

Author: Vivek Maurya [1], Girish Motwani [1], Ankit Jaiswal [1], Sachin Kale [2]

[1] Department of Orthopaedics, Suyog Hospital, Nagpur, Maharashtra, India.
[2] Department of Orthopaedics, Dr D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Vivek Maurya,
Department of Orthopaedics, Suyog Hospital, Nagpur, Maharashtra, India.
E-mail: vivek.vom@gmail.com

Abstract

Background: Avascular necrosis (AVN) of the navicular is a rare but debilitating condition that frequently results in collapse of the medial column and extensive bone loss in later stages. These structural deficits pose a major challenge for achieving reliable fusion with conventional techniques using just bone graft. This study dwells into the use of metallic cage to achieve talo-cuneiform arthrodesis as an alternative to conventional techniques allowing restoration of medial column alignment, maintenance of length, and provision of stable support to facilitate union in cases with substantial osseous defects.
Materials and Methods: This is a clinical, retrospective study, conducted at our institution from March 2021 to March 2024 on 3 patients with AVN of navicular. Diagnosis was made on radiographs and/or magnetic resonance imaging as well as clinical examination. Surgical fixation was individualized with the use of titanium metallic cages to fill the osseous defect and patients followed up for a mean period of 50 weeks (range: 49–50 weeks). Functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score as well as Foot and Ankle Outcome Score (FAOS). Radiological stability was assessed using weight-bearing radiographs on follow-up visits.
Results: The mean AOFAS, FAOS score improved from 48.7 and 42.3 preoperatively to 84.7 and 86 postoperatively indicating a significant improvement (P < 0.05) in functional outcomes. All patients had stable plantigrade foot and radiological stability after a mean 50 weeks follow-up.
Conclusion: The combination of titanium cages, autologous bone grafts, and angular stable screw-plate systems appears to offer a promising alternative to conventional surgical techniques for managing navicular AVN. This method ensures medial column length preservation and provides a stable environment for arthrodesis. Based on our study, we believe that this approach could be more effective than traditional methods, offering a better prognosis for patients with idiopathic AVN (Muller–Weiss syndrome), post-traumatic arthritis, or large bone defects following navicular neoplasm resection.
Keywords: Avascular necrosis of navicular, Navicular neoplasm, Talo-cuneiform arthrodesis, Muller–Weiss syndrome, Osseous defect.

