Radiological and functional assessment of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach: a hospital-based observational study

Background: Tibial shaft fractures are among the most frequently encountered long bone injuries. Due to limited soft tissue coverage and subcutaneous location, the tibia is prone to complications such as non-union, infection and malalignment. The suprapatellar approach for intramedullary nailing has recently gained favour for its potential benefits over the traditional infrapatellar method, reducing anterior knee pain and facilitating easier intraoperative imaging. The aim of this study was to assess the radiological and functional outcome of closed tibial shaft fractures treated with interlocking nails through suprapatellar approach. Methods: This prospective observational study was conducted in the Department of Orthopaedics, National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh, from March 2022 to March 2023. Total 33 patients with closed tibial shaft fractures were included in the study. Results: The study included 33 patients (mean age 38.3±11.6 years), predominantly male (69.7%). Right-sided fractures were more common (60.6%). Most injuries (81.8%) were due to motor vehicle accidents. AO type 42A fractures were most frequent (54.5%). Anterior knee pain was minimal, with a mean VAS of 0.5. Radiological union occurred in 90.9% within 21 weeks (mean 17.9±3.5). Complications were rare (12.1%). Most patients achieved a ROM of 130–139°, with fair to good functional outcomes in over 90% of cases. Conclusions: Suprapatellar nailing offers a reliable and minimally painful solution for managing closed tibial shaft fractures with favourable radiological and functional outcomes

Clinical and functional outcomes of proximal femoral nailing in proximal femur fractures: a prospective study of 100 cases

Background: Intertrochanteric fractures are common in elderly osteoporotic patients and carry high morbidity and mortality if not treated adequately. Proximal femoral nailing (PFN) has been developed to overcome limitations of extramedullary fixation devices. Objectives were to evaluate functional and radiological outcomes of PFN in proximal femur fractures. Methods: A prospective study of 100 patients with intertrochanteric femur fractures was conducted between March 2022 and July 2024. Patients were treated with PFN and followed up for 6-18 months. Functional outcome was assessed using the Harris hip score (HHS). Results: The mean patient age was 648. years (28-95 years). Left-sided fractures (57%) were more common than right (43%). 68% fractures were unstable (Evan’s classification). Average interval from injury to surgery was 42 days, mean operative time 85 minutes. At one-year follow-up, 66% had excellent, 19% good, 10% fair, and 5% poor outcomes (mean HHS: 8882.). Complications occurred in 15% cases. No non-union was observed. Conclusions: PFN is a reliable fixation method for intertrochanteric fractures, offering stable fixation, early mobilization, and favorable functional outcomes with minimal complications

Effectiveness and cost-utility of lumbar facet joint blocks using bupivacaine with and without steroid in the treatment of chronic low back pain in adults

Background: Chronic low back pain (LBP) causes lot of pain and suffering thus contributing to frequent and increased cost and burden on health-care-facilities. In United Kingdom, it has been estimated that economic cost of LBP pain is around £12.3B per annum. It is also associated with increased incidence of depression, anxiety. These morbidities also lead to increased costs for patient. To study effectiveness and cost-utility of lumbar facet joint blocks using bupivacaine with and without steroid in the treatment of chronic LBP in adults. Methods: Hospital-based randomized comparative study was carried out among 100 adult cases of chronic LBP. They were randomly assigned as 50 cases treated with bupivacaine without steroids and 50 cases treated with bupivacaine with steroids. Modified oswestry disability index was used to assess functional improvement and visual analogue scale to assess pain score. Patient data was used to assess cost-utility. Results: Patients in group-II were significantly older, had more pain duration than group-I. Incidence of repeat procedure required was more in group-I compared to group-II (p<0.05). The functional level in both groups was comparable (p>0.05) at baseline. At one, three, six and twelve months, it improved more significantly in group-II compared to group-I (p<0.05). At baseline, pain score was significantly more in group-II compared to group-I (p<0.05). But, at one, three, six and twelve months, it was significantly lesser in group-II compared to group-I (p<0.05). Patients in both groups were comparable for physician cost and facility cost. But total number of procedures and average number of treatments per patient were lesser in group-II compared to group-I. Conclusions: Thus, we conclude that bupivacaine with steroids is not only effective in relief of pain and returning normal functionality, but also cost-effective compared to bupivacaine without steroid in adult patients with chronic LBP

