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Background: Generalised joint hypermobility (GJH) is associated with musculoskeletal symptoms. Beighton score is universally used to measure hypermobility and the cut off score of ≥4 is quoted in literature to define GJH. No data exists on the prevalence of GJH in patients attending orthopaedic outpatients in India. Materials and methods: The objective of this study was to compare the prevalence of GJH in the general versus orthopaedic patients. 406 patients attending a wellness clinic and 1780 patients attending orthopaedic outpatient clinic in a large private hospital in south India were scored for hypermobility using Beighton score. The mean age of the cohorts attending the wellness clinic and orthopaedic clinic was 33.47± 11.63 years and 36.37± 9.36 years respectively. There were more males than females recruited in the orthopaedic clinic. Results: The wellness group had significantly higher numbers in the 20 to 39 year age range compared to the orthopaedic group (p value

To conduct a systematic review and meta-analysis comparing the functional and radiological outcomes in cervical spondylotic myelopathy (CSM) when treated by Laminectomy (LC) vs. laminectomy with instrumented fusion (LCF). The systematic review was conducted in accordance with PRISMA guidelines. A systematic electronic search was performed in PubMed, EMBASE, and CENTRAL databases. All Studies comparing clinical and radiological outcomes in patients with CSM when treated with LCF and LC were included in the systematic review. Neuromuscular function measured by modified Japanese orthopaedic association (mJOA), Cervical lordosis measured by C2-C7 Cobb's angle, and data on complications were retrieved from the studies. Random effect meta-analysis was used to account for heterogeneity. Quality assessment was performed using ROBINS-I and ROB-2 tools. Certainty of evidence was assessed using the GRADE working group recommendations. A total of 3985 articles were retrieved from the databases, of which 9 articles (1 RCT, 8 controlled comparative trials; n = 1146) met the eligibility criteria. The improvement in mJOA showed results favouring laminectomy with fusion with an SMD of 0.45 (95% CI, 0.07-0.84; p = 0.02). The loss of cervical lordosis was significantly lesser in the laminectomy with fusion group with an SMD of - 0.454 (95% CI, (- 0.12) - (- 0.79), p = 0.01). The complication rate in the LCF group was lower (LogOR = - 0.92; 95% CI: (- 1.30) - (- 0.55); p = < 0.05). In CSM, laminectomy with fusion is superior to standalone laminectomy in terms of improvement in m-JOA, maintenance of cervical lordosis and reduction in complications., Competing Interests: Declarations Ethical approval Not applicable. The protocol for the systematic review was registered on PROSPERO (ID Number: CRD42024523083). Conflict of interest The authors of the systematic review have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A 38 year old man with no known comorbidities presented with pain and swelling over the knee joint a few days after recovery from severe COVID-19. Initial debridement and cultures revealed growth of Mucorales affecting a large segment of the distal femur with also positive cultures obtained from the maxillary sinus and the lower lobe of the right lung. Due to this involvement of a long segment of the femur, right lung and left maxillary sinus, a multidisciplinary approach of above knee amputation along with debridement of left maxillary sinus and lobectomy of right lung lower lobe was performed to decrease the fungal load and favour good prognosis. This report warrants the need for early imaging and surgical debridement of tissue for fungal cultures and biopsy in immunocompromised individuals., Competing Interests: "The authors declare that they have no competing interests"., (© 2024 The Authors.)

