搜索结果：Indian journal of orthopaedics

Femoral neck fracture (FNF) is a common injury in both elderly and young population, often resulting from low- and high-energy trauma, respectively. The femoral neck system (FNS), a novel fixed-angle device, has recently emerged as a promising implant offering multiple biomechanical advantages over conventional fixation methods. The purpose of this study is to evaluate the clinical and radiological outcomes of FNS in managing FNFs in an Indian population. This prospective observational study was conducted at SKIMS Medical College, Srinagar, from February 2022 to February 2025 involving 40 skeletally mature patients with FNFs treated using FNS. Patients were followed-up for a minimum of 12 months and a maximum of 30 months, with majority (22) of the patients being followed-up for full 30 months. Four out of forty operated patients were lost to follow-up. Clinical outcomes were assessed using the Harris Hip Score (HHS), whilst radiological union was evaluated with the Radiographic Union Score for Hip (RUSH). Intra-operative parameters, fracture morphology, time to union, and complications were also recorded. Thirty-six patients completed follow-up. Mean time to union was 15.37 weeks, mean RUSH score was 27.75, and mean HHS was 95.08. Radiological union was achieved in 34 cases, with one case each of delayed union and non-union with avascular necrosis. Smoking and medial cortex comminution were significantly associated with delayed union. The device demonstrated low complication rates, minimal blood loss, and reduced operative time. The FNS offers effective fixation for FNFs with excellent intermediate-term clinical and radiological outcomes in the Indian population. Its biomechanical stability and minimally invasive approach make it a viable option, though long-term results remain to be established.

Wrist arthroscopy has been an evolving field in recent times and is widely used for the management of various wrist pathologies. The technique has a steep learning curve and requires specialized training. The present study determines the role cadaveric workshops play in helping surgeons acquire the skills of wrist arthroscopy and incorporate the technique into their surgical practice. Three wrist arthroscopy cadaveric courses were conducted each year between 2017 and 2019. Each course included 25 participants, for a total of 75 participants. We analyzed the data acquired from questionnaires filled by 54 surgeons who attended the full two-day wrist arthroscopy cadaveric course and had a minimum of two&#xa0;years of practice in India after the workshop. Out of 54, 38 participants had no exposure to wrist arthroscopy before the workshop. Of these, 26 were performing wrist arthroscopy two&#xa0;years after the workshop, and among these, 13 surgeons had done three or fewer cases, while 13 surgeons had done more than three cases in a year following the workshop (p&#x2009;<&#x2009;0.05). Considering wrist arthroscopic procedures performed two years after the workshop, 42 participants (77.8%) were performing wrist arthroscopic procedures (p<0.001).&#xa0;Of these, 15 had done fewer than three procedures per year, while 27 had done more than three procedures per year (p&#x2009;<&#x2009;0.001). The requirement for further training, lack of infrastructure, and the need for expert supervision were the three main challenges to performing wrist arthroscopy. Cadaveric courses dedicated to wrist arthroscopy help to impart skills that can be successfully transferred to the operating theater, as seen by a positive change in the practice of surgeons who had completed the cadaveric course.