Age, gender, and site-specific variations in bone mineral density: a cross-sectional analysis of osteoporosis risk factors

Background: Osteoporosis is major health issue defined by decreased bone mineral density (BMD) and elevated fracture susceptibility. This study aimed to analyze age, gender, and site-specific variations in BMD and examine osteoporosis risk factors in an Indian population. Methods: This study was conducted with cross sectional design on 77 participants (54 females, 23 males) aged 20-83 years undergoing 3 Dimensional quantitative computed tomography (QCT) for BMD assessment at a tertiary care hospital in India. BMD measurements of the spine and bilateral hips were analyzed along with demographic and clinical data. Statistical analyses included t-tests, multivariate logistic regression, correlation analysis, and Chi-square tests. Results: The study revealed a high prevalence of osteoporosis (55.8%) and osteopenia (27.3%). Marked disparities in spine bone mineral density were noted between genders (p=0.023) and among age cohorts (p<0.0001). Age showed moderate negative relationship with spine BMD (r=-0.552, p<0.0001) and was recognized as a major predictor of osteoporosis (p<0.0001). Gender was not a significant predictor of osteoporosis after adjusting for age in our study. Conclusions: This study highlights the critical role of age in BMD reduction and osteoporosis risk, with older individuals showing higher rates of osteoporosis. While gender differences in BMD were observed, age emerged as the primary predictor of osteoporosis risk. These findings emphasize the importance of age-related assessments in osteoporosis screening and management strategies

Rare cause of neck pain and gait imbalance: a case report

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon cause of neck pain and radiculopathy that can be easily misdiagnosed. The lack of diagnostic criteria makes the diagnosis of such cases challenging. However, the correlation between clinical presentation with laboratory and radiological findings can help diagnose these patients. Surgical decompression is rarely indicated in the absence of any cause of neuronal compression. Medical treatment of CIDP is currently the main line of treatment. We are presenting a case of a 32-year-old male with no known medical conditions who presented to our spine clinic with a history of chronic neck pain associated with gradual and progressive left upper limb weakness and imbalance. Clinical imaging showed hypertrophied nerve roots of the cervical spine. The patient was treated with intravenous immunoglobulins and corticosteroids, which improved his symptoms significantly

Clinical and radiological outcome of minimally invasive plate osteosynthesis in distal tibial fractures: a retrospective analysis

Background: Distal tibial fractures are a common injury that poses challenges in terms of treatment and outcomes. Minimally invasive plate osteosynthesis (MIPO) has emerged as a promising technique, reducing the need for large incisions while promoting faster recovery and fewer complications compared to traditional open reduction and internal fixation (ORIF). This study evaluates the clinical and radiological outcomes of MIPO in patients with distal tibial fractures. Methods: A retrospective analysis of 40 patients who underwent MIPO for distal tibial fractures between November 2022 and November 2024 at a Tertiary healthcare center, was conducted. Fractures were classified according to the AO/OTA system. Outcomes such as fracture healing, functional recovery (measured using the AOFAS score), pain relief (assessed via the VAS), and complication rates were evaluated. Statistical analysis was performed using SPSS version 25, with p<0.05 considered significant. Results: The mean age of the patients was 42.5±12.3 years. The majority of fractures were classified as type 43-A (70%). Fracture healing was achieved in 95% of cases by 24 weeks, with a mean time to union of 14.3±3.2 weeks. The AOFAS scores improved significantly from 72.5±13.1 at 6 weeks to 85.2±10.3 at 12 weeks (p<0.05). Pain reduction was also significant, with VAS scores decreasing from 6.25±2.14 at 6 weeks to 1.56±1.26 at 24 weeks (p<0.05). Complications were noted in 10% of cases, including superficial infection and delayed union. Conclusions: MIPO offers favourable outcomes in the treatment of distal tibial fractures, with significant improvements in fracture healing, functional recovery, and pain reduction. The technique is associated with a low complication rate, making it a viable option for managing these fractures

Transthoracic discectomy for a rare presentation of calcified dorsal disc herniation

