Introduction:Morphometric data for safe transpedicular screw placement at the thoracolumbar junction (T11–L2) remain limited for Indian populations, despite ethnic variations affecting screw sizing and complications. This study provides prospective computed tomography-based reference values for Western India.Materials and Methods:Prospective analysis of 200 consecutive adults (≥20 years; 110 males, 90 females) with back pain but normal thoracolumbar imaging (June 2021–August 2023) at a Western Indian tertiary center was conducted. Ethical approval taken from Institutional Ethics Committee, AIIMS Jodhpur (IEC No.- AIIMS/IEC/2022/4070). The bilateral pedicle width, interpedicular distance (IPD), anterior cortex depth, and transpedicular angle measured at T11–L2 using digital imaging and communications in medicine viewer (1–2 mm slices). Means ± standard deviation were compared by sex using unpaired t-tests (P < 0.05 significant; Excel).Results:Pedicle width increased caudally (T11: 5.14 ± 0.87 mm; L2: 6.39 ± 0.89 mm), with male > female at T12/L1 (P < 0.01). IPD rose from T11 (1.74 ± 0.20 cm) to L2 (2.15 ± 0.20 cm; L1 P = 0.039 by sex). Transpedicular angle: T11 (19.96 ± 2.20°) to L2 (23.06 ± 1.42°; all P < 0.05 by sex). Anterior cortex depth peaked at L1 (5.05 ± 0.86 cm). Safe screws: Thoracic 4.5–5.5 mm, lumbar 5.5–6.5 mm.Conclusion:Western Indian norms show narrower pedicles than Western data, aligning with other Indian series but adding a T11–L2 focus. This aids in ethnicity-specific screw selection to reduce misplacement in thoracolumbar fixation.

Introduction:Idiopathic congenital dislocation of the knee (CDK) represents a distinct clinical category. Grade III CDK, defined as knee flexion <30° has a poor prognosis. The standard of care is “as soon as possible” manipulation and casting. Waiting for spontaneous reduction is not regarded as an accepted treatment strategy. The purpose of this study is to report on the occurrence of spontaneous reduction in idiopathic grade III CDK.Materials and Methods:This prospective cohort study included consecutive cases of idiopathic CDK treated from April 2020 to August 2025. Inclusion criteria were: Absence of neuromuscular or genetic diseases, diagnosis of grade III CDK, and follow-up until full recovery.Results:Seven knees in five female patients with grade III CDK were included; two had bilateral CDK. All pregnancies were full-term with cephalic presentation; one infant was delivered by cesarean section. Four neonates were firstborn. Hip ultrasound showed dysplasia in three patients, bilateral in two, and unilateral in one. Spontaneous full reduction occurred in six out of seven knees before 1 month of age. In the remaining knee, the flexion gradually improved to 30°, after which reduction was prompted by casting once for 2 weeks at 11 weeks of age. All knees regained a normal, stable range of motion. Bilateral dysplastic hips normalized spontaneously in one patient, while the other two required fewer than 6 weeks of splinting.Conclusion:These findings suggest a potential role for observation in the management of idiopathic grade III CDK. In this cohort, all infants were non-breech, had no foot deformities, or teratologic etiology.Significance of study:A period of observation is warranted for idiopathic CDK. In this series, six out of seven knees reduced spontaneously, and the remaining knee required only a brief period of casting at approximately 3 months of age.

