Introduction: Three-dimensional (3D) technology, also called by various names rapid prototyping, additive manufacturing, or solid free-form technology, has gained momentum over the last 2 decades. Initially, its application was limited because it was seen as unobtainable and expensive with limited clinical application. Initially, it was created by subtraction from the raw material but is currently manufactured by an additive process. 3D printing is a process in which objects are fabricated by fusing or depositing materials in layers from the fed computer data. The physical model is built in layers, with one thin layer at a time after the formulation of the digital design in standard triangle language (STL) format. The physical model is manufactured using both solid and liquid elements and also a large array of materials, including plastics, metals, and ceramics. This facilitates computer-aided design to develop and manufacture orthopedic devices and instruments. Materials and methods: The search words included all the synonyms of 3D printing, prototype, rapid prototyping, and additive printing about arthroplasty in the abstract. The results were limited to English language and human samples. The comprehensive search was run through Ovid Medline, Embase, Scopus, Web of Science, and Cochrane and nonindexed citations to generate papers incorporating 3D printing and arthroplasty primarily. The result dates back from 1908 to March 2018. The total number of papers generated was 4,554. The duplication of papers was reduced to 2,395. The systemic search results for Ovid Medline, Epub ahead of print, in-process and other nonindexed citations, Ovid Medline® Daily, Ovid Medline, and Versions (R). Results: The 2,395 abstracts were scanned for the involvement of 3D printing or rapid prototyping involving the keyword arthroplasty of any region. A total of 58 articles were eligible. The distribution of papers in various regions was hip (21), hip and knee (five), knee (21), pelvic and hip (six), proximal interphalangeal (PIP) (one), shoulder (three), and wrist (one). Conclusion: Three-dimensional (3D) printing application in orthopedic arthroplasty is very exciting and has the definite potential to alter the future of the orthopedic practice. It can mimic and reproduce the complex structure from severe to complicated cases into a physical model that can be used in preoperatively surgical planning of joint arthroplasty. Patient-specific guides can be generated to serve as cutting guides during the surgery. 3D printing facilitates accurate preoperative planning and better outcome, even in complex and deformed cases. The use of 3D printing improves the clinical outcome in arthroplasty. Limitations are the results of long-term use, quality of the model, cost of production, and production time.

Introduction: The reliability of clinical tests in diagnosing De Quervain's disease has been established, but the presence of subcompartmentalization is difficult to identify, which gave the origin of the extensor pollicis brevis (EPB) entrapment test. Diagnosis of several other anatomical variations like a bony crest, multiple abductor pollicis longus (APL), and EPB slips are necessary. However, surgical inspection is the gold standard method for diagnosing anatomical variation, but the improvement in diagnostic efficacy for better prognosis by combining clinical and ultrasound examination is to be assessed. Aim: To determine the correlation between EPB entrapment test and ultrasound wrist findings in patients with de Quervain's tenosynovitis in the detection of anatomical variations of the first extensor compartment. Materials and methods: A total of 40 Finkelstein's test-positive wrists underwent EPB entrapment test and ultrasonography (USG) examination by a surgeon and a radiologist, respectively. Radiological evidence of sub-compartmentalization and other anatomical variations were recorded. Both the surgeon and radiologist were blinded to each other's results. Surgery was done as a reference standard. Results: The sensitivity of the EPB entrapment test in identifying the sub-compartmentalization is 73.6%, and that of the ultrasound examination is 97.4%, with a majority of the distal incomplete septum (75%). The mean number of APL slips was three, and one wrist had multiple EPB slips.³ Ultrasound also showed a bony crest in the radial styloid of 39 wrists (97.5%) Conclusion: The extensor pollicis brevis (EPB) entrapment test, a reliable and simple clinical test for identifying sub-compartmentalization of the first extensor compartment but in combination with ultrasound examination, which identifies anatomical variations, could be vital in deciding appropriate treatment and effective surgical release, thereby preventing treatment failures.

Introduction: Laceration to the dorsum of the foot is usually associated with injury to the extensor hallucis longus (EHL) tendon. But in chronic cases or neglected EHL injuries, the patient develops EHL dysfunction causing a flexion deformity of the great toe at the level of the IP joint. There are various methods (autograft and allograft) for the treatment of large defects in EHL tendons. Tendon diameter mismatch and diminished resistance are common issues in other tendon transfers. Materials and methods: This study had 12 patients with EHL injuries—reconstructed by double looping with extensor digitorum longus (EDL) done from 1^st September 2019 to 28^th February 2023. But intraoperatively, there was a defect of up to 4–6 cm and so in all cases, EDL of the second toe was rerouted and double looping done, and transferred to EHL. The distal part of EDL was tenodesed with extensor digitorum brevis (EDB). In the case of associated fractures, they were anatomically reduced and the EHL defect was repaired. Results and discussion: This is a surgical technique where rerouting of EDL of the second toe along with the EHL and to improve the results further both the tendons were enclosed in the paratenon to promote good tendon healing and to prevent adhesions. This technique provides greater tensile strength and better function. At the final follow-up, all patients recovered with good active hallux extension with good functional results. No reruptures or other complications were reported in this group of patients. Conclusion: Second EDL-to-EHL double loop transfer for EHL reconstruction is a safe, reproducible, and low-cost technique to address EHL ruptures when a primary repair is not possible.