References

1. Molina WF, Gushiken E, Martins GB, Heitzmann LG, Pimenta LS, Fonseca ED, et al. Müller-Weiss disease: The state of the art. J Foot Ankle 2024;18:156-65.
2. Angthong C, Younger ASE, Chuckpaiwong B, Harnroongroj T, Veljkovic A. A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm. Cartilage. 2024 Mar;15(1):65-71. doi: 10.1177/19476035231205684. Epub 2023 Oct 18. PMID: 37850567; PMCID: PMC10985398.
3. Mohamed Z, Msakni A, Boussetta R, Mohseni AA, Nessib MN. Primary subacute hematogenous osteomyelitis of navicular bone: A rare case report in 7-year-old child. Ann Med Surg 2021;71:102911.
4. Cristofaro C., “Clinical Features and Differential Diagnosis of Müller-Weiss Disease,” Foot and Ankle Clinics, vol. 29, no. 3, 2024, p. S1083-7515(24)00215-8.
5. Kitaura Y, Nishimura A, Nakazora S, Fukuda A, Senga Y, Kato K, et al. Spontaneous osteonecrosis of the tarsal navicular: A report of two cases. Case Rep Orthop 2019;2019:5952435.
6. Adams SB, Danilkowicz RM. Talonavicular joint-sparing 3D printed navicular replacement for osteonecrosis of the navicular. Foot Ankle Int 2021;42:1197-204.
7. Claes L, Eckert-Hübner K, Augat P. The fracture gap size influences the local vascularization and tissue differentiation in callus healing. Langenbecks Arch Surg 2003;388:316-22.
8. Kadakia RJ, Wixted CM, Allen NB, Hanselman AE, Adams SB. Clinical applications of custom 3D printed implants in complex lower extremity reconstruction. 3D Print Med 2020;6:29.
9. Ahmed AA, Kandil MI, Tabl EA, Elgazzar AS. Müller-Weiss disease: A topical review. Foot Ankle Int 2019;40:1447-57.
10. Pei, Y., Zhu, L., Xu, Q., Wang, J., Sun, Y. & Wang, G. (2024). Clinical report of microsurgical treatment of Kohler’s disease. Scientific Reports, 14, Article 6341.
11. Wong-Chung J., Blythe A., Lynch-Wong M., McKenna R., Wilson A., Stephens M. Outcomes of Selective Arthrodesis Based on Joints Affected in 33 Feet With Müller-Weiss Disease. Journal of Foot & Ankle Surgery. 2024 Mar-Apr; 63(2):199-206.
12. Higgs, Z., & Senthil Kumar, C. “Principles of Arthrodesis Surgery in Müller–Weiss disease – The Scottish Experience.” Foot & Ankle Clinics, 2025 Apr 4. DOI: 10.1016/j.fcl.2024.08.008.
13. Bai W, Li Y, Shen G, Zhang H, Li X, Zhu Y. Talonavicular-cuneiform arthrodesis for the treatment of Müller-Weiss: Mid-term results of 15 cases after 5 years. BMC Musculoskelet Disord 2023;24:178.
14. So E, Mandas VH, Hlad L. Large osseous defect reconstruction using a custom three-dimensional printed titanium truss implant. J Foot Ankle Surg 2018;57:196-204.
15. Freibott CE, Shoap SC, Evangelista MC, Vosseller JT, Greisberg JK. Graft Collapse and Loss of Fixation in Lateral Column Lengthening. Foot Ankle Orthop. 2019 Nov 1;4(4):2473011419S00177. doi: 10.1177/2473011419S00177. PMCID: PMC8696428.
16. Bulut, HI, Okay E, Onay T, Kanay E, Ozkan K. Innovative approaches to cage reconstructions in orthopedic limb surgery: Advances and insights with two cases. Surg Case Rep 2024;3:100073.
17. Patil SD, Kakkar RS, Saxena S, Patil PD. Reconstruction of large midfoot bone loss using titanium spinal mesh cage with bone graft: A case report. Orthoplastic Surg 2022;9:106-10
18. Noble DM, Small B, Cooper MT, Park JS, Perumal V. Porous Titanium Wedges in Revision First Metatarsophalangeal Arthrodesis. Foot Ankle Orthop. 2022 Jan 21;7(1):2473011421S00378. doi: 10.1177/2473011421S00378. PMCID: PMC8794974.
19. Uzer G, Demirel M, Kara D, Toker B, Yildiz F, Ucan V. Talonavicular-cuneiform arthrodesis in the management of Mueller-Weiss syndrome: A retrospective case series. Acta Orthop Belg 2024;90:154-9.
20. Cao HH, Lu WZ, Tang KL. Isolated talonavicular arthrodesis and talonavicular-cuneiform arthrodesis for the Müller-Weiss disease. J Orthop Surg Res 2017;12:83.

How to Cite this Article: Maurya V, Motwani G, Jaiswal A, Kale S. A Novel Technique of Talo-Cuneiform Arthrodesis Using Metallic Cage in Navicular Avascular Necrosis: A Short-term Retrospective Cohort Study of Three Cases. Journal of Clinical Orthopaedics. July-December 2025;10(2):90-98.

