Background: Low back pain reduces the quality of life. The most common cause is lumbar disc prolapse. Endoscopic discectomy is a minimally invasive procedure used to treat lumbar disc prolapse. The use of intradiscal methylene blue injection in endoscopic lumbar discectomy improves patient's functional outcomes. Aim and objective: To evaluate the functional outcome of methylene blue injection in the endoscopic transforaminal lumbar discectomy in lumbar disc disease patients and clinical improvement in the form of postoperative (postop) radicular pain relief, early return to daily activities, and occupation. Materials and methods: A mixture of 1 mL 1% methylene blue and 1 mL 2% lidocaine. A 30° spinal endoscope with a working channel of 4.1 mm was used in this study. Study design prospective cohort study. A total of 20 patients with lumbar disc prolapse operated with transforaminal endoscopic lumbar discectomy with methylene blue injection. According to pain improvement, functioning abilities, and clinical symptoms, results were done based on the modified Oswestry disability index. Results: In our study, 90% of patients have postop radicular pain relief within 1 week. Around 85% of patients returned to their normal daily day-to-day activities within 3 weeks. Around 80% of patients returned to their work within 4 weeks. Around 75% of patients had neurological recovery in between 3 and 5 weeks. The modified Oswestry disability index in preop and postop patients were studied. The mean value significantly decreased from 69.5% in preop to 31.5% in postop conditions. The p-value is 0.00 (p-value < 0.05) and significant. In Macnab's criteria, our study shows an excellent to good outcome of 75%. Conclusion: This study showed that the use of intradiscal methylene blue injection in endoscopic transforaminal lumbar discectomy gives good radicular pain relief. It improves the accuracy and efficacy of endoscopic spine surgery.

Introduction: Spinal tuberculosis (TB) is more commonly seen in individuals during the first three decades of life, but it can occur at any age. It can result in the collapse of the affected vertebrae, leading to deformities such as kyphosis and sagittal imbalance; the deformity and progression can be worse in the pediatric age-group due to their growth spurt. Neurological complications can occur when the tubercular infection affects the spinal cord or the nerve roots. This typically happens during the active stage of the disease or, in some cases, even after the infection has healed. The surgical approach to spinal TB indeed focuses on achieving specific objectives related to the infectious and structural aspects of the disease. The objective of treatment of kyphotic spinal TB in recent era is to achieve bacteriological quiescence by effective chemotherapy and correction of kyphotic deformity. Development in the field of diagnostic methods and imaging has allowed us to detect TB of the spine in less advanced stages of the disease in most cases. But in spite, few cases present with kyphotic deformity and neurological deficits. The issues that need careful discussion are the identification of children in whom kyphosis should be taken for correction and to reach a consensus on treatment when a patient presents with severe healed kyphosis with or without neural deficit. Materials and methods: We treated six patients with dorsal spinal TB with kyphotic deformity, of which two cases presented with paraparesis—managed by surgical decompression and posterior stabilization; all the cases were followed up periodically. Results: All six cases had good radiological and functional outcomes in terms of kyphotic correction and neurological recovery. There was a significant improvement in the mean kyphotic angle; the mean angle decreased from 34.33 (preoperative) to 11.22 degrees, one year after surgery. Conclusion: This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal TB in adolescents. The multifaceted goals of surgery in spinal TB underscore the importance of a thorough understanding of the disease and a collaborative approach, and it ensures a comprehensive strategy. Thus posterior surgical method is effective in accomplishing debridement, obtaining satisfactory clinical results, correcting kyphotic deformity, and maintaining the correction.

