bluuebunny/crossref_metadata_2025 huggingface dataset:
OVERVIEW OF ROOT CAUSE ANALYSIS MECHANISMS FOR TELECOMMUNICATION NETWORKS
Authors:   National Technical University of Ukraine “Igor Sikorsky Kyiv Polytechnic Institute”, Kyiv, Ukraine, Vlasenko V.V. , Minochkin D.A. ,   National Technical University of Ukraine “Igor Sikorsky Kyiv Polytechnic Institute”, Kyiv, Ukraine
Published: October 2024

Telecommunication networks are an integral part of modern information society, providing data transmission and communication among millions of users worldwide. The complexity and scale of these networks are constantly growing, which increases the demands on their reliability and stability. One of the key tasks in ensuring the efficient operation of telecommunication networks is the identification and elimination of the root causes of failures and anomalies that can significantly affect the quality of service for end users. Root cause analysis (RCA) is a powerful tool for identifying the primary causes of problems, preventing their recurrence, and enhancing the overall reliability of networks. The article provides a detailed review of contemporary methods and tools of RCA used in telecommunication networks. In particular, methods such as fishbone diagram analysis, the «five whys» method, fault tree analysis, and the application of machine learning for big data analysis are considered. Each of these approaches has its advantages and disadvantages, and their comprehensive use allows for higher accuracy and efficiency in identifying the root causes of problems. Practical examples demonstrate the effectiveness of applying various RCA methods to solve specific problems in telecommunication networks. For instance, the use of fishbone diagram analysis and the «five whys» method allows for the identification of the primary causes of network delays and equipment issues at base stations. The implementation of failure prediction systems based on machine learning significantly enhances network reliability by allowing for the early detection of potential problems and the necessary technical measures. The prospects for the development of RCA in telecommunication networks are outlined. The primary focus is on the development of adaptive and self-learning systems capable of dynamically responding to changing network conditions. The use of more complex artificial intelligence algorithms and tools for predicting potential problems will significantly improve the effectiveness of RCA and ensure high-quality telecommunication services.
ANALYSIS OF MODERN AND TRADITIONAL METHODS OF DESIGNING AND MANUFACTURING MILITARY EQUIPMENT USING AUTOMATED INFORMATION SYSTEMS
Authors:   Taras Shevchenko National University of Kyiv, Kyiv, Ukraine, Lienkov S.V. , Grishchak O.M. ,   Taras Shevchenko National University of Kyiv, Kyiv, Ukraine, Okhramovych M.M. ,   Taras Shevchenko National University of Kyiv, Kyiv, Ukraine, Sotnikov Y.O. ,   Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
Published: October 2024

In the article, the authors perform one type of analysis of existing and prospective methods of designing and manufacturing military equipment using automated information systems. It is known that AIS software has the characteristic features of a complex system and is subject to the laws of complex systems science. The current stage of development of complex information systems is characterized by a sharp increase in the complexity of management tasks, which is increasingly reflected in the volume of software for managing technical objects, technological processes, and production. The work classifies programs according to SPE, which represents “a model of another model within the theory of abstract representation of individual objects.” It can be classified into one of three classes: S-class - these are programs whose functions are formally defined by specifications and follow from them. The correspondence between input and output is decisive, and any change creates a new program. P-class - these are programs whose solution acceptability is assessed by comparison with the real situation, meaning that programs of this class must constantly change depending on the environment, data refinement, etc. E-class programs themselves become part of the implementation of the situation they model, meaning they are even more prone to changes than P-programs. The main phases of the AIS life cycle are considered, and their features are defined: definition, design, implementation, deployment, and operation. The conceptual unity of approaches used at the stages of obtaining system specifications, designing the modular structure, and implementing modules allowed for the integration of individual decisions into a single methodology for designing correct special software, the main differences of which are: layering achieved through the use of the abstraction principle (hierarchy); combining the design process with the modeling process achieved through the application of graph models obtained during design, and the possibility of using each level of the hierarchy as a model of the special software; continuity of the design process ensured by the compatibility of models obtained at different stages, the participation of the system programmer from the initial stage, and the possibility of starting coding from the first stage.
Empleabilidad y su influencia en la calidad de vida de la generación X en Guayaquil, Ecuador
Authors: Guerrero Cabrera Josue Paul , Vera Torres Hans Josue , Ascencio Burgos Karina Anabella , Sumba Nacipucha Nicolas , Cueva Estrada Jorge Manuel
Published: October 2024