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Comparative Study of Core Decompression with Autologous Iliac Crest Bone Graft Versus Bone Marrow Infiltration in Osteonecrosis of Femoral Head

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.786

Open Access License: CC BY-NC 4.0

Submitted Date: 26 Aug 2025, Review Date: 12 Sep 2025, Accepted Date: 27 Oct 2025 & Published Date: 10 Dec 2025

Author: Manish Kumar Yadav [1], O.P Lakhwani [1], Rajan Kumar Kaushal [1], Sathyendra KG [1], Venkatesh Kumar S [2], Sanjay Singh Rawat [2]

[1] Department of Orthopaedics , ESI-PGIMSR,Hospital Basaidarapur, New Delhi-110015
[2] Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College And Hospital, Siruvachur, Perambalur – 621 113. Tamilnadu, India

Address of Correspondence

Dr. Dr. Sathyendra KG,
Senior Resident, Department of Orthopaedics , ESI-PGIMSR,Hospital Basaidarapur, New Delhi-110015
E-mail: drsathyendrakg@gmail.com

Abstract

Background: We intend to determine the difference in outcome of core decompression with autologous iliac crest bone graft versus bone marrow infiltration in avascular necrosis (AVN) of femoral head.
Materials and Methods: Stage II, III of Ficat and Arlet of AVN of femoral head evaluated clinically and radiologically before getting included into this study. A minimum of 20 cases were studied after clearance from the Ethics committee.
Results: In our study, the mean HHS were statistically significant differences between the groups at 3 months and 6 months (P <0.05). At 3 months, the mean Visual Analog Scale (VAS) was 5.7 in Group A and 4.3 in Group B. At the end of the study (6 months), the mean VAS was 4.9 in group A and 2.7 in Group B. However, there were statistically significant differences between the groups at 3 months and 6 months (P < 0.05). Stage III X-ray finding was most common in Group a (63.6%) at pre-operative, and Stage II was most common in Group B (63.6%) at pre-operative. A similar finding was found at 6 months post-operative. Stage III magnetic resonance imaging (MRI) finding was most common in Group a (63.6%) at pre-operative and Stage II was most common in Group B (63.6%) at pre-operative. There was no significant difference (P > 0.05) in MRI and X-ray findings at pre-operative and 6 months between the groups.
Conclusion: We conclude that core decompression with bone marrow infiltration is better to iliac crest bone graft because of better HHS and VAS at 6 months in Stage II, III of Ficat and Arlet of AVN of femoral head.
Keywords: Osteonecrosis of femoral head, Core decompression, Autologous iliac crest bone graft, Bone marrow infiltration, Harris Hip Score

References

1. Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment. EFORT Open Rev 2019;4:85-97.
2. Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop 2015;6:590-601.
3. Musso ES, Mitchell SN, Schink-Ascani M, Bassett CA. Results of conservative management of osteonecrosis of the femoral head. A retrospective review. Clin Orthop Relat Res 1986;207:209-15.
4. Atilla B, Bakırcıoğlu S, Shope AJ, Parvızı J. Joint-preserving procedures for osteonecrosis of the femoral head. EFORT Open Rev 2020;4:647-58.
5. Babhulkar S. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting. Indian J Orthop 2009;43:27-35.
6. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: Ten years later. J Bone Joint Surg Am 2006;88:1117-32.
7. Wu ZY, Sun Q, Liu M, Grottkau BE, He ZX, Zou Q, et al. Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability. BMC Musculoskelet Disord 2020;21:55.
8. Kangari P, Talaei-Khozani T, Razeghian-Jahromi I, Razmkhah M. Mesenchymal stem cells: Amazing remedies for bone and cartilage defects. Stem Cell Res Ther 2020;11:492.
9. Sen RK, Tripathy SK, Aggarwal S, Marwaha N, Sharma RR, Khandelwal N. Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: A randomized control study. J Arthroplasty 2012;27:679-86.
10. Shukla BB, Malviya D, Kumar S, Misra S, Kumar S, Parashar S. Comparative evaluation of Visual Analog Scale and pupillary diameter for post-operative pain: An observational study. Indian J Anaesth 2023;67:S93-8.
11. Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol 2006;186:1761-70.
12. Stroie OM, Vu VH. Osteonecrosis imaging. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK604199 Accessed 26 November 2025.
13. Karimi M, Moharrami A, Vahedian Aedakani M, Mirghaderi SP, Ghadimi E, Mortazavi SJ. Predictors of core decompression success in patients with femoral head avascular necrosis. Arch Bone Jt Surg 2023;11:517-23.
14. Shiravani Brojeni S, Hesarikia H, Rahimnia A, Emami Meybodi MK, Rahimnia A. Treatment of femoral head osteonecrosis (stages 2b, 3 ficat) through open direct core decompression by allograft impaction and light bulb technique. Arch Bone Jt Surg 2020;8:613-9.

