Arvind Kumar

The femoral neck system (FNS) is a relatively new internal fixation device designed to improve stability in unstable femoral neck fractures. Despite its increasing use, a comprehensive mapping of the research landscape regarding its application in high-shear Pauwels III fractures is lacking. This study aims to provide a bibliometric analysis of the current literature to identify trends, research hotspots, and evidence gaps. A systematic search of the PubMed database was conducted for studies published between 2017 and 2026. Data extraction included publication year, source journals, authorship, institutional affiliations, and country of origin. Bibliometric mapping was performed using the R-package Bibliometrix. Studies were categorized by methodology (Clinical, Biomechanical/Cadaveric, Finite Element Analysis, or Mixed) and level of evidence. Thirty-five studies were identified, with a mean document age of 2.51 years, reflecting a burgeoning interest in the FNS. Research is heavily concentrated in East Asia, with China contributing 88.5% (n=31) of the total output. BMC Musculoskeletal Disorders was the most prolific journal (n=7). The majority of studies utilized computational or experimental designs: 14 FEA, nine biomechanical/cadaveric, and nine clinical studies. Notably, most clinical studies were retrospective cohorts providing Level III evidence, with an absence of Level I or II randomized controlled trials. The evidence base for the FNS in Pauwels III fractures is rapidly expanding but remains in a foundational phase dominated by biomechanical and finite element simulations. While early clinical results from specialized centers in China are promising, there is a critical need for prospective, multicenter international trials to elevate the level of evidence and validate long-term patient outcomes across diverse populations.

Introduction Subtrochanteric fracture non-unions present significant surgical challenges due to complex biomechanics, muscle forces, and limited vascularity, often leading to malunion, nonunion, and implant failure. We aim to present diverse approaches to the management of subtrochanteric fracture nonunions. Methods We reviewed surgically managed subtrochanteric femoral nonunion cases aged 18–80 years while excluding infected nonunions and periprosthetic fractures. Preoperative planning involved identifying nonunion contributing factors and devising a plan for biomechanical and biological optimization, including realignment, margin freshening, compression and bone grafting. Implant choice was individualized based on the failure mechanism. The primary outcome was progression to union, and secondary outcomes included time to union, Merle d’Aubigne scores, and complications. Results 44 eligible cases underwent revision surgeries, with all achieving union by the last follow-up. The mean patient age was 42.82 years. Twin-screw proximal femur nails were the most common initial fixation device. Pre-existing mechanical factors contributing to non-union included a fracture gap and malalignment. Revision fixation modalities (with bone grafting) mostly included the use of 95° angled blade plates, augmentation with an anterior plate with previous implant retention and use of proximal femur locking plates. The mean follow-up was 17.30 months, and functional outcomes were good with minimal complications. Conclusions A comprehensive, individualized approach that addresses mechanical alignment, fracture compression, rigid fixation, and biological healing is crucial for subtrochanteric nonunion. High union rates and good functional outcomes may be achieved through well-planned fixation strategies, considering altered bony morphology and appropriate implant selection based on the extent of malalignment and loosening.

Displaced intra-articular calcaneal fractures often pose challenging situations, especially concerning wound-related complications, be it surgical wounds or the associated open wounds. This literature suggests evolving trends favoring less-invasive methods of fixation of these fractures. Joystick methods have been advocated for closed manipulation of calcaneal fractures. However, the less-invasive reduction techniques for articular restoration are still limited and poorly described. In this technical note, we describe a simple percutaneous technique that allows the reduction of articular fragments along the subtalar joint and simultaneously corrects the lateral wall blowout in cases where conventional joystick methods may not help.

Introduction There has been an increased interest in the external and percutaneous fixation of proximal humerus fractures. Numerous advantages of external fixation like less blood loss, ease of application, and rigid fixation provide a promising new avenue for the management of humeral fractures. This retrospective case series aims to assess the radiological and functional outcome of proximal humerus fractures treated with the Joshi External Stabilization system (JESS). Materials and Methods A retrospective review of records was performed using hospital records from January 2020 to January 2024. The records of patients more than 18 years of age with proximal humerus fractures who were operated with the JESS fixator were reviewed and a proforma based on each follow-up was filled by the investigators. Results A total of 28 patients met the inclusion criteria with an average age of 65.17 ± 13.1 years. Neers type 3 injuries were most common (38.3%, n = 11). All fractures united on 6-week follow-up. 75% (n = 21) reported good 25% (n = 7) excellent Constant scores at 24 weeks. The overall complication rate was 28.6%. Common complications were superficial pin tract infections and fixator loosening. Conclusion The JESS is an acceptable treatment option for orthopaedic surgeons for the fixation of proximal humeral fractures, especially in geriatric patients. Like other external fixation devices, pin tract infection and pin loosening are inherent to the system.