Complications after open reduction and internal fixation (ORIF) of ankle fractures are not uncommon, negatively impacting the postoperative outcome. Tibiotalocalcaneal (TTC) arthrodesis has been shown to be a viable treatment option in these cases. The aim of this study was to describe the operative technique and the outcome of patients presenting failed osteosynthesis of the ankle joint managed with TTC using a retrograde femoral IM nail. This is a retrospective observational study of adult patients (18&#xa0;years or older) operated on for failure in osteosynthesis of the ankle joint (malleolar or tibial pilon fractures) using a retrograde femoral nail to perform TTC arthrodesis, with a minimum follow-up of 24&#xa0;months. Patient demographics, initial injury characterization, comorbidities, initial treatment, time from initial injury to TTC arthrodesis, time to union, secondary procedures, and complications were recorded. Patients were evaluated clinically and radiographically at 12 and 24&#xa0;months using, respectively, a modified version of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores and full-weight-bearing anteroposterior and lateral radiographs. During the study period, 17 patients were treated with TTC arthrodesis using a retrograde femoral nail. The initial injury was a pilon fracture in 4 patients and a malleolar ankle fracture in 13 patients. The time between the initial injury and TTC arthrodesis ranged from 8 to 52&#xa0;months, with a mean of 14.7&#xa0;months. Complete radiographic fusion of the tibiotalar joint occurred uneventfully in all patients, whereas in four (23.5%) cases, complete radiographic fusion of the subtalar joint was not observed, although these patients were considered to have a satisfactory outcome due to a functional, painless, and properly aligned hindfoot after TTC arthrodesis. The mean time to union was 8&#xa0;months, with a range of 5 to 10&#xa0;months. Secondary procedures were performed in 2 patients. Four patients experienced minor complications. There were no statistically significant differences between patients who sustained a tibial pilon fracture and a malleolar ankle fracture in all variables analysed. The modified AOFAS score at 24&#xa0;months ranged from 64 to 94, with a mean of 81 points. The use of a femoral retrograde IM nail for TTC arthrodesis is a viable option for patients with sequelae of tibial pilon and ankle malleolar fractures due to fixation failure.

Fracture neck of femur in the young presents significant challenges with high rates of complications. Osteosynthesis of femoral neck fractures in young adults is treated by anatomical reduction, along with stable internal fixation with multiple cannulated cancellous screws, dynamic hip screws, or a femoral neck system to preserve the natural femoral head. The biplane double-supported screw fixation (BDSF) method has emerged as a novel technique proposing enhanced stability, supported by promising biomechanical and cadaveric studies. However, clinical evidence evaluating the effectiveness of the BDSF method remains limited. This study was aimed at assessing the functional and radiological outcomes of the BDSF method in treating fracture of the neck of femur in the young. This study is a prospective study involving 30 patients with a fractured neck of femur with a mean age of 45.43&#xa0;years (range 18-55&#xa0;years). All patients underwent the BDSF method for fixation and were followed up for 1&#xa0;year. Radiological outcomes were assessed at 6&#xa0;weeks, 3&#xa0;months, 6&#xa0;months, and 1&#xa0;year to look for fracture union, non-union, avascular necrosis (AVN) in the femoral head, and arthritic changes. Functional outcomes were assessed using the modified Harris hip score. The rate of fracture union with the BDSF method of fixation was 96.7%. Complications observed were avascular necrosis (AVN) in 6.7%, non-union in 3.3%, and varus collapse in 13.3% of cases. Functional outcomes, evaluated using the Harris hip score, showed 50.0% excellent, 30.0% good, and 20.0% poor results. The mean Harris hip score was 83.3 at 1-year follow-up. The BDSF method for fixation of fracture of the neck of femur provides a reliable, biplanar stability with an acceptable union rate. The BDSF method ensures early rehabilitation and good functional outcome in fracture of the neck of the femur in young patients by preserving the natural femoral head, indicating its potential as a viable treatment option, although further large-scale, long-term research is warranted.

Confidentiality forms the foundation of the doctor-patient relationship, fostering trust and promoting honest conversations. With the evolving landscape of clinical practice, ensuring patient privacy has become increasingly complex, requiring a nuanced understanding of ethical obligations and legal responsibilities. This article explores the concept of medical confidentiality, outlines its scope and limitations, and examines real-world scenarios where maintaining confidentiality presents ethical dilemmas and practical challenges. This article is a narrative review based on a thematic analysis of relevant literature from PubMed, Scopus, and Google Scholar. Ethical principles, professional guidelines, and clinical scenarios were reviewed to explore key issues in doctor-patient confidentiality. The aim was to provide a practical and ethically grounded perspective for clinicians. Findings underscore that confidentiality extends beyond sensitive clinical data to include all forms of identifiable patient information, across verbal, written, and digital modes. Illustrative examples were used to highlight grey zones in the application of confidentiality principles. Clinical practice often demands context-specific judgment, particularly in team-based care, interactions with families, and digital communication. Maintaining confidentiality requires discretion, clear institutional protocols, and a patient-centered approach. Confidentiality is not merely a professional norm but a core ethical commitment. In an era of increasing digitization and collaboration, safeguarding patient privacy demands vigilance, sensitivity, and proactive communication. Medical professionals must navigate competing interests while upholding the dignity and privacy of their patients.