How to Cite this Article: Yadav MK, Lakhwani OP, Kaushal RK, Sathyendra KG, Venkatesh Kumar S, Sanjay Singh Rawat. Comparative Study of Core Decompression with Autologous Iliac Crest Bone Graft Versus Bone Marrow Infiltration in Osteonecrosis of Femoral Head. Journal of Clinical Orthopaedics. July-December 2025;10(2):85-89.

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Utilization of Packed Cell and Whole Blood in Patients with Femur Fracture in a Tertiary Care Center: A Retrospective Study of 45 Cases

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.784

Open Access License: CC BY-NC 4.0

Submitted Date: 19 Sep 2025, Review Date: 23 Sept 2025, Accepted Date: 24 Oct 2025 & Published Date: 10 Dec 2025

Author: Sanjay Surase [1], Bharat Ghodke [1], Sumedha Shinde [1], Priya Borkar [1]

[1] Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Priya Borkar,
Department of Pathology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai – 400008, Maharashtra, India.
E-mail: priyaborkar921@gmail.com

Abstract

Background: Femur fractures are often associated with substantial blood loss, necessitating timely transfusion support. Optimizing the use of whole blood (WB) and packed red blood cells (PRBC) is essential for effective management in tertiary care settings.
Materials and Methods: This retrospective observational study was conducted at a tertiary care center and included 45 patients aged ≥18 years with radiologically confirmed femur fractures admitted between July 2022 and June 2023. Data were obtained from hospital records, and the blood bank registers. Data include demographics, blood group, and transfusion details.`
Results: The study included 27 males (60.0%) and 18 females (40.0%), with a mean age of 46.1 ± 17.9 years. The most common blood groups were B+ (35.6%), O+ (31.1%), and A+ (24.4%). A total of 25 patients (55.6%) received WB and 27 (60.0%) received PRBC; of these, 20 (44.4%) received only PRBC, 18 (40.0%) only WB, and 7 (15.6%) both components. WB transfusions totaled 46 units (mean 1.67 ± 0.95/patient), while PRBC accounted for 50 units (mean 2.05 ± 1.12/patient). The highest WB utilization was in B+ patients (14 units), whereas O+ patients required the most PRBC (18 units). All patients (100%) required transfusion during hospitalization.
Conclusion: PRBC was the predominant transfusion modality in femur fracture patients, with higher utilization than WB. The predominance of B+ and O+ groups underscores the need for targeted inventory management. These findings support evidence‐based transfusion protocols and optimized resource planning in orthopedic emergencies.
Keywords: Femur fracture, Blood transfusion, Packed red blood cells, Whole blood, Blood utilization