Introduction: Diagnostic methods for first extensor compartment tenosynovitis are widely accepted, yet identifying variations in its anatomy and addressing compartmental challenges remains elusive. The extensor pollicis brevis (EPB) entrapment test has emerged as a valuable diagnostic tool. Integrating clinical assessment with ultrasound examination improves diagnostic efficacy, highlighting the importance of evaluating functional outcomes. Aim: To evaluate the connection between identified anatomical variations in patients with De Quervain's tenosynovitis and their functional outcomes and to ascertain how these variations are associated with the results of the EPB entrapment test and ultrasound wrist findings. Materials and methods: A total of 60 participants showed positive Finkelstein test results for wrist pain, underwent EPB entrapment, and underwent ultrasound examinations by a surgeon and radiologist. Surgery was the definitive benchmark. The preoperative assessment included disability of arm, shoulder, and hand (DASH) scores and visual analog scale (VAS) pain measurements at 6 weeks, with postoperative evaluations at both 6 weeks and 6 months. Results: Preoperatively (after 4 weeks), the QuickDASH score mean was 58.27%. Postoperative QuickDash score mean for 6 weeks and 6 months was 56.027 and 3.44%. The preoperative VAS score mean was 6.5. Postoperative VAS scores for 6 weeks and 6 months were 2.29 and 0.54. The p-value for DASH and VAS was highly significant, with a value of 0.0005. Conclusion: Our study emphasizes the significance of detecting anatomical variations in De Quervain's disease. Employing reliable diagnostic methods enhances surgical precision, improves patient recovery and recurrence prevention, and optimizes disease management.

Aims and background: Proximal femoral angles, specifically the neck-shaft angle (NSA) and anteversion (AV), are pivotal factors in understanding hip joint biomechanics, the changes in different hip pathologies and guiding various orthopedic interventions. Our study aims to evaluate these angles in the subcontinent of India. Materials and methods: A total of 50 dry samples of femora were selected at the Anatomy Department, Madras Medical College. Inclusion and exclusion criteria were established based on the study design. The AV and NSA were measured using three methods—direct measurement, biplanar radiography, and axial computed tomography (CT). Comparative analyzes were performed to assess the precision of these measurement techniques. Results: Our study revealed that the X-ray method was the most accurate in measuring the NSA among the three techniques. The measurements of AV were more accurate using the X-ray method than the CT method. Additionally, a prevalence of 20% for retroversion was identified in the Indian population, signifying a higher occurrence compared to prior studies. Conclusion: These findings underscore the critical importance of precise angle measurements in orthopedic hip procedures. The study's data supports informed preoperative planning and the enhancement of orthopedic interventions, particularly in the Indian population. Clinical significance: The study's findings on AV and NSA in the adult Indian population provide significant insights for orthopedic interventions, emphasizing the need for accurate measurements to enhance preoperative planning and optimize surgical outcomes.

Introduction: Anterior cruciate ligament (ACL) injury is one of the most common knee ligament injuries. There is much debate about the best treatment for this injury, and many studies have been conducted to compare different graft options. Hamstring (HT) autografts have withstood the test of time and are currently the most commonly used graft for ACL reconstruction (ACLR). However, there are also many alternative graft options that have been explored and are being used. In this article, we will explore whether the peroneus longus (PL) graft can be a comparable alternative to the HT graft. Materials and methods: We conducted a prospective randomized study involving 80 patients who underwent ACLR. These patients were divided into two equal groups randomly—the HT group and the peroneus longus tendon (PLT) group. To evaluate functional outcomes, we utilized the International Knee Documentation Committee (IKDC) score for the knee joint, while the American Orthopaedics Foot and Ankle Scoring System (AOFAS) was employed for assessing the ankle joint. To gauge donor site morbidity, we measured thigh circumference preoperatively and postoperatively. These measurements were taken at 1- and 2-year follow-up intervals. Results: A total of 80 patients were evaluated with a minimum follow-up of 2 years. In terms of clinical outcomes and knee stability, neither group displayed any discernible differences. The diameter of the PL graft was substantially bigger than the diameter of the HT. The PLT group did not appear to have any abnormal ankle joint function according to the assessment of AOFAS and ankle range of motion (ROM). The HT group showed a significant wasting of the quadriceps when compared to the PLT group. Conclusion: With regard to its strength, larger graft diameter, satisfactory ankle function, and prevention of potential complications of HT autograft obtained from the knee region, the current study demonstrated that PLT autograft might be considered a safe and practical autograft source for arthroscopic ACLR.