Thoracic disc herniation is rare entity, with incidence of 0.5%-4% of all disc herniation. Mostly are asymptomatic and does not need treatment if symptomatic cause intractable pain, intercostal neuralgia, persistent axial back pain and myelopathic symptom need surgical excision. We present a case of 74-year female with central calcified dorsal disc herniation at T11-12 level. surgical excision done by transthoracic discectomy

A case report of rare incidence of benign vascular lesion of hand masquerading magnetic resonance imaging findings

Vascular anomalies of hand can present as soft tissue swelling and can be one of differential along with the common ones’ ganglion cyst, giant cell tumor (GCT), and epidermoid cyst. It can be hemangioma or vascular malformation, they differ based on histological, clinical and biological characteristics. A 65-year-old male presented with swelling in right little finger dorsal part since one month. It was insidious in onset and not associated with pain or trauma. Vascular lesions of hand should be kept in mind as one of differential while examining swellings of hand. Initial investigation like ultrasonography (USG), X ray, magnetic resonance imaging (MRI) and fine needle aspiration cytology (FNAC) should always be followed by excisional histopathology for confirmation and labelling the diagnosis.

The study of functional outcome of k-wire fixation with link joints in proximal humerus fractures

    Background: Proximal humeral fractures are the common type of osteoporotic fractures seen in elderly patients. The objective was to evaluate the functional outcome of a novel modification of percutaneous k-wire fixation technique using Neer’s classification. In this technique, the transfixing K wires were linked together with a link joint which functions as an external fixator, easily available and cheap compared to MIROS (Minimally invasive reduction and osteosyntesis system) and also has additional advantage of trans fixation. Methods: The prospective study was conducted in MBS and new medical college, Kota, India over a 24 months period, we treated 25 patients of minimally displaced two-, three- and four-part fractures, 14 patients (56%) were males and 11 patients (44%) were females. Mean age of the patients were 50.52±14.46 years, the mean surgical time was 30.4 min. mean fluoroscopy time was 42.64 seconds, all k wire and link joints removed at 9.5 weeks. mean clinical union was 7.94 weeks. Results: Final constant score at 18 months was 80.28±4.09. Mean abduction was 129.6±30.6 degrees, the mean anterior forward flexion was 125.5±25degrees. 2 patients developed pin tract infection, 1 patient developed stiffness .4 patients (16%) had fair results, 18 patients (72%) had good results and 3 patients (12%) had excellent results. Conclusions: The modified novel method that takes advantage of the minimal invasive approach for treating proximal humeral fractures by Kirschner wire mutual linking technique with link joints, providing a great deal of flexibility in the fixation construct's composition which is cost effective and provide even more stability.

Clinical practice trends and therapeutic preferences in osteoarthritis management: a cross-sectional survey of orthopaedic surgeons in India

Background: Osteoarthritis (OA) is a leading cause of disability worldwide and presents a growing challenge, particularly in India’s aging population. Despite its burden, there is a limited data exist on how OA is managed in real-world clinical settings across India. This study assessed the prescribing patterns and therapeutic preferences of orthopaedic surgeons in India, focusing on pharmacological interventions, intra-articular therapies, and the utilization of adjunctive treatments such as collagen and nutritional supplements. Methods: A total of 250 orthopaedic surgeons across India participated in this cross-sectional survey carried out by the Indian Orthopaedic Rheumatology Association (IORA). The 32-item questionnaire created by orthopaedic surgeons explored clinical observations, treatment preferences, comorbidity challenges, and attitudes toward nutraceutical use in OA management. Results: Most clinicians reported a high OA burden in their practice, with symptom onset frequently observed as early as 30–45 years. Obesity and poor nutritional status were identified as common complicating factors. Lifestyle modification was the preferred initial approach, followed by acetaminophen as the first-line pharmacologic agent, especially in elderly patients or those with comorbidities. Topical NSAIDs were favoured for their efficacy and safety profile. A growing role for undenatured collagen type II (UC-II, Lonza) was evident, with 55.2% of respondents prescribing it routinely, particularly in mild-to-moderate OA. Over 75% supported its early initiation, and nearly half considered it for preventive use in high-risk individuals. Conclusions: Indian orthopaedic surgeons are increasingly adopting a holistic, multimodal approach for osteoarthritis management, balancing early intervention with safety. The growing use of UC-II and nutritional supplements highlights a preventive shift in clinical practice