References

1. Agarwal-Harding KJ, Meara JG, Greenberg SL, Hagander LE, Zurakowski D, Dyer GS. Estimating the global incidence of femoral fracture from road traffic collisions: A literature review. J Bone Joint Surg Am 2015;97:e31.
2. Njoroge CN, Ramadhani AB, Cherop LT. Blood loss and transfusion during open femur fracture surgeries at Moi teaching and referral hospital, eldoret, Kenya. Int J Sci Res Publ 2024;14:207-20.
3. Dim EM, Ugbeye ME, Ugwoegbulem OA. Adult traumatic femoral shaft fractures: A review of the literature. Ibom Med J 2012;5:26-38.
4. Stevenson JD, Wall C, Patel A, Lim J. Multiple myeloma: A review. Orthop Trauma 2014;28:187-93.
5. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32 Suppl 1:S1-170.
6. Cai J, Tang M, Wu H, Yuan J, Liang H, Wu X, et al. Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis. Heliyon 2023;9:e15997.
7. Giribabu P, Karan N, Sriganesh K, Shukla D, Devi BI. Incidence, risk factors and impact of anemia after elective neurosurgery: A retrospective cohort study. World Neurosurg X 2024;22:100289.
8. Soleimani MA, Bastani F, Negarandeh R, Greysen R. Perceptions of people living with Parkinson’s disease: A qualitative study in Iran. Br J Community Nurs 2016;21:188-95.
9. Brecher ME, Monk T, Goodnough LT. A standardized method for calculating blood loss. Transfusion 1997;37:1070-4.
10. Gerdessen L, Meybohm P, Choorapoikayil S, Herrmann E, Taeuber I, Neef V, et al. Comparison of common perioperative blood loss estimation techniques: A systematic review and meta-analysis. J Clin Monit Comput 2021;35:245-58.
11. Yaddanapudi S, Yaddanapudi LN. Indications for blood and blood product transfusion. Indian J Anaesth 2014;58:538-42.
12. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011;365:2453-62.
13. Yudelowitz B, Scribante J, Perrie H, Oosthuizen E. Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital. Health SA Gesondheid 2016;21:309-14.
14. Lotterman S, Sharma S. Blood transfusion. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2025.
15. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, De Jonge S, De Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis 2016;16:e288-303.
16. Park J, Kwon J, Lee SH, Lee JH, Min JJ, Kim J, et al. Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery. PLoS One 2021;16:e0241114.
17. Shekhar L, Salphale Y. Analysis of factors influencing true blood loss in navigated total knee replacements. Surg Sci 2019;10:59-69.
18. Mistry PK, Gaunay GS, Hoenig DM. Prediction of surgical complications in the elderly: Can we improve outcomes? Asian J Urol 2017;4:44-9.
19. Gupta D, Kushwaha NK, Gupta V. A prospective study of the patients, commonly elderly people of complex proximal femur fractures, in North India tertiary teaching hospital. Int J Orthop Sci 2021;7:219-21.
20. Baghdadi S, Kiyani M, Kalantar SH, Shiri S, Sohrabi O, Beheshti Fard S, et al. Mortality following proximal femoral fractures in elderly patients: A large retrospective cohort study of incidence and risk factors. BMC Musculoskelet Disord 2023;24:693.
21. Trincado RM, Mori MA, Fernandes LS, Perlaky TA, Hungria JO. Epidemiology of proximal femur fracture in older adults in a philanthropical hospital in São Paulo. Acta Ortop Bras 2022;30:e255963.
22. Jang SY, Cha YH, Yoo JI, Oh T, Kim JT, Park CH, et al. Blood transfusion for elderly patients with hip fracture: A nationwide cohort study. J Korean Med Sci 2020;35:e313.
23. Xie X, Huang Y, Huang X, Gui R. Multi-center retrospective study of factors affecting perioperative transfusion of packed red blood cells for pelvic fracture patients. Orthop Surg 2022;14:1778-89.
24. Giri PA, Yadav S, Parhar GS, Phalke DB. Frequency of ABO and Rhesus blood groups: A study from a rural tertiary care teaching hospital in India. Int J Biol Med Res 2011;2:988-90.
25. Jaff MS. ABO and rhesus blood group distribution in kurds. J Blood Med 2010;1:143-6.

How to Cite this Article: Surase S, Ghodke B, Shinde S, Borkar P. Utilization of Packed Cell and Whole Blood in Patients with Femur Fracture in a Tertiary Care Center: A Retrospective Study of 45 Casess. Journal of Clinical Orthopaedics. July-December 2025;10(2):79-84.