Background: Distal radius fractures (DRFs) are some of the most common injuries suffered by the elderly; however, there are varied opinions on management. As there is limited research on patient factors affecting functional outcomes in conservatively managed patients with DRFs, this study aimed to find predictive factors for functional outcomes in such patients. Methods: Patients with DRFs satisfying the inclusion criteria were managed with closed reduction and slab followed by cast application. Radiological parameters (radioulnar angulation, dorsal tilt, radial height, and ulnar variance) and functional scores (patient-rated wrist evaluation [PRWE] score, Short Form 8 questionnaire [SF-8], and QuickDASH [Disabilities of the Arm, Shoulder, and Hand]-9) were recorded prereduction, postreduction, at the time of cast removal, and in follow-up visits. Patient factors such as underlying diseases were also recorded, and correlations were analyzed using appropriate software. Results: Patients with diabetes (43.33% of patients) and those with loss in radial height through the course of treatment were found to have poorer functional outcomes ( P -values less than .05 for all functional scores—PRWE, QuickDASH-9, SF-8—except SF-8 at 12 weeks). Patients younger than 60 years were also found to have better functional outcomes at 24 weeks (for PRWE: P -value = .048, for QuickDASH-9: P -value = .032, and for SF-8: P -value = .026). Conclusion: Conservative management plays a major role in the treatment of DRFs, despite the increasing trend of operative management. Diabetes was found to be a predictor of poorer functional outcomes; however, further research is needed to determine the role of these and other factors in detail.

[This corrects the article DOI: 10.1007/s43465-023-01068-1.].

Introduction Orthopaedic surgeons are among the most frequent users of radiation and are often exposed to X-Ray radiation regularly. There is an overall unsatisfactory level of knowledge, attitude, and practices regarding the same among surgeons. This study aimed to assess the practices among orthopaedic surgeons regarding radiation and its hazards in India. Methodology This questionnaire-based survey was conducted between March and September 2022. The questionnaire broadly assessed the knowledge, awareness, and practices among orthopaedic surgeons regularly exposed to X-ray radiation. The questionnaire consisted of objective and Likert scale questions which were distributed to the respondents electronically using publicly available contact information. A qualitative review of interpretations obtained from the responses and available evidence in the literature was then performed. Results The response rate for the survey was 36.4%. 65.9% reported using trunk protection all the time during procedures. 57.1% of respondents reported not using thyroid protection during procedures. 92.3% reported not using protective goggles and 100% did not use appropriate gloves. 76.9% were not issued dosimeters, and only 5.5% of those who had been issued one wore it during radiation procedures. 58.2% reported having a dedicated employee to operate the machine. 86.8% of respondents did not have formal training and 81.3% were not aware of institutes offering formal training. Conclusion There is very high compliance with the use of protection aprons among the respondents however, the use of other apparel like thyroid shields, protection goggles and gloves was poor. The awareness regarding radiation exposure was also poor as most respondents were not issued dosimeters, however, those issued with one were well aware of their exposure. It is imperative to prioritize both surgeons’ and patients’ safety where radiation exposure is concerned.

We present a case of a 16-year-old male with a Salter-Harris type II physeal slip of the distal femur managed with closed reduction and K wire and clamp-based external fixator. Knee range of motion exercises were initiated after one week. The union was observed at 10 weeks, and implant removal was done on an outpatient basis. At one year follow-up, the patient had good clinical and radiological outcomes. The K-wire-based external fixator frame is an effective fixation method for distal femur physeal slips in older children, providing favorable radiological and functional outcomes.

Purpose The orthopaedic surgeons, especially the young budding surgeons should have a well-balanced knowledge of the past evidence as well the current evidence in the literature for the appropriate as well as optimum management of tibial plateau fractures. Bibliometric analysis of the top-cited papers on tibial plateau fracture management can help know their concurrent interests, deficiencies and conflicting issues regarding their management. This study aimed to identify the 50 most cited research articles in tibial plateau research and analyse their characteristics. Methods We searched the Thompson Reuters Web of Science database for articles relevant to tibial plateau fracture and prepared a list of top 50 cited articles that included original articles and review articles concerning tibial plateau fractures. The included articles were analysed for contributing journals, corresponding author’s country, publication year, cumulative citations, annual citations, citation trends over time, level of evidence and a qualitative review. Results The search strategy resulted in 2263 articles. The top 50 cited articles were published from 1974 to 2014 and belonged to 12 journal sources. There were 47 original articles and 3 review articles. The average citations per article were 126.2, and the annual citations per article were 6.478 per year. The top-cited articles were relevant to the strategies in the management, classification, fracture reduction, articular restoration, types and number of fixation devices, surgical approaches, associated menisco-ligamentous injuries and applicability of bone grafts/substitutes in tibial plateau fractures. Conclusion The current bibliometric analysis summarises the top-cited evidence concerning tibial plateau fractures and can be a potential resource for reviewing and locating the same. The analysis shows that most top-cited evidence belongs to the year 2000 onwards. Also, recent articles have a higher annual citation rate. A limited number of journals and mostly, western countries have contributed to the top-cited evidence. Whilst the top-cited evidence has touched several aspects of tibial plateau fractures, it is in the form of level IV case series. It needs better prospective evidence to establish sound recommendations.