Introduction:Distal femur fractures associated with patellar incarceration are rare, complex injuries that pose significant diagnostic and surgical challenges. The patella, an essential component of the knee extensor mechanism, may become entrapped within distal femoral fracture fragments following high-energy trauma, creating a mechanical block to reduction. Failure to recognize this uncommon injury pattern can result in repeated unsuccessful attempts at closed reduction, leading to chondral injury, knee stiffness, and suboptimal functional outcomes. Early diagnosis using computed tomography (CT) imaging and prompt open reduction are crucial to restore articular congruity and extensor mechanism integrity. Due to the rarity of this condition, existing literature is limited primarily to isolated case reports. This study evaluates the functional and radiological outcomes of open reduction and internal fixation in patients with distal femur fractures associated with patellar incarceration.Materials and Methods:This case series was conducted at a tertiary health-care center between February 2024 and January 2026 after institutional ethical approval. Five patients aged 12–35 years with intra-articular distal femur fractures (AO types 33B and 33C) associated with incarcerated patella were included. One patient had a Salter–Harris Type IV physeal injury. Patients with additional ipsilateral limb fractures, prior knee surgery, or severe open fractures (Gustilo–Anderson IIIB/C) were excluded. Pre-operative assessment included radiographs and CT with three-dimensional reconstruction to confirm patellar incarceration and fracture configuration. All patients underwent open reduction, retrieval of the incarcerated patella, anatomical fracture reduction, retinacular repair, and fixation using cannulated cancellous screws and distal femur locking compression plates. A physeal-sparing technique was employed in the skeletally immature patient. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score at 1-year follow-up.Results:We included five patients (four males and one female) with a mean age of 22.2 years (standard deviation 8.9). Four patients had AO type 33C fractures, and one had type 33B. Retinacular injury was present in all cases. The mean time to union was 10 weeks (range 8–12 weeks). At 1-year follow-up, the mean knee flexion was 118°, and the mean IKDC score was 88, indicating good to excellent functional outcomes. One patient developed post-operative stiffness requiring mobilization under anesthesia. No cases of implant failure, non-union, infection, patellar maltracking, or extensor mechanism dysfunction were observed.Conclusion:Distal femur fractures with patellar incarceration are rare and often irreducible by closed methods. Early CT-based diagnosis followed by prompt open reduction, meticulous retinacular repair, and stable internal fixation results in reliable fracture union and favorable functional outcomes. Timely recognition and intervention are essential to prevent complications and optimize recovery.

Introduction: Aim and Background:Anterior cruciate ligament (ACL) reconstruction is frequently followed by post-operative pain, restricted knee range of motion (ROM), and functional limitations. Multimodal rehabilitation approaches, such as therapeutic exercise (TE), muscle energy technique (MET), and transcutaneous electrical nerve stimulation (TENS) are commonly used; however, comparative evidence on combined interventions remains limited. This study aimed to compare the effects of TE combined with TENS and MET combined with TENS on pain intensity, knee ROM, and functional outcomes following ACL reconstruction.Materials and Methods:A prospective, non-randomized pilot study was conducted on 40 participants (18–40 years) who had undergone ACL reconstruction. Participants were allocated into two groups: Group A received TE plus TENS, and Group B received MET plus TENS. Interventions were administered for 5 weeks. Outcome measures included the numeric pain rating scale (NPRS), goniometric assessment of knee flexion and extension, and the knee injury and osteoarthritis outcome score (KOOS). Assessments were performed at baseline, Day 14, and Day 35. Data were analyzed using repeated-measures analysis of variance with post hoc comparisons.Results:Both groups demonstrated significant reductions in pain intensity over time (P < 0.001). A significant Time × Group interaction (P = 0.017) indicated statistically faster early pain relief in the MET + TENS group. Knee flexion and extension improved significantly in both groups (P < 0.001), with no significant between-group differences (P = 0.115). KOOS subscale scores (pain, symptoms, activities of daily living, sports/recreation, and quality of life) improved significantly in both groups (P < 0.001), with comparable functional gains (P = 0.091).Conclusion:This prospective pilot study suggests that both TE combined with TENS and MET combined with TENS are associated with short-term improvements in pain, knee ROM, and functional outcomes following ACL reconstruction.