La empleabilidad en la calidad de vida de las personas de la generación X, emerge como un factor fundamental que no solo da forma a sus trayectorias profesionales, sino que también impacta de manera directa en el bienestar emocional, la estabilidad financiera y la satisfacción integral de quienes conforman este grupo generacional. El objetivo de este artículo es analizar la empleabilidad de la generación “X” de Guayaquil y su incidencia en la calidad de vida de esta población. Para lograrlo se utilizó una metodología con un enfoque cuantitativo, no experimental y de corte transversal. Se realizó una encuesta mediante un cuestionario en línea y se recolectó la información de 384 personas. Los resultados mostraron la prevalencia del empleo informal, las percepciones sobre la influencia del empleo en la calidad de vida y los desafíos enfrentados por esta generación, se exploran las implicaciones para el bienestar emocional y físico, así como las posibles mejoras a través de apoyo gubernamental. Estos resultados señalan la importancia de comprender la empleabilidad de la generación X para identificar sus necesidades y promover un mercado laboral más inclusivo e implementar políticas públicas que fomenten la creación de empleos formales y dignos, a fin de mejorar sus condiciones laborales para contribuir a su desarrollo personal y profesional.
Evaluation of split flexor carpi ulnaris tendon transfer for fingers and thumb extension, pronator teres transfer for wrist extension in high radial nerve palsy
Authors: Bhakta Ananta K. , Mondol Pankoj K. , Rahman M. Ziaur , Kabir M. Humayun , Biswas Bappy K. , Sahid Syed M. , Kumar Sree A. , Khan M. Rakiz
Published: October 2024

Background: The radial nerve is the largest terminal branch of the brachial plexus. Loss of radial nerve function creates a significant disability in the hand. The grip is severely impaired following loss of radial nerve function as a result of loss of extension of wrist, metacarpophalangeal joints of fingers and interphalangeal joints of the thumb.
Methods: Prospective, quasi experimental study carried out for 3 years at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Forty-eight patients of high radial nerve palsy were selected for tendon transfer (split FCU tendon to EDC and EPL) and PT transferred to ECRB.
Results: Mean age of the patients was 28.92 years (range 15-45 years), significantly higher in 26-35 years age group. There was preponderance of injury to the dominant right side (58.33%) than the none-dominant left side (41.67%). Motor vehicle accident (66.67%) was the common cause of injury followed by assault (33.33%). Out of 48 patients, 28 patients score 8-9 (excellent), 16 patients score 7 (good), 4 patients scores 5 (fair). So that, total 44 patients achieved satisfactory outcome (91.67%) and 4 patients achieved unsatisfactory outcome (8.33%). All patients can extend their wrist, fingers and thumb. Beyond this, all patients can flex their fingers up to mid palmar crease and thumb can be extended separately-independent of EDC function.
Conclusions: Transfer of split FCU tendon to EDC and EPL for fingers and thumb extension in irreparable and neglected long standing high radial nerve palsy results significant functional outcome.
Peadiatric amputation from traditional bone setters’ gangrene in Ibadan: a malady
Authors: Balogun Mosimabale J. , Morhason-Bello Jemiludeen O. , Olusola Idowu K.
Published: October 2024

