Sudarsan Behera

Case: A man in his late forties presented with infected nonunion of both-bone forearm fractures with implant failure and persistent discharge. After implant removal and thorough debridement, Ilizarov ring fixation with the accordion technique was applied. Intraoperative cultures grew Staphylococcus aureus , and targeted antibiotics were administered. Progressive union was achieved by 6 months and was maintained at 18-month follow-up with significant functional improvement. Conclusion: Ilizarov fixation combined with the accordion maneuver is an effective single-stage option for infected forearm nonunion, enabling infection control, reliable union, and early functional recovery.

Neglected hip pathologies in adolescents frequently result in pain, instability, limb-length discrepancy, and significant gait abnormalities, posing complex reconstructive challenges. In such cases, total hip arthroplasty is often unsuitable due to young age and altered anatomy. Pelvic support osteotomy (PSO) with Ilizarov modification serves as a viable biological reconstruction option aimed at restoring stability, alignment, and limb length. We report two adolescent patients with chronic hip sequelae—one following septic arthritis and the other with developmental dysplasia of the hip—who underwent proximal pelvic support osteotomy combined with distal femoral osteotomy and application of a limb reconstruction system. Gradual postoperative distraction and early weight-bearing were initiated as per protocol. Both patients demonstrated significant improvement in hip stability, correction of limb alignment, and enhancement of functional outcomes as assessed by the Harris Hip Score. Radiological union was achieved in all osteotomy sites. One patient developed knee stiffness during the course of treatment and subsequently required quadricepsplasty, following which satisfactory knee range of motion was restored. At final follow-up, both patients achieved functional limb length, improved gait pattern, and satisfactory clinical outcomes. Pelvic support osteotomy with Ilizarov modification is an effective reconstructive strategy in adolescents with neglected hip conditions, offering restoration of hip stability, limb alignment, and function. Meticulous preoperative planning, adherence to physiotherapy, and close follow-up are crucial to achieving optimal results.

Background Simultaneous bilateral total knee replacement (SBTKR) is increasingly used to manage advanced bilateral knee osteoarthritis, particularly in India, where the disease affects approximately 22–39% of the population. Although SBTKR offers advantages such as single anesthesia, reduced hospital stay, and lower overall costs, it is accompanied by significant clinical and medicolegal concerns, particularly in high-risk populations. Objective This review explores the clinical outcomes and litigation landscape of SBTKR in India, analyzes landmark legal cases, and proposes strategies to enhance both surgical safety and medicolegal accountability. Methods A narrative review was conducted using the literature from PubMed, Scopus, and Indian legal databases. Clinical data were synthesized from studies published between 2000 and 2025. Legal precedents were drawn from consumer forum judgments and higher court rulings relevant to orthopedic malpractice and informed consent issues. Results Contemporary evidence indicates that SBTKR is as safe as staged procedures in well-selected patients. However, perioperative complications, such as infections, thromboembolic events, and unanticipated systemic deterioration, continue to trigger litigation. Legal case analysis revealed that lapses in preoperative evaluation, absence of cardiology clearance, and inadequate or undocumented consent were pivotal in determining the judicial outcomes. Conversely, detailed documentation and adherence to guidelines significantly strengthened the defense positions. Conclusion Optimizing patient selection, enforcing thorough informed consent, maintaining comprehensive records, and integrating multidisciplinary preoperative assessments are crucial for enhancing both clinical and legal outcomes of SBTKR. Establishing robust institutional protocols and medicolegal training can mitigate the risk of litigation in orthopedic practice.

Introduction Arthroscopic ACL reconstruction, a cornerstone in modern orthopedics, aims to restore knee stability while minimizing complications. Bibliometric analysis provides insights into research trends, influential contributors, and advancements in this field. Materials and Methods A systematic analysis of 104 eligible articles on ACL reconstruction complications was conducted using the Web of Science database. Data, including titles, authors, and journals, were extracted. Bibliometric insights were generated using R software, while VOS viewer visualized bibliographic coupling, co-authorship networks, and keyword co-occurrence through interactive mapping techniques. Results Annual publications peaked in 2022, with the U.S. contributing 73 studies and fostering global collaborations. Arthroscopy: The Journal of Arthroscopic and Related Surgery emerged as the leading journal, with the highest H-index and G-index. Dr. Brian Forsythe was identified as the most prolific author. Key articles addressed complications such as infections. Co-citation and co-authorship analyses highlighted collaborative efforts among institutions, while keyword analysis revealed prominent research themes, including ACL reconstruction techniques, complication management, and outcomes. Conclusion This 20-year bibliometric review underscores global research trends in arthroscopic ACL reconstruction, with the U.S. leading in both publication volume and impact. Journals like Arthroscopy set benchmarks in the field, while emerging research focuses on improving outcomes, addressing complications, and refining patellar tendon graft techniques.

Objective: It aims to assess the efficacy of these treatments, specifically in the presence of osteoporotic bone conditions. The findings of this study offer insights into the suitability of TEA as an alternative treatment option in such cases. Methods: In this study, sixty patients with distal humerus fractures were divided into two groups. The first group received ORIF for fracture fixation, while the second group underwent primary TEA treatment. The study evaluated various outcomes, including elbow range of movement, elbow stability, and comparison of Mayo Elbow Performance Scores (MEPS) between the two groups at three- and twelve-month follow-up periods. Results: In the three- and twelve-month follow-up periods, noticeable differences in elbow motion range were observed between the ORIF and TEA groups. The ORIF group experienced more significant restrictions in daily activities due to stiffness and pain, unlike the TEA group. However, both groups showed improvements in elbow function after one year. Furthermore, there were significant differences in the mean MEPS between the two groups at the three- and twelve-month follow-up period. However, no considerable differences were found between these periods within either group. Conclusion: TEA is emerging as a promising option for elderly patients with comminuted distal humerus fractures, considering the osteoporotic bone condition. The results of this study hold substantial implications for the decision-making process in treatment selection.

Pigmented villonodular synovitis (PVNS) is a locally aggressive benign tumour of the synovial membrane and tendon sheath. The unique presentation of this tumour is hemosiderin deposition with synovial proliferation. Depending on the situation, surgical excision is always the first line of treatment with adjuvant radiotherapy. Arthroscopic excision is preferred in some intraarticular nodular PVNS cases. This is a rare pigmented villonodular synovitis involving flexor hallusis longus, flexor digitorum longus, and tibialis posterior (TP). The tumour was entirely extra-articular without any joint involvement. The tumour was the diffuse type of PVNS and was treated by excision followed by radiotherapy. There is no recurrence till nine months of follow-up.