Aims and background: The standard arthroscopic intraarticular anterior cruciate ligament (ACL) reconstruction with various grafts and techniques has failure rates of up to 16%. Modified Lemaire's technique is one procedure done to reduce the rate of revision ACL surgeries by adding a tenodesis laterally, thereby reducing anterolateral laxity. This study has been done to analyze the functional outcome of modified Lemaire's procedure in a 2-year follow-up period. Materials and methods: A prospective outcome study involving 30 patients who underwent modified Lemaire's procedure with ACL reconstruction in the Department of Orthopedics in Stanley Medical College and Hospital, Chennai, Tamil Nadu, India, were followed up in 6 months, 1 year, and 2 years and their preoperative (pre-op) and postoperative (post-op) pivot shift score, Tegner–Lysholm scoring and International Knee Documentation Committee (IKDC) scoring were analyzed. Results: All 30 patients who have undergone modified Lemaire's procedure have improved post-op Tegner–Lysholm scores and IKDC scores and reduced pivot shift scores. A statistically significant difference in mean between pre-op Lysholm and at 6 months Lysholm, at 1- and 2-year Lysholm with a p-value of <0.05. Conclusion: Improved post-op Tegner–Lysholm scoring and IKDC scoring show that the modified Lemaire's technique is a good procedure to reduce the rate of revision ACL surgeries. This procedure also addresses the anterolateral deficiency by reducing the prevalence of pivot-shift. Clinical significance: By adding modified Lemaire's procedure to ACL reconstruction, we can augment the ACL reconstruction and reduce the anterolateral laxities in patients with high-grade pivot shift.

Introduction: Issues that begin with feet can cause persistent pain in the knees, hips, and back. Misalignments of the foot bones and different constructions in the foot can adjust how a person can walk and how the lower limb bears weight as a person moves. To evaluate the influence of total knee arthroplasty on foot pressure changes in varus osteoarthritic knee using pedobarography. Methods: It is a prospective study done at Velammal Hospital, Velammal Medical College and Research Institute, Madurai, Tamil Nadu, India, among patients with primary osteoarthritis with varus deformity undergoing total knee replacement (TKR) from April 2021 to 2023. The inclusion criteria are patients with primary osteoarthritis with varus deformity undergoing TKR. Only patients with grade II varus (10–20°) deformities are included. Patients who satisfied the inclusion criteria and were willing to participate in the study filled out the informed consent form, and preoperative (pre-op) and postoperative (post-op) pedobarography was done and analyzed. Results: Preoperatively, the high-pressure changes were seen in the lateral metatarsal, lateral midfoot, and lateral heel. Postoperatively, there was a significant shift in pressure changes toward medial foot zones, including the hallux, medial metatarsal, central metatarsals, and medial heel. Conclusion: Posttotal knee replacement, the distribution of foot pressure changes toward the normal foot pressure distribution.