Proximal humerus fractures with medial calcar disruption present a surgical challenge. Screw cut-out and varus collapse are common complications following fixation. Augmentation of fixation using intramedullary fibular autograft with medialization along the calcar adequately restores the medial column, which is a well-described technique in the literature. We undertook this study to evaluate the results of central intramedullary placement of fibular autograft without medialization. We conducted this prospective study with 15 patients over 2&#xa0;years with a minimum follow-up of 1&#xa0;year. The inclusion criteria included all patients greater than 18&#xa0;years of age with a fracture of the proximal humerus but with medial calcar disruption (>2&#xa0;mm cortical discontinuity in anteroposterior or axillary views, or absence of continuity between calcar and proximal fragment in comminuted fracture) patterns. All the patients were operated upon using deltopectoral approach with a proximal humerus locking plate with central placement of intramedullary fibular strut autograft without medialization. The patients were followed up at six weeks, three months, six months, and one year. At each follow-up, X-rays were done and the shoulder range of motion was assessed. Disabilities of Arm, Shoulder and Hand (DASH) score and Visual Analog Score (VAS) were also recorded. All fractures had united by (mean) 6.5&#xa0;months. None of the patients reported with avascular necrosis, screw cut-out, or varus collapse at the final follow-up. One patient had a deep infection which required debridement, plate removal, but the fibular graft was retained. There were no fibular autograft donor-site complications. Humeral head height and humerus neck shaft angle were well maintained (p&#xa0;<&#xa0;0.05). The DASH and VAS scores decreased significantly (p&#xa0;<&#xa0;0.05) over serial follow-ups. The DASH (Mean&#xb1;Standard Deviation) score was 27.27&#xb1;5.80 and the VAS score was 1.33&#xb1;0.98 at the final follow-up (1&#xa0;year) (p&#xa0;<&#xa0;0.05). There were significant improvements (p&#xa0;<&#xa0;0.05) in the shoulder range of motion at the final follow-up (Mean&#xb1;Standard Deviation) flexion 138.6&#xb1;11.7 degrees, extension 40.3&#xb1;7.7&#xa0;degrees, abduction 135.3&#xb1;9.7 degrees, adduction 38.4&#xb1;5.7 degrees, internal rotation 50.6&#xb1;9.5 degrees and external rotation 42.0&#xb1;6.9 degrees. We admit the limitations of our study, namely small sample size, lack of control group (locking plate alone or locking plate with medialized fibular graft), and lack of biomechanical data, but we can conclude that central intramedullary placement provides satisfactory medial support in this small series to maintain a valgus reduction. Larger comparative studies are required before asserting equivalence with medialized graft placement.

Although bone transport is a well-established technique for reconstructing segmental tibial bone defects, it is often associated with complications due to prolonged external fixation. Bone transport over a plate (BTOP) offers the advantage of reducing external fixation time, potentially lowering the complication rate compared to the traditional method. This study aims to evaluate BTOP-specific complications and their incidence in the treatment of tibial bone defects. A total of 32 cases (30 patients), with a mean age at the time of surgery of 47.1&#xa0;years (range: 16-80), were included. All underwent the BTOP procedure between 2009 and 2023. Success or failure was determined by the bone healing status at both the distraction and docking sites. The ASAMI bony and functional outcomes were assessed at the latest follow-up. Complications were categorized as problems, obstacles, or sequelae. The mean defect size was 7.9&#xa0;cm. Procedural success was achieved in 28 cases, although 6 required additional surgeries. There were 4 cases of failure, all associated with deep infection. The mean duration of external fixation was 90.9&#xa0;days, with a mean external fixation index of 12.8&#xa0;days/cm. Twenty-five of the 32 cases showed excellent or good outcomes in both bony and functional assessments. A total of 45 complications were reported (22 problems, 9 obstacles, and 14 sequelae), with a mean of 1.41 complications per patient. Docking site nonunion occurred in 4 cases and was attributed to mechanical instability. BTOP appears to be a promising technique for reconstructing segmental tibial defects, offering a high success rate with reduced external fixation time and fewer complications. However, docking site nonunion remains a specific challenge of the BTOP technique, warranting further attention.