Inflammatory spondyloarthropathy (SpA) is an underdiagnosed cause of chronic low back pain leading to prolonged suffering and numerous visits to hospitals. The aim of this study was to ascertain the prevalence of sacroiliitis, which is an early indicator of inflammatory SpA, among patients who present with chronic low back pain. Materials and methods: A total of 200 consecutive lumbosacral (LS) spine MRI scans performed at Manipal Hospitals, Bengaluru, Karnataka, India, were analyzed by two radiologists and a spine fellow. The demographic data of the patients and the presence of sacroiliitis and other abnormalities on the scans were noted. Results: Among the 200 patients included in the study, 119 were male, and 81 were female, with a mean age of 35.07 years. A total of 31 (15.5%) patients were diagnosed to have sacroiliitis, which included 14 males (11.76%) and 17 females (20.99%). Conclusion: The study showed that 15.5% of patients who presented with low back pain had sacroiliitis, which is more than previously reported. Thus, it is important to carefully assess the sacroiliac joints of low backache patients both clinically and radiologically so that the diagnosis is not missed and appropriate treatment can be given. Clinical significance: This article stresses the fact that the clinician must always look into the sacroiliac joints, both clinically and radiologically, of any patient presenting with complaints of low backache in the outpatient department.

Introduction: The treatment of distal femur fractures with metaphyseal comminution is often complicated by nonunion, varus collapse, and implant failure. The accepted standard of treatment is lateral plating with a distal femur-locking compression plate. The addition of an extra medial plate to the lateral plate provides more mechanical stability. We compared the radiological and functional outcome of these fractures following dual plating and lateral plating. Materials and methods: A total of 20 were selected and randomized and divided into two groups. The inclusion criteria were all distal femur fractures with metaphyseal comminution. Gustilo-Anderson type IIIB and type IIIC fractures were excluded from the study. Dual plating was done in the first group by two approaches, lateral and subvastus approach, while lateral plating was done in the second group by the lateral approach. Patients were followed up for 2 years. Radiological and functional outcomes were assessed on follow-up. Result: There was a statistically significant difference in average time for radiological union, which was 13 weeks in the dual plating group and 28 weeks in the lateral plating group (p-value = 0.038). Patients with dual plating had early weight bearing. There was no significant difference in functional outcome between both groups. Conclusion: Dual plating for distal femur fractures with metaphyseal comminution results in an early radiological union and early weight bearing and allows an early return to work.

Background: Primary migration of the femoral head into the acetabulum (Protrusio) is something not seen very often. It is seen in hip arthritis secondary to ankylosing spondylitis, rheumatoid arthritis (RA), Paget's disease and previous trauma. Primary total hip replacement (THR) can be demanding technically as there is significant proximal and medial migration of the joint center and reduced bony support to the acetabular component placed at the rim. Aim and objective: To analyze the functional and radiological outcome of Protrusio acetabuli managed with total hip arthroplasty (THA). Materials and methods: This study has been conducted in the Department of Orthopaedics, Medical College Hospital, Tirunelveli, Tamil Nadu, India, during the period of December–November 2022 and is a prospective study. The morselized femoral head, antiprotrusio cage, and multihole cup were used in this study. Clinical outcome was determined by using Harris hip score. Results: Patients were followed up every month for a period of 2 years. X-rays were taken during each follow-up to assess the graft incorporation and cup position, and patients are examined clinically by assessing a range of movements, and pain during movements. In our study, most of our patients have a moderate (5–15 mm) grade of protrusion. In our study group, we've encountered about 10% of complications including distal femur fracture and nerve injury. The preoperative (pre-op) mean Harris hip score of 48 has been increased to 78.4 in our study. Conclusion: Total hip arthroplasty (THA) overseen utilizing impacted morselized bone graft along with cementless metal modular cups with trabecular lining was powerful in managing people with various grades of protrusion. The impacted graft is used in acetabular reconstruction for restoring the medial wall, providing a buttress for the acetabular implant to be seated, and lateralizing the implant to restore the center of the hip. However, structural issues with the acetabulum should be carefully considered and potential defects include problems with the weak acetabulum and a thin acetabular wall.