Intertrochanteric fracture management require effective management strategies for early return to function and minimise complications. Intramedullary devices like proximal femoral nail have an biomechanical advantage, particularly in unstable intertrochanteric fractures. Such unstable injury patterns not only require precise reduction technique, but also right implant design to minimise the complications. Novel concepts of reduction like medial cortical support classification and antero-posterior reduction (Subtype classification system) refine the reduction strategies. Despite reporting of the reduction analysis, there has been continuing number of implant failures following proximal femoral nail implantation. Complications like 'Z' effect and reverse 'Z' effect are very well reported with the 2 screw Recon - Proximal femur nails. Analysis of failure and complications have constantly upgraded the designs of proximal femur nails. Design of the new generation intramedullary implants for treatment of intertrochanteric fractures like Gamma nail, PFNA-II (Proximal Femoral Nail Anterotation), Zimmer Natural Nail, Trigen Intertan nail and TFN - Advanced (Trochanteric Femoral Nail Advanced) are described in this review. While the new implant designs offer advancements, fundamental principles of reduction remains crucial for successful outcomes. Design rationale and instrumentation of each implant must be known at the time of application along with techniques of maintaining the reduction for a successful outcome., Competing Interests: All the authors of the manuscript declare that there are no conflicts of interest to declare. Authors also declare that there are no financial or non-financial interests that are directly or indirectly related to the work submitted for publication to be declared.All the authors of the research work and this manuscript declare that there are no conflicts of interest or competing interest. There is no funding involved in carrying out research or publication of this manuscript., (© 2024 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon, and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. Treatment options in literature reviews for such rare injuries included open reduction of pip joint with volar plate arthroplasty, extension block pinning, hemi hamate arthroplasty, pip joint arthrodesis, Suzuki dynamic frame fixation, open reduction and repair of capsule and collateral ligaments with suture anchors. Few cases of amputation following treatment were even reported in literature emphasizing the role of meticulous soft tissue handling in such neglected cases of hand. We report six cases of neglected (more than three months old) dorsal dislocation of the PIP joint of the hand, treated with volar plate arthroplasty and extension block pinning. A functional range of motion with a stable joint can be achieved in such injuries with volar plate arthroplasty, as long as the articular cartilage is relatively preserved and bone loss is <30%., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Gottipati et al.)

Proximal tibia depression fracture often occur isolated or in conjunction with complex fracture presentations and elevation of such depression is required to retard arthritis in long term. Conventional open reduction by sub meniscal approach has many percutaneous alternatives from arthroscopy assisted reduction to balloon tibioplasty. Few authors even reported usage of PCL jig and percutaneous pins to elevate, while the primary author has previously described an instrument to elevate the depressed fragment percutaneously. With the shortcomings of the same instrument, authors have designed modifications in the same to address anterior and posterior extensions of depression without widening the metaphyseal window. In this article, we describe the size and concept of the modified design and its efficacy to address depression injuries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Delhi Orthopedic Association. All rights reserved.)

Background: Menopause is regarded as the marker for various symptoms such as physical, psychological, vasomotor, and sexual impairing the quality of life (QOL)., Objectives: To assess the menopause-related QOL and determine associated factors among postmenopausal women., Materials and Methods: A cross-sectional study was conducted among 378 postmenopausal women attending the obstetrics and gynecology department of a tertiary care hospital using a standardized menopause-specific QOL (MENQOL) questionnaire consisting of physical, vasomotor, psychosocial, and sexual domains., Results: The study included 378 women aged above 40 years, with majority belonging to the age group of 46-50 years. The total MENQOL mean score was found to be 19.35 ± 16.20, with physical domain score the highest 14.89 ± 11.85, followed by vasomotor 1.98 ± 3.83, psychosocial 1.82 ± 3.29, and the least as sexual domain with score of 0.624 ± 2.21. Post menopausal women with age less than 50 years, No formal education, High socio-economic status, Home makers and duration of menopause less than 5 years was found to have statistical significant association with higher vasomotor domain score; No formal education, higher socio economic status and duration of menopause with greater than 5 years was found to be significant with higher sexual domain scores., Conclusions: Menopause may be associated with a decrease in QOL. Certain sociodemographic variables showed a statistically significant association with the vasomotor and sexual domains. Awareness and interventions that affect the modifiable factors may help in increasing the QOL at menopause., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Mid-life Health.)