In orthopaedic surgical practice, clinical excellence must be complemented by effective communication and ethical clarity. Inadequate communication and ethical lapses are increasingly linked to compromised patient outcomes, loss of trust, and rising incidents of violence against healthcare professionals. To examine the intersection of communication, ethics, and clinical outcomes in orthopaedics, drawing insights from Indian literature, real-world interventions, and recent educational reforms. This paper employs a triangulated qualitative approach comprising: (i) a review of three authoritative Indian sources-Communicate. Care. Cure. A Guide to Healthcare Communication (edited by Dr. Alexander Thomas, Association of Healthcare Providers India [AHPI], 2019), Perils in Practice: Prevention of Violence Against Healthcare Professionals (also edited by Dr. Alexander Thomas, AHPI, 2024), and Biomedical Ethics (authored by Dr. Olinda Timms, 2019); (ii) analysis of patient-provider narratives; and (iii) thematic insights from hospital-based interventions and national medical curriculum reforms. Findings demonstrate that ethically grounded and culturally sensitive communication significantly enhances patient safety, satisfaction, and institutional trust. The incorporation of communication and ethics training in orthopaedic practice has led to improved care delivery and reduced conflict in clinical settings. Communication and ethics are interdependent pillars of high-quality orthopaedic care. Embedding them into professional training and institutional policy is essential to achieving patient-centered outcomes, preventing conflict, and fostering ethical resilience among healthcare providers.

Avascular necrosis (AVN) of the talus is a challenging complication following talar fractures. The modified Blair fusion technique, which preserves the talar body and enhances fixation, has emerged as a viable salvage procedure. However, data on outcomes remain limited. We present data of 10 patients with post-traumatic AVN of the talus following talar neck/body fractures, who underwent modified Blair fusion. Two patients were stabilized with an Ilizarov fixator, while 8 were fixed with wires, screws, or plate and screw constructs. The primary outcomes included the AOFAS score and radiological. Secondary outcomes include the nature and rate of complications. Fusion was achieved in 9 patients. All cases that fused showed evidence of revascularization of the necrotic talar body. The mean preoperative AOFAS score (measured on a scale from 0 to 86) was 41.5&#x2009;&#xb1;&#x2009;10.2 (range, 18-56) and improved to 70.0&#x2009;&#xb1;&#x2009;6.9 (range, 58-83) at the final follow-up (P&#x2009;=&#x2009;0.0001). Arthrosis of the subtalar joint was noted in 5 patients. One patient had residual varus deformity. Superficial infection and deep infection were noted in one case each. The mean follow-up duration was 5.9&#x2009;&#xb1;&#x2009;6.1&#xa0;years (range, 1-18&#xa0;years). Modified Blair fusion with preservation of the necrotic head provides a reliable salvage option in patients with complications and arthrosis after complex talus fractures. Saving the talus body contributes to the stability of the reconstruction, while maintaining the distance between the tibia and calcaneus, with evidence of subsequent revascularization and subtalar joint remodeling seen on a long-term follow-up.

Despite increasing gender diversity in medicine, orthopedic surgery remains male-dominated, especially in India. This study aimed to explore male orthopedic surgeons' perspectives on the competence of female colleagues, their intraoperative preferences, and training experiences. A cross-sectional survey was conducted among 226 male orthopedic surgeons in India. Data on age, years of experience, type of practice, and training history were collected. Respondents shared their perceptions regarding gender-based competence, surgical assistance preferences, and challenges in training women. Statistical analysis (chi-square and t tests) was performed to assess associations between demographic variables, perceptions, and preferences. Most respondents worked in the private sector (69.9%), with 55.4% having 11-30&#xa0;years of experience. Only 9.7% had trained more than five female residents, and 33.6% had trained none. While 74.9% believed men and women were equally competent, 34.5% preferred male assistants intraoperatively. Surgeons with&#x2009;>30&#xa0;years of experience were significantly more likely to perceive women as competent (&#x3c7; 2&#x2009;=&#x2009;10.88, p&#x2009;=&#x2009;0.004), and were older (52.3&#x2009;&#xb1;&#x2009;10.3&#xa0;years vs. 48.5&#x2009;&#xb1;&#x2009;10.7&#xa0;years; p&#x2009;=&#x2009;0.03). Preference for male assistants correlated significantly with fewer women trained (&#x3c7;2&#x2009;=&#x2009;8.11, p&#x2009;=&#x2009;0.017) and with lower perceived competence of women (&#x3c7;2&#x2009;=&#x2009;58.73, p&#x2009;<&#x2009;0.001). Word frequency analysis showed "sincerity" and "ethic" for women, and "strength" and "emergencies" for men. Key challenges in training women included perceived sensitivity to criticism and adaptation issues. Although gender competence is increasingly acknowledged as equal, unconscious bias persists in surgical training and assistant preferences. Promoting female mentorship and inclusive training environments is essential to address systemic disparities in orthopedics.

