Purpose: Suspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II). Materials and methods: This was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery. Results: Postoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9). Conclusion: ACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results. Level of evidence: 1.

Background: Femoral head avascular necrosis leads to osteoarthritis of the hip joint and affects its functional capacity in sickle cell disease patients. The functional outcomes of total hip replacement (THR) on patients with congruous joints who underwent hip replacement after having a failed joint preservation surgery are unknown. This study aimed to compare the functional outcomes of THR in patients with sickle cell disease having avascular necrosis with and without loss of hip joint congruency.Methods: This retrospective study included 35 patients (age, 20–52 years; 18 males and 17 females) who underwent uncemented THR. Patients were divided into Group-A (n = 18, good hip joint congruency) and Group-B (n = 17, obliterated hip joint congruency). The Harris Hip Score (HHS) was used to assess functional outcomes. All patients were followed up at 6-weekly intervals then 6-monthly intervals.Results: The mean follow-up period was 8.26 ± 3.01 years. The mean preoperative HHSs of Group-A and Group-B were 45.22 ± 3.021 and 25.94 ± 4.437, respectively. Postoperatively, a subsequent increase in HHS was found in both groups, and a significant difference between the groups was observed at 6 weeks (p < 0.0001*) and 1 year (p < 0.0006*). Interestingly, HHS was not significantly different (p = 0.0688) at 5-year follow-up between the groups. The differences in HHS within the group at each subsequent follow-up were also statistically significant (ANOVA,p < 0.0001*).Conclusion: A significant improvement was observed with THR in both groups. Nevertheless, the flattened hip joint congruency group showed significantly better HHS improvements than the normal congruency groups. These findings may aid in the decision-making capabilities of the surgeons.

Sclerotherapy offers an alternative to surgery to treat an aneurysmal bone cyst (ABC). The present study's main objective was to assess the radiological efficacy of sclerotherapy in the healing of the cyst cavity secondary to biopsy-proven ABC on X-rays and assess clinical efficacy on pain, recurrence, and complications. Between 2016 and 2018, 26 patients (12 females, 14 males) with biopsy-proven ABC treated by sclerotherapy were included. All patients received an injection of polidocanol 3% intralesional as standard treatment under fluoroscopic guidance. Ossification was assessed on plain X-ray, and the pain was evaluated on a visual analog scale (VAS). Ossification was complete in 24 (92.3%) patients and partial in two (7.7%) patients. Eighteen patients (70%) were pain-free at the end of three months. There was an improvement in the VAS score, and clinically, there was a significant reduction in pain and swelling. Two patients developed recurrence within two years of follow-up, treated successfully by the re-application of intralesional polidocanol 3% injection. Sclerotherapy provides an effective, minimally invasive treatment for ABC and is particularly useful for deep lesions, challenging access for surgery and potentially damaging vital structures. The use of percutaneous polidocanol 3% under fluoroscopic control seems to improve the risk/benefit ratio. Its clinical and radiological efficacy makes sclerotherapy an alternative treatment option in ABC. IV, prospective study

Spinal cord injury (SCI) is a devasting neurological condition producing physical dependency, morbidity, psychological stress, and financial burden. During the last 30 years, its global prevalence has increased from 236 to 1298 cases per million populations. Two types of spinal cord injury are primary and secondary injury. Primary injury is mechanical damage to the cord itself whereas secondary injury results from one or more biochemical and cellular processes that are triggered by the primary lesion. In 1700 BC, in an Egyptian surgical papyrus, they describe the frustration of health care professionals in treating a severe spinal cord injury, the Papyrus reported spinal fractures as a “disease that should not be treated”. Most of these studies approach a patient with acute spinal cord injury (ASCI) in one of four manners: corrective surgery or a physical, biological, or pharmacological treatment method. Science is unraveling the mechanisms of cell protection and neuroregeneration, but clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration. The combination of several therapeutic strategies should, at a minimum, allow for partial functional recoveries for these patients, which could improve their quality of life. More studies were done on spinalized animals that indicate that most of these pharmacological agents may act on receptors present in the spinal cord, thus facilitate to produce coordinated locomotor movement, whereas some other drugs used to improve the neuropathological changes caused because of spinal cord injury (SCI), such as spasticity or demyelination, to improve walking.

Introduction. The treatment of long bone shaft nonunions is challenging. The technique of osteoperiosteal decortications flap for approaching the nonunion site coupled with fixation modalities was first described by Judet in 1963. Despite promising clinical and radiological union, this technique is not popular among orthopaedic surgeons. Our study aimed to evaluate the radiological union and functional results of shaft tibia nonunions treated by the osteoperiosteal decortication approach. Methods. This retrospective study included all the cases with established tibial shaft nonunion following stringent inclusion and exclusion criteria and operated upon by following the principle of osteoperiosteal flap technique from April 2015 to July 2019. Further subgroups were made based on nonunions complexity based on nonunion scoring system (NUSS) score. The outcome measures included radiological union scale in tibial fractures (RUST) and lower extremity functional scale (LEFS). The preoperative scores for union and function were recorded, and the subsequent scores were obtained at three, six, and nine months and one year. Appropriate statistical analysis of the data was done. Results. Thirty-four cases were shortlisted for analysis, fulfilling our inclusion and exclusion criteria. There were 22 males (64.7%) and 12 females (35.3%) with a mean age of 34.17 +/- 10.3 years. Subgroup analysis based on the complexity of nonunion (NUSS score) revealed 14 cases in group A, 10 cases in group B, 10 cases in group C, and 0 cases in group D. The average time from fracture to surgery in these cases was 14.6 months. The average time to achieve union was 9.6 months, with patients in groups A, B, and C, having a mean duration of 9, 10.5, and 12 months, respectively. Statistically, significant improvement was seen in both RUST scores and LEFS score. Complications included infection in seven cases, wound dehiscence in two cases, and four cases of persistent nonunion. Conclusion. Osteoperiosteal decortication remains a highly effective surgical technique in the management of nonunion of long bones. NUSS scoring is an essential tool for prognosticating nonunion cases. This score is inversely related to the radiological union (RUST score) of the bone and functional recovery (LEFS score) of the patient.

Introduction: Bone-specific alkaline phosphatase (BALP) has been a sensitive and reliable marker of bone metabolic activity. The study aimed to study the epidemiology of orthopaedic trauma patients and estimate the level of BALP in these patients. Material and methods: This hospital-based observational cross-sectional study was conducted on over 300 patients admitted to the orthopaedic trauma unit in the level I trauma centre of North India during the study period from January 2020 to January 2021. The level of BALP was assessed in serum samples of 258 patients. Result: A total of 300 patients were included in this study, with an average age of 33.52±17.16 years. Road traffic accidents were the most common mode of injury among admitted patients. We found a significant linear correlation between age and mean BALP levels (P-value < 0.005). The mean age of patients having abnormal BALP is 63.0±16.61 years. Females (22.61±16.23) had greater mean BALP levels than males (13.15±5.86). Among different fractures, fractures around the hip had a higher mean BALP level (23.17±15.07). Patients with diabetes mellitus have higher mean BALP levels. Conclusion: BALP is a cost-effective, readily available bone marker to assess the metabolic activity of orthopaedic trauma patients. Old age patients should undergo routine BALP estimation at admission to rule out metabolic disorders, and timely intervention will prevent complications associated with metabolic disorders.