We studied the publication trend in the field of orthopaedics and sports medicine over the last 25 years (1996 -2021), by various countries, and regions of the world. There was an increasing trend in publications, across the globe. Some of the Asian countries like China and India have shown a substantial growth in their research output. Europe continent has contributed the most publications in the last 25 years, whereas the United States as a country has been on the top of the list of contributors. Most research-publications came from high-income countries and disproportionately less from low- and middle-income countries.

Background: Little has been published about TKA in windswept deformities of the knees where combined varus and valgus deformities present in the same patient. Windswept deformities present with unique problems and must be addressed as two halves of a complex entity. Through this review we aim to understand the interrelation between the deformities, examine outcomes following simultaneous bilateral total knee arthroplasty in windswept deformities, and develop an algorithm for the management of windswept deformities by total knee arthroplasty. Methods: An extensive online literature search for the keywords yielded 31 articles on which we based our review.Articles were analyzed in context to our research questions and are presented in a tabular format for quick reference and a better perspective. Results: The abnormal biomechanics and force moment of the knee cause progressive arthritis of the knee. The valgus deformity usually precedes a varus deformity on the contralateral knee in windswept deformities. Correct restoration of mechanical tibiofemoral angles by individualizing valgus correction angles have better outcomes after TKA. Conclusion A well-planned and judiciously executed simultaneous bilateral total knee replacement can offer distinct advantages to the patient and surgeon and provides optimum utilization of time and resources in the management of windswept knees.

Purpose: Megaprosthesis or endoprosthetic replacement of the proximal and distal femur is a well-established modality for treatment of tumors. The indications for megaprosthesis have been expanded to the treatment of some non-neoplastic conditions of the knee and hip, with the severe bone loss associated with failed arthroplasty, communited fractures in the elderly with poor bone quality, and resistant non-union. Th aim of this study is to find out whether megaprosthesis of the knee and hip is successful in the treatment of non-neoplastic condtions. The study comprises a review of the indications, complications, and outcomes of megaprosthesis of the proximal and distal femur in non-neoplastic conditions of the knee and hip joints. Methods: We extensively reviewed the literature on non-neoplastic indications for megaprosthesis of the proximal and distal femur after performing a detailed search of the Pubmed database using the medical subject heading (MeSH) terms ‘proximal femur replacement’ or ‘distal femur replacement’ and ‘hip or knee megaprosthesis.’ The data obtained after the structured search were entered into a Microsoft Excel spreadsheet. The frequency distribution of the demographic data, indications, complications, and outcome was calculated.Result: We included ten studies (seven proximal femur replacement and three distal femur replacement) of 245 proximal femur and 54 distal femur mega prostheses for treatment of non-neoplastic conditions. Bone loss in failed arthroplasty, either due to periprosthetic fracture or deep infection, was the most common indication for megaprosthesis. Dislocation was the most common complication after proximal femur megaprosthesis, and infection was the leading cause of complications after distal femur megaprosthesis. Conclusion Megaprosthesis for treatment of non-neoplastic conditions around the distal and proximal femur is a viable option for limb salvage, with an acceptable long-term outcome. Although the complications and survival rates of megaprosthesis in non-neoplastic conditions are inferior to a primary arthroplasty of the hip and knee but are comparable or better than the mega prosthetic replacement in the neoplastic conditions. Proximal femoral megaprosthesis has higher dislocation rates and requirement for revision compared to distal femoral megaprosthesis. However, the proximal femoral megaprosthesis has lower rates of infection, periprosthetic fractures, and soft tissue complications, as compared to distal femoral megaprosthetic replacement. Both associated with aseptic loosening but not statistically significant.

Background: Little has been published about TKA in windswept deformities of the knees where combined varus and valgus deformities present in the same patient. Windswept deformities present with unique problems and must be addressed as two halves of a complex entity. Through this review we aim to understand the interrelation between the deformities, examine outcomes following simultaneous bilateral total knee arthroplasty in windswept deformities, and develop an algorithm for the management of windswept deformities by total knee arthroplasty. Methods: An extensive online literature search for the keywords yielded 31 articles on which we based our review.Articles were analyzed in context to our research questions and are presented in a tabular format for quick reference and a better perspective. Results: The abnormal biomechanics and force moment of the knee cause progressive arthritis of the knee. The valgus deformity usually precedes a varus deformity on the contralateral knee in windswept deformities. Correct restoration of mechanical tibiofemoral angles by individualizing valgus correction angles have better outcomes after TKA. Conclusion A well-planned and judiciously executed simultaneous bilateral total knee replacement can offer distinct advantages to the patient and surgeon and provides optimum utilization of time and resources in the management of windswept knees.