Aim: Glenohumeral joint, due to its biomechanics and structure, is the most unstable and commonly dislocated joint. Produces double-peak age dispersal, with a second peak in older patients, owing to the recent changes in lifestyle. Elderly dislocations usually present with mosaic injury patterns—rotator cuff tears, disruption of ligamentous structures, labrum [Bankart and superior labral anterior to posterior (SLAP)], bone (Hill-Sach), fractures, and neurovascular injuries can be a challenge to the treating clinicians. But little has been reported. The goal of this paper is to analyze the epidemiology, pathoanatomy, treatment, and functional outcome in >50 years of the age cohort. Materials and methods: In a prospective study between January 2018 and January 2020, 48 patients were enrolled with shoulder dislocation, with 18 of them aged above 50. Analysis was done on injury patterns, radiological characteristics, treatment methods, and functional outcomes using our institutional protocol. Monitored over a period of a minimum of 2 years with Constant-Murley and American Shoulder and Elbow Surgeons (ASES) scores. Results: Around 33.33% of dislocations were in an elderly population, which is quite high than previously reported. Rotator cuff pathology was found in three-fourths of the cohort. A total of 88.89% underwent surgical procedures; among them, 71.42% were involved in cuff repair alone. The solitary incident of biceps tenodesis and repair of the ruptured axillary artery with concomitant open reduction. None had recurrent instability. Constant-Murley and ASES scores improved significantly during the final follow-up. Conclusion: Early diagnosis and ruling out concomitant injuries in anterior shoulder dislocation among >50 years of age and managing them at the earliest has produced good outcomes and warrants a better, complete life in years to come. Clinical significance: Early magnetic resonance imaging (MRI) with computerized tomography (CT) screening helps in diagnosing significant cuff pathology with a portion of labral injury–needing individualized management. Thus, a structured approach is necessary to diagnose and treat this injury pattern which is critical for the recovery and quality of life in this age group.

Background: Failed intertrochanteric (IT) fractures are the most common fractures seen in an elderly population. It causes more morbidity and mortality in old people. Hence fixation of failed IT fractures is necessary. The aim of our study is to assess the functional outcome of failed IT fracture fixation like a dynamic hip screw and bone grafting, total hip replacement (THR), hemiarthroplasty, and exchange nailing and bone grafting. Materials and methods: It is a prospective study done between June 2020 and May 2022 in Rex Ortho Hospital. Our study consists of 57 patients who had IT fractures primarily fixed with anyone of the following—like proximal femoral nailing (PFN) and dynamic hip screw fixation, and then failed due to various reasons like unstable fracture pattern, poor reduction techniques, implant failure, or loosening. Patient functional outcomes were assessed by Modified Harris Hip Score (MHHS), and the pain was assessed by visual analog scale (VAS) score at regular intervals preoperatively (pre-op), 3 months, 6 months, and 1 year. Results: Our study population comprised 27 males and 30 females with failed IT fractures. The average follow-up was 12–24 months. Out of 57 patients, 18 had cemented THR, 17 had a dynamic hip screw and bone grafting, 13 had cemented hemiarthroplasty, and nine patients had exchange nailing and bone grafting. At the end of 12 months, among 11 patients with cemented THR patients, three (27.2%) had excellent outcomes and eight (72.7%) had good outcomes. Among eight patients with dental bone graft (DHS) and bone grafting, six (75%) had good outcomes and two (25%) had fair outcomes. Among seven patients with cemented hemiarthroplasty, six (85.7%) had good outcomes and one (14.2%) had a fair outcome. Among nine patients with exchange nailing and bone grafting, two had good outcomes, and five had poor outcomes. Out of refixation, 25 out of 26 nonunions were healed. One nonunion again went for nonunion, which was a case of exchange nailing and bone grafting, and had revision cemented hemiarthroplasty. All patients are free of pain. Two patients had hyponatremia postoperatively (post-op) and three patients had post-op pain due to hardware impingement, but they were ambulatory. One had a superficial wound infection and one had a greater trochanter (GT) fracture intraoperatively. Conclusion: In the selected group of patients who had refixation with bone grafting in the young population, all had excellent outcomes. The elderly who underwent THR had an excellent outcome, and patients with bipolar hemiarthroplasty scored less. Thus, we recommended head-conserving surgery where ever possible, and if not THR, and last option being bipolar hemiarthroplasty.