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Low-level Laser Therapy in Knee Osteoarthritis: A Prospective Analytical Study

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.782

Open Access License: CC BY-NC 4.0

Submitted Date: 29 Jul 2025, Review Date: 10 Sep 2025, Accepted Date: 18 Oct 2025 & Published Date: 10 Dec 2025

Author: V Sriram [1], K K Nrupathunga [2], L Sachin Patel [3]

[1] Department of Orthopaedics, East Point Medical College, Bengaluru, Karnataka, India,
[2] Department of Orthopaedics, BGS MCH Hospital, Bengaluru, Karnataka, India,
[3] Department of Orthopaedics, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, India

Address of Correspondence

Dr. L Sachin Patel,
Assistant Professor, Department of Orthopaedics, PES University Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
E-mail: spatel.bl@gmail.com

Abstract

Background/Aims: Osteoarthritis (OA) is the second common rheumatologic disorder and the most prevalent joint disease in India, affecting 20–40% of the population. Low-level laser therapy (LLLT) has been used to alleviate pain in musculoskeletal conditions. Despite the fact that LLLT is extensively used, the consequences from both experimental and medical research continue to be inconsistent. This study aims to assess the pain-relieving effectiveness of LLLT in patients with Kellgren–Lawrence Grade I and II knee OA, using the Visual Analog Scale (VAS) and the Western Ontario McMaster Osteoarthritis Index (WOMAC).
Materials and Methods: The study was carried out at a tertiary care center in Bengaluru. Fifty patients were recruited primarily based on the following inclusion criteria:
1. Idiopathic knee OA
2. Grade I or II bilateral knee OA confirmed by X-ray
3. Average pain intensity of 40 or greater on a 100-mm VAS
4. Age: 45–65 years, of both sexes.
Patients attended weekly therapy sessions. Each session included isometric quadriceps muscle contractions and 10 repetitions of active range of motion exercises for the knee joint, following a 5-min LLLT application.
Results: On X-ray, 52% (22 patients) had Grade I OA knee, and 48% (20 patients) had Grade II OA knee. There was a significant reduction in VAS and WOMAC post-treatment scores compared to pre-treatment.
Conclusion: OA is a long-term, degenerative condition that causes deterioration of joint tissues, resulting in excessive pain, stiffness, and restricted mobility. Treatment strategies for OA continue to be crucial for research. Our study suggests a widespread improvement in pain alleviation with LLLT. Further studies are needed to compare the efficacy of LLLT with other pain management strategies and explore combined treatment plans.
Keywords: Low-level Laser, OA knee, VAS, WOMAC

References

1. Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, et al. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res (Hoboken) 2013;65:703-11.
2. Hutton CW. Osteoarthritis: The cause not result of joint failure? Ann Rheum Dis 1989;48:958-61.
3. Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull 2013;105:185-99.
4. Scheiman JM. Gastrointestinal toxicity caused by NSAIDs is the most frequent drug side effect in the US. Gastroenterol Clin North Am 1996;25:279-98.
5. Cheing GL, Hui-Chan CW, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil 2002;16:749-60.
6. Talbot LA, Gaines JM, Ling SM, Metter EJ. A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee. J Rheumatol 2003;30:1571-8.
7. Kozanoglu E, Basaran S, Guzel R, Guler-Uysal F. Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Med Wkly 2003;133:333-8.
8. Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: A randomized, controlled trial. Ann Int Med 2000;132:173-81.
9. Oral A, Ilieva EM, Küçükdeveci AA, Varela E, Valero R, Berteanu M, et al. Local soft tissue musculoskeletal disorders and injuries. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM section professional practice committee. Eur J Phys Rehabil Med 2013;49:727-42.
10. Özdemir F, Birtane M, Kokino S. The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis. Clin Rheumatol 2001;20:181-4.
11. Simunovic Z, Trobonjaca T, Trobonjaca Z. Treatment of medial and lateral epicondylitis–tennis and golfer’s elbow–with low level laser therapy: A multicenter double blind, placebo-controlled clinical study on 324 patients. J Clin Laser Med Surg 1998;16:145-51.
12. Haker EH, Lundeberg TC. Lateral epicondylalgia: Report of noneffective midlaser treatment. Arch Phys Med Rehabil 1991;72:984-8.
13. Vecchio P, Cave M, King V, Adebajo AO, Smith M, Hazleman BL. A double-blind study of the effectiveness of low level laser treatment of rotator cuff tendinitis. Rheumatology 1993;32:740-2.
14. Goats GC, Hunter JA, Flett E, Stirling A. Low intensity laser and phototherapy for rheumatoid arthritis. Physiotherapy 1996;82:311-20.