Intoduction:In patients who are hemodynamically stable, thrombosis indicators including fibrin degradation products (FDP), D-dimer, prothrombin time-international normalized ratio (PT-INR), along with the FDP-to-fibrinogen proportion may be capable determine artery escape as well as allow for timely treatment.Objectives:The objective of the study was to explore the possible use of anticoagulation biomarkers as additional or additional tests for diagnosis to computed tomography (CT) by evaluating their prediction accuracy for vascular invasion among people with pelvic fractures who have stable hemodynamics.Materials and Methods:Over the course of 20 months, prospective observational cohort research was carried out at the LLR Hospital, GSVM Medical College, Kanpur. We excluded individuals with instability health or significant concomitant injuries and only considered those who were adults (>18 years old) with broken pelvis with stable hemodynamics. Following CT angiography, patients were split into a couple of categories: Extravasation (Group 1, n = 24) along with non-extravasation (Group 2, n = 16). FDP, D-dimer, (PT), active partial thromboplastin time, platelet count, fibrinogen, and the FDP-to-fibrinogen ratio were all measured in blood draws obtained during admittance. To evaluate the predictive abilities of biomarkers, statistical studies were conducted using receiver operating characteristic (ROC) curves, Chi-square tests, along with t-tests.Results:The Extravasation group exhibited significantly higher FDP (14.31 µg/mL vs. 5.52 µg/mL, P < 0.001), D-dimer (789.17 ng/mL vs. 253.38 ng/mL, P < 0.001), PT (16.92 s vs. 13.27 s, P < 0.0001), INR (1.46 vs. 1.16, P = 0.012), and FDP-to-fibrinogen ratio (0.0219 vs. 0.0129, P = 0.0035) compared to the non-extravasation group. The FDP-to-fibrinogen ratio demonstrated the highest area under the ROC curve (area under the curve [AUC] = 0.92), followed by FDP (AUC = 0.85) and D-dimer (AUC = 0.83). Patients with elevated biomarkers were more likely to require angiographic embolization (P < 0.05). Injury Severity Scores were higher in the Extravasation group (mean 17.5 vs. 10.5, P < 0.05). Mortality was low (2.5%, one case in Group 1).Conclusion:Coagulation biomarkers, particularly the FDP-to-fibrinogen ratio, FDP, and D-dimer, are robust predictors of arterial extravasation in hemodynamically stable pelvic fracture patients.

Introduction:Ankylosing spondylitis (AS) is a chronic inflammatory disease that can lead to progressive joint ankylosis, most commonly affecting the spine and hips. Severe cases may result in functional autoarthrodesis of multiple lower extremity joints, significantly impairing mobility and quality of life. Although total hip and knee arthroplasty are well-described individually in AS, management of simultaneous multi-joint ankylosis in extreme flexion deformity is rarely reported.Case Report:We report the case of a 23-year-old male with advanced AS resulting in bilateral hip and knee autoarthrodesis fixed in severe flexion, rendering him wheelchair-bound for 3 years. He underwent four staged arthroplasty procedures over the course of 1 year, consisting of bilateral total hip arthroplasties followed by bilateral total knee arthroplasties, with approximately 8-week intervals between procedures. Significant intraoperative challenges included absent normal joint anatomy, extreme flexion deformities (hips 80–85° and knees 70–75°), and complex patient positioning. The hips were addressed through an anterolateral approach, and the knees through a medial parapatellar approach with adjunctive osteotomies and soft-tissue releases as needed. Postoperatively, the patient underwent intensive rehabilitation and subsequent manipulation under anesthesia to improve the range of motion. Functional outcome measures demonstrated substantial improvement, with hip disability and osteoarthritis outcome score increasing from 6.9 to 61.3, Harris Hip Score from 15 to 63, and knee injury and osteoarthritis outcome score from 9 to 41.Conclusion:Staged total hip and knee arthroplasty in severe AS with autoarthrodesis can result in meaningful functional recovery. Careful pre-operative planning, staged reconstruction, and tailored rehabilitation are essential to optimize outcomes and minimize complications in these complex cases.