Background: Trigger finger, also known as stenosing tenosynovitis, is a common cause of hand pain and dysfunction, with symptoms of pain, swelling, limited finger motion, and triggering sensation. When conservative treatments are not effective, the percutaneous release of the A1 pulley can be performed, which has high clinical outcomes and patient satisfaction with low complication rates. Our aim of the study is to assess the pain and functional outcome following the percutaneous release of the trigger finger by using the visual analog scale (VAS), quick disabilities of the arm, shoulder, and hand (Q-DASH) score, and Quinnell's criteria, respectively, at regular follow-up intervals of 1, 3, 6 months, and 1 year. Material and methods: This is a prospective study conducted between March 2021 and February 2023. A total of 25 patients of both sexes who were not responding to conservative management with trigger-finger were included. Patients with grades III, IV, and V of modified Quinnell's grading were included, and patients who did not respond to conservative management were included in the study. Patients with congenital triggering were excluded. Results: In our present study, the clinical assessment was done by using modified Quinnell grading of trigger finger at the interval of preprocedure, 1, 3, 6 months, and 1 year. Which showed that 21 patients (84%) had excellent results, three patients (12%) had good results, and one patient (4%) had poor results. Only one patient (4%) developed digital nerve injury. Conclusion: Percutaneous hypodermic needle release for the trigger finger is a safe, effective, convenient, and inexpensive day-care procedure without any significant complications in the management of the trigger finger. It is a safe alternative to open surgery. Percutaneous release of the trigger finger has excellent to good results and improves the overall functional outcome. Hence, percutaneous hypodermic needle release can be considered a preferable treatment option for trigger finger.

Aim: Lumbar spondylolisthesis has been a major cause of disability in the general population, mostly in the later part of the productive age-group. Various modes of treatment and surgeries have come up to tackle this morbidity, but with differing results. This study aims to assess clinical and radiological outcomes in patients who underwent transforaminal lumbar interbody fusion (TLIF) with a polyether ether ketone (PEEK) cage for lumbar spondylolisthesis. Materials and methods: A total of 38 patients with varying grades of lumbar spondylolisthesis, among which, 11 males and 27 females were included in this study. All underwent TLIF with PEEK cage surgery. Their preoperative and postoperative pain score, functional scores, and radiological parameters were compared. All patients were followed up to 12 months. Results: The mean preoperative visual analog scale (VAS) started from 8.53 and came to 2.79, postoperatively. Around 68.4% of patients showed minimal disability. Around 60.5% of patients showed excellent outcomes. Around 73.7% of patients showed fusion at 12 months. Near-normal radiological parameters were achieved in all the patients. Five patients showed complications. Conclusion: Overall patient satisfaction was observed in this study, and good radiological outcomes were achieved. The PEEK cage augments the mechanical support provided by TLIF. Clinical significance: The modulus of elasticity of PEEK (3.6 GPa) makes it more closely aligned with cancellous bone (1–20 GPa) compared to traditionally used titanium cages (120 GPa). This alignment contributes to lower rates of bone dehiscence and improved patient outcomes.

Aim: To conduct a prospective randomized study comparing the functional and radiological outcomes of dynamic hip screw (DHS) and modified proximal femoral locking compression plate (PFLCP) in Asian population with intertrochanteric fractures. Materials and methods: The modified PFLCP design has been created by the authors. The modification to the standard PFLCP design involves increasing the screw density for the trochanteric area, along with the provision of locking as well as compression screw slots. It is an angular stable construct with the ability to achieve compression across the fracture site. We included 112 patients (1:1 parallel design, n = 56) with intertrochanteric fractures. Randomization was done using the lottery method. The mean age was 65.66 years (range, 28–90) and 64.07 years (range, 31–90) in the DHS group and PFLCP group, respectively. The mean duration of surgery, intraoperative blood loss, and functional outcome at 6 months using the Harris hip score (HHS) were compared. Results: In the DHS group and PFLCP group, the mean time to union was 18.3 and 17.2 weeks, respectively. Significant shortening at final follow-up occurred in 15.68 and 12% of patients (p = 0.59). Postoperative discharge from the surgical site occurred in 5.88 and 4% of patients. Implant failure occurred in 3.92 and 8% of patients (p = 0.43). Varus collapse occurred in 33.33 and 14% of patients (p = 0.022), respectively. The mean HHS was 82.6 and 86.3 in the DHS and PFLCP groups, respectively (p = 0.19). Conclusion: The modified PFLCP is capable of providing equally effective radiological and functional outcomes. The modified PFLCP can be used as an alternative to the DHS in intertrochanteric fractures in severely osteoporotic patients.