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Objectives: Shoulder instability is a commonly seen injury in orthopedics practice. The current survey aimed to assess strategies in the management of shoulder instability among orthopedic surgeons in India. Materials and Methods: A survey was created by a group of surgeons who are regularly managing shoulder instability and it was distributed among the various orthopedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies, and the rehabilitation protocol. We also assess any difference in management strategies of Orthopaedic surgeon (OS group) as compared to fellowship trained sports surgeons/shoulder surgeons (FS group). Results: Ninety-seven orthopedic surgeons participated in the survey. Sixty-four percent were in the age group between 35 and 50 years. Forty-six percent of them were managing these injuries for more than 12 years. 37.5% of surgeons were from government academic institutes. Eighty percent of respondents treat first-time dislocation conservatively. The decision regarding the type of surgery is based on the percentage of bone loss, the number of dislocations, age of the patients as per the majority of respondents. Arthroscopic Bankart's repair is the most commonly used procedure for anterior shoulder instability. The common criteria for return to sports include a glenohumeral range of motion, rotator strength, functional performance test, type of sports, and ability of the athlete to perform. Conclusion: Bankart's repair is the most common procedure performed in patients with shoulder instability with minimal bone loss. Computer tomography scan is one of the preferred investigation modalities along with X-ray and magnetic resonance imaging in the first-time dislocation as per FS group. Remplissage in addition to Bankart's repair is performed by a significantly higher number of participants from FS group as compared to OS group. Level of Evidence: Level V, expert opinion.

Objective: Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design. Materials and Methods: This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up. Results: We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version. Conclusion: The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability. Level of Evidence: Level III, therapeutic study.

Today, there is increasing demand for quality medical care to be made available for a large population at a reasonable cost. In a society with limited health-care infrastructure and budget, it has become imperative to evolve scientifically proven clinical care pathways. No country is willing to accept infructuous expenditure on treatment modalities with ambiguous patient outcomes. Hence, evidence-based medicine has been introduced into most health-care systems. When it comes to orthopedics, a serious concern is that, the existing literature has extremely poor quality of evidence. There are very few best practice guidelines, which are supported by high quality clinical studies. In this review article, we have made an attempt to bring out the recurring lacunae in orthopedic research papers. Following which we have also given tips on how to plan, design, and conduct a high quality clinical trial. We have made an attempt to explain commonly required knowledge of statistical tools. In the end we have briefly described, how to prepare a protocol, execute the study, analyze the results, and write the final article to get published.

Background: Fracture healing is a complex biological phenomenon which is influenced by various environmental factors. From time immemorial, there has been a constant endeavor to look for means to enhance fracture healing which would limit disability and restore preinjury level of function at the earliest. Hyperbaric oxygen therapy is one such therapy which has shown some role in enhancing fracture healing in established fracture nonunion but its role in acute fracture healing has not been studied. Materials and Methods: The study was conducted in a military hyperbaric oxygen therapy (HBOT) facility co-located with a tertiary care military hospital. Sixty patients between 20 and 50 years of age with acute closed fractures of the metacarpal, planned to be managed conservatively, were equally randomized to the HBOT (n = 30) and sham HBOT (n = 30) group. Patients in the sham HBOT group, apart from receiving standard of care for the fracture, received a sham exposure of HBOT for 4 weeks, whereas those in the HBOT group, received HBOT therapy for the same duration. The patients were actively followed up for 6 months. Primary outcome measure was rate of fracture healing as assessed by radiology and ultrasound evaluation and functional recovery as assessed by the disabilities of the arm, shoulder, and hand score (DASH). Secondary outcomes included the assessment quality of life and complication rate. Results: The 6-month follow-up rate was 100%. All fractures in both the groups united, there was no significant difference in rate of fracture healing at 12 weeks (P = 0.731) or functional outcome at 24 weeks, as assessed by DASH score (P = 0.127), between the groups. There were 6 (20%) malunions in sham HBOT group and 2 (07%) in HBOT group. There were four cases of reflex sympathetic dystrophy in sham HBOT group and three cases in HBOT group. Conclusions: HBOT in acute diaphyseal fractures does not alter the rate of healing when assessed clinicoradiologically and has no effect on functional outcome at 6 months of follow-up. Level of Evidence: Level I

Profunda femoris artery injury following osteosynthesis of the proximal femur fracture is a rare complication and is usually caused by iatrogenic trauma or rarely due to bony spikes. Presentation can be delayed because of nonspecific features such as pain, swelling, anemia, fever, and hematoma. We report a case of posttraumatic profunda femoris aneurysm which presented more than a year after surgery with near-complete resorption of proximal femur and failure of implant requiring evacuation of huge layered thrombus, ligation of profunda femoris, and reconstruction of proximal femur with tumor megaprosthesis. Literature has not described a similar case.