The intraoperative breakage and retention of surgical instruments is a recognised complication in orthopaedic surgery, with implications on patient safety, medicolegal accountability, and surgical decision-making. While the incidence of intraoperative instrument breakage has been described internationally, locoregional data from Singapore and the region is limited. We conducted a retrospective review of institutional incident reports for orthopaedic surgeries performed at a 700-bed regional hospital between 2019 and 2024. Cases related to broken surgical instruments were identified. Patient demographics, surgical characteristics, instrument type, anatomical site, surgeon seniority, follow-up duration, the need for secondary intervention, and disclosure practices were analysed. Among 21,606 orthopaedic procedures, 34 cases of intraoperative breakage of surgical instruments were recorded, yielding an overall incidence of 0.16%. Incidence was highest in trauma surgeries (0.56%), compared with elective (0.06%) and spine procedures (0.06%). The majority of patients were male (61.8%), and the mean operative duration was 158&#xa0;min. The femur was most frequently affected (35.3%), followed by the tibia and upper limb bones. Drill bits (38.2%), K-wires (26.5%), and screws (14.7%) were the most commonly implicated instruments. Consultants performed 70.6% of the index operations. None of the patients required a secondary procedure at the point of data extraction during a mean follow-up of 9.93&#xa0;months. Open disclosure was documented in all cases within 24&#xa0;h. The incidence of intraoperative instrument breakage and retention at our institution is low and comparable to international reports, with trauma procedures and drill bits most frequently involved. While most retained fragments remain clinically silent, robust prevention, detection, and reporting systems are critical for maintaining patient safety and mitigating medicolegal risk. Standardised protocols for disclosure and monitoring should be integral to orthopaedic surgical governance.

Integrated fixation is an emerging technique for the treatment of posttraumatic tibial bone defects that reduces external frame duration by combining external fixation with internal fixation to minimize complications. This systematic review focuses on integrated fixation strategies and assesses outcomes when managing posttraumatic tibial bone defects. A systematic review following PRISMA guidelines was conducted across MEDLINE&#xae;, EMBASE&#xae;, and PubMed&#xae;. Studies published between 1975 and 2025 reporting integrated fixation techniques in skeletally mature patients with posttraumatic tibial defects were included. Outcomes assessed included union rates, complications, external fixation duration, Association for the Study and Application of Methods of Ilizarov (ASAMI) function and bone scores, and pain. Following identification of 699 studies and removal of 86 duplicates, 38 articles underwent full-text screening. Six studies, including 64 patients (mean age 41.2&#xa0;years), met inclusion criteria. Integrated fixation demonstrated a combined union rate of 97%, with an average external fixation duration of 151.3&#xa0;days and a mean union time of 6.6&#xa0;months. Complications included pin-tract infections (44%), equinus contractures (10%), and refractures (4.7%). ASAMI scores were excellent in 74% of evaluated patients for functional outcomes and 91% for bone outcomes, with minimal or absent pain in 100% of cases. Integrated fixation demonstrated favorable outcomes in managing posttraumatic tibial bone defects. This approach offers a promising alternative to conventional methods, by reducing complications resulting from prolonged external fixation. The online version contains supplementary material available at 10.1007/s43465-025-01537-9.