Background: Young adults and the elderly frequently suffer from distal humerus fractures. Although internal fixation technology has advanced, treating these fractures still poses difficulties. Both orthogonal and parallel plating offer sufficient functional outcomes and mechanically stable structures that enable early mobilization and a wider range of motion. Aim: The aim of the study is to assess the clinical as well as functional results of these fractures operated with orthogonal plating. Study and design: Prospective study in Government Royapettah Hospital, Chennai, Tamil Nadu, India. Materials and methods: A total of 25 patients with comminuted fractures of the distal humerus from January 2012 to 2017 in the age-group of 18–65 years were included in the study and were operated on with orthogonal plating. All the patients were followed at 3, 6, 12, and 24 weeks, and at 1 year. During follow-up, patients were assessed in terms of time for union, range of motion, Mayo score, disabilities of the arm, shoulder and hand (DASH) score, and complication rate. Results: At the final follow-up, Mayo score was 96.32 ± 04.96 from 5.00 ± 01.26, and the DASH score was 31.42 ± 2.04, which dropped from 150 ± 05.34, range of motion improved from 21.38 to 116.1 with 100% union rate and complications <17%. Conclusion: Orthogonal plating is an excellent method for fixing the distal humerus, which is biomechanically stable, providing an advantage of early mobilization with a fracture union rate comparable to other studies with good to excellent outcomes according to the Mayo and DASH scores with minimal complications. Olecranon osteotomy provides good exposure to the fracture, which aids in the anatomical reduction of the fracture.

Background: The preferred treatment of choice in patients with unstable spine injuries and neurological deficits is posterior stabilization. Instrumentation is usually done with pedicle screws and rods, additionally; pedicle screws can also be inserted in fractured vertebrae. This research comprised 30 patients involving fixation additionally in fractured vertebra- intermediate pedicle screw fixation. This study is to prove that patients operated on with additional intermediate pedicle screws have a better postoperative functional outcome. Materials and methods: This is a study of 30 patients with thoracolumbar fractures, who were admitted to Thoothukudi Medical College, Thoothukudi, Tamil Nadu, India. Patients were resuscitated and operated on after radiological and clinical evaluation. Results: Patients were analyzed based on demographic criteria preoperatively and postoperatively by visual analog scale (VAS), Oswestry Disability Index (ODI), and Denis pain score. Conclusion: Patients operated on using intermediate pedicle screw fixation showed a good postoperative outcome.

Introduction: Spine fractures in patients with ankylosing spondylitis (AS) frequently result from even a low energy mechanism and are associated with spinal cord injury in over 29–91%. The aim of this study is to analyze the pattern, clinical, and radiological outcomes of spine fractures in such patients. Materials and methods: We reviewed 18 patients suffering from AS who sustained a spinal fracture and were treated between 2014 and 2022. Injury mechanism, method of diagnosis, the location and the type of the fracture, neurological status pre and postoperatively (post-op), and management and clinical outcome were studied. Seven of them were diagnosed in X-rays at the initial examination, and the remaining 11 in magnetic resonance imaging (MRI)/computed tomography (CT). Fracture healing and neurological function recovery were observed over the follow-up period. Results: A total of 18 patients were included, all male, with AS, who presented with spine fractures and neurological impairment. The most common level of the spine involved was the thoracolumbar spine (66.66%). Diagnosis of fractures was possible with X-rays only in 31% of cases. The most common pattern of fracture was found to be a chance fracture (33.33%). A total of 13 cases presented varying grades of neurological deficits (72.2%). The neurological function and fracture healing of these patients improved significantly after surgery. The conservatively treated patient had a poor prognosis, and one of the cervical fractures surgically treated patients had respiratory complications. Conclusion: The diagnosis of spine fracture in AS requires higher imaging modalities. Since most cases present with neurological deficits, surgery is required for treatment and has shown to be effective in improving neurological deficits.

Calcific myonecrosis, a complication of late compartment syndrome, is a rare disorder characterized by peripheral calcification and central liquefaction of the entire muscle mass. We present a case of myositis ossificans impersonation that was not only unusual but also posed difficulty in diagnosis and therapeutic management. The patient was a 45-year-old man presented with right leg pain and swelling for 6 months with no constitutional symptoms. He also had a history of trauma 1 year ago. Clinically, the swelling was multilobulated, fluctuant, and tender over the mid-anterolateral aspect of right leg. Neurological examination revealed right ankle dorsiflexion and eversion of right foot. X-ray of right leg full length revealed a homogeneous radiopaque lesion over the anterior and lateral aspect. Magnetic resonance imaging (MRI) suggested a myositis ossificans lesion limited to the right leg's lateral and anterior compartments, with no hypervascularity. Routine blood tests, including liver function test, serum calcium, phosphorus, and alkaline phosphatase levels, were all normal. A nerve conduction study revealed that the right superficial and deep peroneal nerves had a lower conduction velocity. The tru-cut biopsy revealed myositis ossificans. Pus from the excision biopsy was sent for histopathological analysis, and the results revealed calcific myonecrosis. Following excision, along with physiotherapy and a course of indomethacin, patient got relieved off his symptoms and on follow-up had no signs of recurrence.