Acetabular impaction fractures when not adequately addressed leads to early arthritis. Dome impaction injuries and marginal impaction injuries have to be properly planned pre-operatively with respect to surgical approach, disimpaction techniques and fixation strategies. CT scan is the best modality to analyse the site, extent of impaction and plan strategies to reduce. Emphasis of early mobilisation should not drive the surgeon towards the motive of rigid fixation of columns alone, as the inadequate reduction of acetabular impaction leads to loss of mechanical support on weight bearing and thereby cause loss of reduction. Bone grafting either by auto or allograft or graft substitutes in the void after disimpaction helps in reducing anatomically and provide mechanical support adequately. In cases of severe comminution, reconstruction of the wall defect with autologous graft is a better treatment option. In this article we reviewed the characteristics of impaction injuries of acetabulum exploring surgical procedures, approaches and techniques for achieving open reduction and internal fixation., Competing Interests: The authors declare no conflicts of interest., (© 2020 Delhi Orthopedic Association. All rights reserved.)

Introduction: Subtrochanteric fractures of femur remain most challenging injuries faced by orthopaedic surgeons. The implant choice shifted from extra medullary to intramedullary nails over the last two decades. Effort to achieve anatomical reduction before nail insertion for better outcomes has been emphasized well in literature. We reviewed various surgical techniques for reduction of fracture in more biological way that can be used to overcome the deforming forces of the muscles acting on fracture fragments., Conclusion: Regardless of the closed vs open reduction for subtrochanteric fracture fixation, the key point to reduce the risk of complications is quality of reduction of fracture. This article highlights specific strategies to achieve reliable, efficient and desired outcomes when using intramedullary nails for subtrochanteric fractures.

Open fractures can cause an "out-in" injury, wherein a foreign body can penetrate the skin causing fracture. There are few reports of allogenic bone getting embedded in soft tissue, but one causing fracture to the host bone has not been reported till date. We present a case, wherein a large cortical bony fragment from one individual penetrated the thigh of another person causing fracture of medial femoral condyle during a head-on collision involving two motorbikes.

Bicondylar Hoffa's fractures of the femur is very uncommon. Conjoint bicondylar Hoffa fracture with ipsilateral patellar dislocation, Bicondylar Hoffa's with patellar fracture and extensor mechanism rupture has been described in literature. We report a case of unconjoint bicondylar Hoffa's fracture with lateral patellar dislocation in 17-year-old male patient treated with open reduction and cancellous screw fixation that subsequently healed well with good functional outcome.

Background: Posterior heel pain due to retrocalcaneal bursitis, is a disabling condition that responds well to the conventional methods of treatment. Patients who do not respond to conservative treatment may require surgical intervention. This study evaluates the outcome of endoscopic decompression of retrocalcaneal bursitis, with resection of posterosuperior eminence of the calcaneum., Materials and Methods: This present study included 25 heels from 23 consecutive patients with posterior heel pain, who did not respond to conservative treatment and underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. The functional outcome was evaluated by comparing the pre and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores. The Maryland ankle and foot score was used postoperatively to assess the patient's satisfaction at the one-year followup., Results: The University of Maryland scores of 25 heels were categorized as the nonparametric categories, and it was observed that 16 patients had an excellent outcome, six good, three fair and there were no poor results. The AOFAS scores averaged 57.92 ± 6.224 points preoperatively and 89.08 ± 5.267 points postoperatively (P < 0.001), at an average followup of 16.4 months. The 12 heels having noninsertional tendinosis on ultrasound had low AOFAS scores compared to 13 heels having retrocalcaneal bursitis alone. At one year followup, correlation for preoperative ultrasound assessment of tendoachilles degeneration versus postoperative Maryland score (Spearman correlation) had shown a strong negative correlation., Conclusion: Endoscopic calcaneal resection is highly effective in patients with mild or no degeneration and yields cosmetically better results with fewer complications. Patients with degenerative changes in Achilles tendon had poorer outcomes in terms of subjective satisfaction.