Artificial Intelligence (AI) is transforming pediatric orthopedics by harnessing the power of technology to address the unique challenges associated with the growing musculoskeletal system and to adapt to modern healthcare delivery models. This article reviews the literature on recent advancements in AI impacting paediatric orthopedic practices and summarizes our own experience in the development and application of AI in pediatric orthopedics. AI-driven imaging techniques, such as automated ultrasound analysis, have significantly improved screening for developmental dysplasia of the hip (DDH) by enhancing accuracy and accessibility while minimizing radiation exposure. Similarly, machine learning has automated and improved diagnostic precision in complex assessments like bone age determination. In surgical planning, AI-powered robotic systems have optimized spinal instrumentation placement, reduced complications and enhance procedural accuracy. AI-based predictive modeling allows surgeons to develop personalized operative strategies through detailed 3D modeling and simulation, critical for pediatric deformity correction. Remote gait analysis via wearable sensors and smartphone-based video analytics facilitates continuous monitoring, personalized rehabilitation, and early complication detection. Clinical workflow efficiency is improved through AI-enhanced documentation, virtual assistants, and scheduling optimization tools. AI promises substantial benefits for pediatric orthopedic care. Integration allows for more precise diagnosis, treatment personalization, and positive long-term patient outcomes. Ongoing research should focus on clinical adoption strategies and expanding the scope of conditions to which the technology can be applied to maximize the benefit of AI in pediatric orthopedics.

Hoffa fractures are rare, unstable coronal plane injuries of the distal femur. Optimal fixation strategies remain debated, particularly in cases complicated by medial voids or nonunion. We performed a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from January 2000 to March 2025 using predefined keywords. Eligible studies included randomized and observational clinical studies reporting outcomes of operative fixation for Hoffa fractures. Data extracted included union rate, time to union, functional scores, complications, and fixation method. Risk of bias was assessed with the ROBINS-I tool, and certainty of evidence was rated using GRADE. Pooled estimates were calculated using fixed- or random-effects models depending on heterogeneity, with subgroup analyses for fixation strategy and medial voids. Publication bias was assessed using funnel plots and Egger's test, where&#x2009;&#x2265;&#x2009;10 studies were available. Seventeen studies (n&#x2009;=&#x2009;432 patients) were included: 246 treated with screw/single-plate fixation and 186 with dual plating.Union rate: 99.2% (95% CI 97.4-99.9; I 2&#x2009;=&#x2009;12%).Time to union: Weighted mean 15.4&#xa0;weeks across 12 studies; most did not report variance data, precluding pooled meta-analysis. Healing was delayed by&#x2009;~&#x2009;5.5&#xa0;weeks in studies describing medial voids.Functional outcomes: Eight studies reported scores using various systems (KSS, IKDC, Neer, and Letenneur). Results clustered around a weighted mean of&#x2009;~&#x2009;84/100. Variance data were inconsistently reported; therefore, outcomes were summarized descriptively. Dual plating groups tended to show higher scores (~&#x2009;87) than screw/single-plate fixation (~&#x2009;81).Complications: 7.1% (95% CI 5.5-9.3; I 2&#x2009;=&#x2009;15%), based on ten studies. Dual plating was associated with fewer reported complications (2.1% vs. 7.10%).Funnel plots showed no major asymmetry. Certainty of evidence was moderate for union, moderate-high for complications, and low for time to union and function. Both screw/single-plate and dual plating achieve high union rates in Hoffa fractures. Dual plating was associated with fewer complications and higher reported functional outcomes, particularly in fractures with medial voids or comminution. While these findings support dual plating in complex cases, the evidence base is limited by small sample sizes and incomplete variance reporting. Prospective multicenter trials with standardized outcome measures are needed to refine fixation strategies. The online version contains supplementary material available at 10.1007/s43465-025-01650-9.