How to Cite this Article: Sriram V, Nrupatunga KK, Patel SL. Low-level Laser Therapy in Knee Osteoarthritis: A Prospective Analytical Study. Journal of Clinical Orthopaedics. July-December 2025;10(2):76-88.

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Use of Limb Reconstruction External Fixator as a Definitive option in Management of Grade II and Grade III Compound Long Bone Fractures

December 10, 2025/in Vol 10 | Issue 2 | July-December 2025 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.780

Open Access License: CC BY-NC 4.0

Submitted Date: 18 Sep 2025, Review Date: 25 Oct 2025, Accepted Date: 13 Nov 2025 & Published Date: 10 Dec 2025

Author: Rajan Kumar Kaushal [1], O P Lakhwani [1], K G Sathyendra [1], Manish Kumar Yadav [1], Pushprajan Chauhan [2], S Venkatesh Kumar [3]

[1] Department of Orthopaedics, ESI-PGIMSR, Hospital Basaidarapur, New Delhi, India,
[2] Department of Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India,
[3] Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu, India

Address of Correspondence

Dr. K G Sathyendra,
Department of Orthopaedics, ESI-PGIMSR, Hospital Basaidarapur, New Delhi-110015, India.
E-mail: drsathyendrakg@gmail.com

Abstract

Background: We intend to determine the utility of the limb reconstruction external fixator as a definitive tool in managing grade II and grade III compound long bone fractures.
Materials and Methods: All patients with Grade II and Grade III complex long bone fractures were evaluated clinically and radiologically before inclusion in this prospective observational cohort study. A minimum of 20 cases were studied after clearance from the Ethics Committee.
Results: In our study, there is a variable wound healing time, with 20% of patients getting their wound healed within 4 weeks and 80% of patients getting their wound healed within 12 weeks. The mean wound healing time was 9.45 ± 5.78 weeks. 18 patients (90%) in the study showed signs of radiological union with a radiographic union scale in tibial fracture score of 2 or 3. Mean bone union time was 18.11 ± 5.24 weeks after injury. According to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system, the bone results were excellent in 14 (70%) patients, good in 3 (15%) patients, fair in 1 (5%) patient, and poor in 2 (10%) patients. The functional results as per the ASAMI scoring system were excellent in 13 (65%) patients, good in 6 (30%) patients, and poor in 1 (5%) patient. In our study, 11 patients did not encounter any complications. The common complication was pin tract infections. Limb shortening was observed in 45% of patients. 85% of patients had insignificant limb shortening and did not require a shoe raise.
Conclusion: In our study, we achieved excellent to good results in our series by using the limb reconstruction system type of external fixator with fracture union in all the patients in our study. Limb reconstruction external fixators can be used as definitive tools in managing grade II and grade III compound long bone fractures.
Keywords: Limb reconstruction external fixator, grade II and grade III compound long bone fractures, wound healing time, association for the study and application of the methods of ilizarov scoring system, complication.