Introduction:Hip dislocations are a result of significant force and trauma and constitute one of the many orthopedic emergencies which require immediate attention. Of the hip dislocations, posterior hip dislocation is more common. Over the years, significant changes have been made with respect to the techniques of reducing hip dislocation. Depending on the technique used and the build of the surgeon and the patient, there is variation with respect to the number of assistants required, the position of the patient, the force required to achieve the traction, and the requirement of additional adjuvants such as traction table. However, traction still remains the main principle in the reduction of the dislocated hip joint.Case Report:Two patients presented with post-traumatic posterior dislocation of the hip joint. We used a novel technique which completely eliminates the requirement for traction in the reduction of the hip joint. It can be shortly described as a maneuver encompassing the following “Hyperflexion-Adduction-Internal rotation-Abduction-External rotation-Extension.”Conclusion:Despite the improvement in the techniques of reduction for posterior dislocation of the hip, traction remains the mainstay. Our described technique does not require traction. It significantly reduces the strain on the surgeon’s back and is ergonomic. It can be done in the supine position and no assistants are required, saving time and manpower. It is simple, easily replicable, and independent of the build of the surgeon and the patient. Our “no traction” novel technique is simple, easily replicable and learnable, ergonomic, surgeon friendly technique which will ease the effort of reducing a posteriorly dislocated hip.

Introduction:Aneurysmal bone cyst (ABC) is a benign, locally aggressive lesion seen in the long bones and vertebrae. The tumor is rarely seen in the tarsal bones. Chronic pain and pathological fracture are often the presenting features. Radiographs and Magnetic Resonance Imaging are usually diagnostic and guide the management.Case Report:We present a case of a 27-year-old male with chronic midfoot pain diagnosed as avascular necrosis of the lateral cuneiform, managed with biopsy needle decompression and platelet-rich plasma injection. The patient presented with persistent pain, and the workup revealed an ABC with a pathological fracture. Core biopsy report suggested ABC of lateral cuneiform, which was later managed by excisional curettage and pan lateral cuneiform arthrodesis using a tricortical Iliac crest graft with a favorable outcome.Conclusion:ABC in a long bone is a straightforward diagnosis due to its classical radiographic features. The diagnosis is challenging when presented in unusual locations. An incisional biopsy to is the easiest way to confirm the histopathological diagnosis and aid in surgical planning.

Introduction:Occipital condyle fractures (OCFs) are rare injuries presenting with neurologic sequelae that may be debilitating or even fatal. Treatment options for unstable OCFs include fusion or halo placement. Fusion of the occipitocervical junction is associated with a significant loss of motion.Case Report:This study presents a case of bilateral occipital condylar fractures with C1-C2 rotatory subluxation treated with temporary fusionless occipitocervical fixation.Conclusion:This is a rare case of bilateral OCFs with atlantoaxial instability that underwent fusionless instrumentation and subsequent hardware removal. Treatment resulted in excellent radiographic and clinical outcomes regarding pain and motion at the most recent follow-up.

Background:Traumatic dural tears associated with thoracolumbar burst fractures are uncommon and are rarely complicated by entrapment of neural elements. Pre-operative diagnosis is challenging, and such injuries are often identified only during surgery. Unrecognized dural tears and entrapped nerve roots may result in further neurological injury during operative manipulation.Case Report:A 34-year-old male presented with an L3 burst fracture following a fall from height and had an incomplete neurological deficit below the L2 level. Radiological evaluation revealed an unstable lumbar burst fracture with laminar involvement. During posterior decompression and stabilization, a large traumatic dural tear with entrapment of nerve rootlets within the laminar fracture was identified intraoperatively. Careful release of the entrapped neural elements and primary dural repair were performed, followed by posterior instrumentation. The patient showed progressive neurological recovery with no cerebrospinal fluid-related complications.Conclusion:Traumatic durotomy with nerve root entrapment can occur in high-energy lumbar burst fractures, particularly in the presence of laminar fractures, and may be missed on pre-operative imaging. A high index of suspicion and meticulous intraoperative evaluation are essential to prevent iatrogenic neurological injury and to achieve favorable outcomes.