Orthopaedic practice is undergoing a paradigm shift toward more physiological and regenerative approaches for managing complex and degenerative musculoskeletal conditions. This shift is evidenced by the exponential rise in the use of orthobiologics and cellular therapies in routine surgical practice. Despite their growing clinical relevance, the integration of regenerative medicine into medical education remains inconsistent and fragmented across institutions and countries. A qualitative synthesis was conducted based on curricular proposals and institutional models from leading regenerative medicine organizations. These include the American Board of Regenerative Medicine (ABRM), the Academy of Regenerative Medicine (ARM) in the UK, the Brazilian Academy of Regenerative Medicine (ABMR), and the Fellowship in Stemcell and Regenerative Medicine (FISRM) under Agathisha Stemcell Academy in India. Key barriers to curricular integration-such as lack of standardized guidelines, pedagogical resistance, instructor shortages, and infrastructure deficits-were identified and analyzed. Strategies for overcoming these barriers, including faculty development and adoption of proven pedagogical frameworks, were explored. Findings indicate that while regenerative medicine is increasingly adopted in clinical practice, its educational incorporation is hindered by systemic and logistical challenges. Pioneering institutions have proposed competency-based models that emphasize practical training, interdisciplinary collaboration, and global standardization. Faculty training and curricular innovation emerged as critical enablers for scalable implementation. To legitimize and optimize the clinical use of regenerative therapies, it is imperative to strengthen their presence in medical education. A globally harmonized, competency-driven curriculum supported by trained faculty and robust infrastructure will enhance safety, efficacy, and professional acceptance of regenerative medicine in orthopaedic practice.

The incorporation of artificial intelligence (AI) and robotic systems into orthopaedic procedures is transforming diagnostic accuracy, surgical efficiency, and clinical outcomes. Despite these technological advancements, they also bring forth significant ethical, legal, and professional challenges that remain underexplored-especially in countries with evolving regulatory landscapes. This review synthesizes current literature on AI- and robotics-related medicolegal concerns in orthopaedics, focusing on diagnostic inaccuracies, mechanical or software-related failures, and the complexities of obtaining valid informed consent in a digital age. The analysis also considers the status of training and credentialing processes in low and middle-income settings. Our findings reveal critical gaps in accountability structures for AI-driven decisions, risk management protocols for robotic failures, and legal protections for both patients and surgeons. Additionally, there is a marked deficiency in standardized educational pathways for the safe and competent use of these technologies in clinical orthopaedics. As AI and robotics become more prevalent in orthopaedic practice, particularly in India, there is an immediate need to establish comprehensive legal, ethical, and professional frameworks. Proactive regulation, clear guidelines, and structured training programs are essential to ensure patient safety and minimize medico-legal risk.

The effectiveness of a shooting method based on patient and fluoroscopy positioning to reduce the number of shots and radiation exposure in posterior pelvic injuries characterized by sacroiliac joint disruption was investigated. Patients who underwent intraoperative pelvic radiological imaging or percutaneous sacroiliac screw application due to sacral fracture, sacroiliac instability, dislocation, or pelvic instability between 2017 and 2023 were included. A total of 40 patients (17 male, 23 female) were randomly selected and distributed equally into two groups (Group 1: traditional method, Group 2: angle-measured method) by the first author. Each group consisted of 20 patients, and imaging was performed by two different fluoroscopy technicians (Technician A and Technician B), with 10 patients per group examined by each technician. Coccyx lateral, pelvic inlet, and pelvic outlet radiographs were obtained in both groups. The number of shots required to obtain diagnostically adequate images was recorded and compared. In Group 1 shots, Technician A obtained suitable images with the following number of shots: Coccyx lateral 12.3&#x2009;&#xb1;&#x2009;3.2 (range 7-18); pelvic inlet 10.8&#x2009;&#xb1;&#x2009;2.4 (range 6-16); pelvic outlet 12.5&#x2009;&#xb1;&#x2009;2.8 (range 7-17). Technician B obtained: Coccyx lateral 12.8&#x2009;&#xb1;&#x2009;1.5 (range 10-16); pelvic inlet 12.2&#x2009;&#xb1;&#x2009;3.1 (range 6-18); pelvic outlet 14.5&#x2009;&#xb1;&#x2009;2.7 (range 10-18). In Group 2 shots, Technician A obtained: Coccyx lateral 3.5&#x2009;&#xb1;&#x2009;1.4 (range 1-7); pelvic inlet 3.8&#x2009;&#xb1;&#x2009;1.8 (range 1-9); pelvic outlet 4.3&#x2009;&#xb1;&#x2009;1.7 (range 2-7). Technician B obtained: Coccyx lateral 3.1&#x2009;&#xb1;&#x2009;1.07 (range 1-5); pelvic inlet 4.1&#x2009;&#xb1;&#x2009;1.4 (range 2-7); pelvic outlet 5.9&#x2009;&#xb1;&#x2009;2.2 (range 3-10). Statistically significant differences were observed in the number of shots for coccyx lateral (p&#x2009;<&#x2009;0.001, f: 365.8, df: 1), pelvic inlet (p&#x2009;<&#x2009;0.001, f: 227.7, df: 1), and pelvic outlet (p&#x2009;<&#x2009;0.001, f: 270.6, df: 1) images between Group 1 and Group 2. Preoperative patient positioning and proper fluoroscopy positioning according to the lateral sacral tilt angle significantly affected the number of shots and the quality of the obtained images. The angle-measured method required fewer shots and reduced radiation exposure during posterior pelvic surgical procedures.