Background: McMurray’s osteotomy of the hip was a popular surgery practiced for almost 5 decades for the management of the fractured neck of the femur and hip osteoarthritis since its first description in 1936. It is an oblique, medial displacement intertrochanteric osteotomy. In the long term, McMurray's osteotomy patients develop limb length discrepancy and secondary osteoarthritis due to the altered biomechanics of the hip and may require total hip replacement (THR). THR after the previous osteotomy is more challenging than that for unoperated hip joints due to severe distortion of the hip anatomy and soft-tissue contractures. These challenges are related to distorted bony anatomy, soft-tissue contractures, and the choice of implants. Methods: Three patients with previous McMurray's osteotomy of the hip developed secondary osteoarthritis and underwent total hip replacement. We discussed specific challenges encountered during THR and techniques to deal with such problems. Results: All patients had pain-free hip, with minimal residual shortening (average, 1.2 cm) at an average follow-up of 3.67 years (range, 1 to 6 years). The Harris hip score improved significantly postoperatively and no complications were encountered. Conclusions A detailed and careful preoperative planning, correct execution of surgical techniques, and postoperative rehabilitation are the keys to the successful management of these cases.

Purpose:: The technology of 3D printing (3DP) exists for quite some time, but it is still not utilized to its full potential in the field of orthopaedics and traumatology, such as underestimating its worth in virtual preoperative planning (VPP) and designing various models, templates, and jigs. It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications. Methods:: An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation. Virtual preoperative planning and 3DP were used in the management of these fractures. Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data. Results:: In all the 91 cases, where VPP and 3DP were used, the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively. Surgical time was reduced, with a better outcome. Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation. The average score of the questionnaire was 4.5, out of a maximum of 6, suggesting a positive role of 3DP in orthopaedics. Conclusion: 3DP is useful in complex trauma management by accurate reduction and placement of implants, reduction of surgical time and with a better outcome. Although there is an initial learning curve to understand and execute the VPP and 3DP, these become easier with practice and experience.

Purpose:The technology of 3D printing (3DP) exists for quite some time,but it is still not utilized to its full potential in the field of orthopaedics and traumatology,such as underestimating its worth in virtual preoperative planning (VPP) and designing various models,templates,and jigs.It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications.Methods:An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation.Virtual preoperative planning and 3DP were used in the management of these fractures.Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data.Results:In all the 91 cases,where VPP and 3DP were used,the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively.Surgical time was reduced,with a better outcome.Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation.The average score of the questionnaire was 4.5,out of a maximum of 6,suggesting a positive role of 3DP in orthopaedics.Conclusion:3DP is useful in complex trauma management by accurate reduction and placement of implants,reduction of surgical time and with a better outcome.Although there is an initial learning curve to understand and execute the VPP and 3DP,these become easier with practice and experience.

PURPOSEFractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome.

METHODSTotally, 32 patients with lateral end clavicle fracture (Neer's Type II) were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and internal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day 1 and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand (DASH) scoring.

RESULTSThere were no intraoperative complications in the procedure. The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively.

CONCLUSIONThe precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.

Adolescent ; Adult ; Bone Plates ; Clavicle ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Pain Measurement

The management of multiple complicated injured patients remains a great challenge despite advance- ments in modern medical care. We present a rare case of bilateral unstable pelvic fractures associated with bilateral segmental femoral shaft fractures.We have proposed a mechanism of such complex injury pattern and discussed the plan of management. We believe that a timely and aggressive surgical intervention to fix all the major fractures soon after medically stabilizing the patient helped our patient to overcome these serious and lethal injuries. It is necessary to establish an optimal protocol for management of such complex fractures by conducting prospective and multicentric studies in the future.
Adult ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Humans ; Pelvic Bones ; diagnostic imaging ; injuries

Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees. Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication. When dislocation is associated with patellar tendon rupture, the management includes restoration of the extensor apparatus along with a stable knee. Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure. Ideal method of restoration of the extensor apparatus is a matter of debate. There are various modalities used ranging from primary end-to-end repair, augmentation by medial gastrocnemius flap, semitendinosus and synthetic implants and allograft tendoachilles. We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery. The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair. The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert. The management of this complex problem along with the review of literature is discussed in this case report.
Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; Female ; Humans ; Joint Dislocations ; etiology ; Patellar Ligament ; injuries ; Rupture ; Tendon Injuries ; etiology