References

1. Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. Clin Orthop Relat Res 2012;470:3270-4.
2. Jindal R, Dhillon M, Mittal N, Aggarwal A, Malhotra A, Garg SK. Gaps in the care of open fractures: An Indian scenario. Indian J Orthop 2021;56:280-8.
3. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury 1998;29:529-34.
4. Hoit G, Bonyun M, Nauth A. Hardware considerations in infection and nonunion management: When and how to revise the fixation. OTA Int 2020;3:e055.
5. Costa FC, Reis JM, Reis SP, Bartelega LA, Melo NF, Araújo CD. Epidemiology of open fractures and degree of satisfaction of initial care. Acta Ortop Bras 2022;30:e245221.
6. Elseth A, Nunez Lopez O. Wound grafts. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564382 [Last accessed on 2025 Jul 05].
7. Gessmann J, Citak M, Jettkant B, Schildhauer TA, Seybold D. The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: Tensioned wires vs. half-pins. J Orthop Surg Res 2011;6:61.
8. Cross WW 3rd, Swiontkowski MF. Treatment principles in the management of open fractures. Indian J Orthop 2008;42:377-86.
9. Dheenadhayalan J, Nagashree V, Devendra A, Velmurugesan PS, Rajasekaran S. Management of open fractures: A narrative review. J Clin Orthop Trauma 2023;44:102246.
10. Cho SK, Mattke S, Gordon H, Sheridan M, Ennis W. Development of a model to predict healing of chronic wounds within 12 weeks. Adv Wound Care (New Rochelle) 2020;9:516-24.
11. Patil MY, Gupta SM, Kurupati SK, Agarwal S, Chandarana V. Definitive management of open tibia fractures using limb reconstruction system. J Clin Diagn Res 2016;10:RC01-4.
12. Gokul Nath R, Shabi AV. Orthofix in management of compound tibia fractures: A prospective study. MedPulse Int J Orthop 2017;3:8-12.
13. Ajmera A, Verma A, Agrawal M, Jain S, Mukherjee A. Outcome of limb reconstruction system in open tibial diaphyseal fractures. Indian J Orthop 2015;49:429-35.
14. Mahajan NP, Mangukiya HJ. Extended use of limb reconstruction system in management of compound tibia diaphyseal fracture as primary and definitive tool. Int J Res Orthop 2017;3:1157-64.
15. Pal CP, Kumar H, Kumar D, Dinkar KS, Mittal V, Singh NK. Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators. Chin J Traumatol 2015;18:347-51.
16. Tekin AÇ, Saygılı MS, Adaş M, Çabuk H, Arslan SM, Dedeoğlu SS. Outcome of type 3 open tibial diaphyseal fractures managed with a limb reconstruction system: Analysis of a 49-patient cohort. Med Princ Pract 2016;25:270-5.
17. Aslan A, Uysal E, Özmeriç A. A staged surgical treatment outcome of type 3 open tibial fractures. ISRN Orthop 2014;2014:721041.
18. Gill SP, Raj M, Kumar S, Singh P, Kumar D, Singh J, et al. Early conversion of external fixation to interlocked nailing in open fractures of both bone leg assisted with vacuum closure (VAC)-Final outcome. J Clin Diagn Res 2016;10:RC10-4.

How to Cite this Article: Kaushal RK, Lakhwani OP, Sathyendra KG, Yadav MK, Pushprajan, Kumar SV. Use of Limb Reconstruction External Fixator as a Definitive Option in Management of Grade II and Grade III Compound Long Bone Fractures. Journal of Clinical Orthopaedics. July-December 2025;10(2):70-75.

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Author: J S R G Saran [1], Varun Devdass [1], Durai Anand [1]

Author: Ahmed A. Khalifa [1, 2], Muhammad Khair Al Muhammad [2]

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Author: Manish Kumar Yadav [1], O.P Lakhwani [1], Rajan Kumar Kaushal [1], Sathyendra KG [1], Venkatesh Kumar S [2], Sanjay Singh Rawat [2]

Author: Sanjay Surase [1], Bharat Ghodke [1], Sumedha Shinde [1], Priya Borkar [1]

Author: V Sriram [1], K K Nrupathunga [2], L Sachin Patel [3]

Author: Rajan Kumar Kaushal [1], O P Lakhwani [1], K G Sathyendra [1], Manish Kumar Yadav [1], Pushprajan Chauhan [2], S Venkatesh Kumar [3]

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