This study sought to evaluate the use of frailty, compared to age alone and American Society of Anesthesiologists (ASA) score, for prediction of mortality and failure to rescue (FTR) in patients undergoing surgical fixation of distal femur fractures (DFFs). The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent surgical management of DFFs. Frailty was evaluated using the 5-Item Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI). Outcomes included 30-day mortality and FTR (mortality following major complication). Multivariate regression and receiver operating characteristic curve (AUROC) analyses were performed to assess odds ratio (OR) and discriminatory accuracy (quantified by C-statistic), respectively. There were 2638 patients (median age 73&#xa0;years) undergoing DFF fixation included in this study. Of these, 90 (3.4%) patients experienced mortality, while FTR occurred in 51 (1.9%) patients. Increasing frailty, as rated by the mFI-5 and RAI, was significantly associated with higher odds of 30-day mortality and FTR in patients undergoing surgical fixation of DFF. Additionally, RAI showed superior discriminatory accuracy for 30-day mortality and FTR compared to mFI-5, age, and ASA. The RAI demonstrates superior predictive value and discriminatory accuracy for postoperative mortality. Given these findings, frailty as measured by the RAI may be a useful bedside screening tool to identify patients at risk for adverse outcomes. In doing so, patients can be optimized preoperatively to improve clinical care.

Fractures of the distal femur present significant challenges in orthopaedic trauma due to their complex anatomy, biomechanical demands, and potential complications such as malunion, non union, and stiffness. These fractures, though relatively rare (accounting for 6-7% of femur fractures), are associated with high morbidity, particularly in elderly osteoporotic patients and younger individuals with high-energy trauma. This study evaluates the role of&#xa0;multi lock retrograde intramedullary nailing-a minimally invasive fixation method-in the management of these fractures, focusing on functional and radiological outcomes. This prospective observational study included 60 patients (>&#x2009;18&#xa0;years) with AO classification types A1, A2, A3, C1, and C2 fractures treated at S.N. Medical College, Agra, between May 2023 and January 2025. All underwent multi lock retrograde nailing via a minimally invasive approach. Functional outcomes were assessed using the American Knee Society Score (AKSS) at 1, 3, and 6&#xa0;months. Radiological outcomes were evaluated using standard anteroposterior and lateral X-rays. Secondary parameters included pain (VAS score), range of motion (ROM), complications, and time to full weight-bearing. At six months, most patients showed favourable recovery. Functional outcomes improved with 66.7% achieving good to excellent results, while only 10.0% had poor scores. Radiologically, 53.3% achieved complete union and just 3.3% showed no callus formation (p&#x2009;=&#x2009;0.001). Range of motion of knee improved in 83.4% with&#x2009;>&#x2009;90&#xb0;, and pain reduced significantly, with 60.0% reporting minimal VAS scores (0-3) (p&#x2009;=&#x2009;0.001). Complications were low (16.7%), mainly pain, stiffness, extensor lag, and one superficial infection, all managed conservatively. Full weight bearing was achieved in 93.3% within six months (p&#x2009;=&#x2009;0.001). Multilock retrograde nailing is a safe and effective method for managing selected distal femur fractures, offering stable fixation, early mobilization, and favourable functional recovery with minimal complications.