Background: Pediatric amputations resulting from gangrene pose a significant medical challenge, especially in resource-limited settings. In Nigeria, traditional bone setters (TBS) often serve as the first point of contact for musculoskeletal injuries, but their practices can lead to severe complications, including gangrene. Our hospital manages many of such cases. This study aims to explore the epidemiology, clinical presentation, and outcomes of pediatric patients who developed gangrene requiring amputation following TBS treatment, with the goal of informing public health strategies and improving pediatric care quality.
Methods: The study is a retrospective study which seek to extract the data from the hospital record all the patient who underwent amputation due to gangrene after initial TBS treatment. All the case notes were retrieved and data was extracted and analyzed using descriptive statistics. The study adhered to ethical standards and anonymized data to protect patient confidentiality, ensuring the study's integrity.
Results: The study involved 33 pediatric patients aged 8.3 years, with a significant gender disparity. Most patients were from the Yoruba ethnic group and practiced Islam. 87.9% of parents had no formal education. Gangrene was most common in the left hand, and falls were the leading cause of initial injury. The average surgery time was 81.2 minutes, with a 13-day hospital stay. Post-operative complications occurred in 43.5% of patients, with surgical site infections (SSI) being the most common. Only 8.7% received occupational therapy.
Conclusions: The study highlights post-operative care challenges in pediatric amputations, including high complications and limited access to services. It suggests targeted interventions, infection control, and public health campaigns to improve outcomes. Future research should include long-term follow-up studies.
Can tip-apex distance and calcar reference tip-apex distance predict lag screw cut-out in elderly patients with trochanteric femoral fractures treated with gamma3 nails
Authors: Iamsum-Ang Chonlathan , Chensupakarn Chinkrit , Wannachotphawet Supinya
Published: October 2024

Background: The most common complication of cephalomedullary nail fixation for femoral fractures is lag screw cut-out. The significance of the tip-apex distance (TAD) in predicting lag screw cut-out is still debated. There has been no study conducted on the calcar reference tip-apex distance (CalTAD) regarding its impact on lag screw cut-out. To compare the average TAD and CalTAD between groups with and without lag screw cut-out and to determine the TAD and CalTAD values associated with the highest risk of lag screw cut-out.
Methods: This was a prognostic prediction study utilizing a retrospective cohort of 756 patients with trochanteric femoral fractures treated with Gamma3 nails. This study compared the differences in TAD and CalTAD values between the two groups.
Results: The group without lag screw cut-out had lower TAD and CalTAD values compared to the group with lag screw cut-out (TAD; 20.3±5.3 mm vs. 22.1±5.7 mm; p=0.044); (CalTAD 22.3±4.4 mm vs. 25.2±5.3 mm; p<0.001). The cutoff points of TAD >23 mm and CalTAD >25 mm were associated with the highest risk of lag screw cut-out (TAD: OR, 2.91; 95% CI, 1.47-5.77; p=0.002); (CalTAD: OR, 3.43; 95% CI, 1.73-6.80; p<0.001).
Conclusions: The lag screw cut-out group had higher TAD and CalTAD values. TAD values greater than 23 mm and CalTAD values greater than 25 mm were associated with the highest risk of lag screw cut-out.
Tranexamic acid with vitamin K mixture decreases bleeding of total hip arthroplasty in a Jordanian population
Authors: Obeidat Mohammad , Bashmaf Omar , Alrwashdeh Sami , Ababneh Faris , Sharadgah Suleiman
Published: October 2024

Background: Bleeding of total hip arthroplasty has severe consequences on postoperative recovery. 75–90% of early bleeding after surgery and during surgery is caused by operative technical issues. tranexamic acid decreases bleeding of arthroplasty. vitamin k has late and dose sensitive effect in clotting.
Methods: This retrospective investigation included subjects of middle age and of both genders scheduled for primary hip replacement at Queen Alia hospital, Jordanian Royal medical services, between March 2022 and June 2023. Subjects were classified into two groups. Group I subject were administered intravenous mixture of Tranexamic acid 10 mg/kg with vitamin K1 of 10 mg 5 min pre-skin incision followed by an infusion of Tranexamic acid 1 mg/kg/h and vitamin K1 0.2 mg/kg/h, until skin closure. Group II subjects were administered only intravenous vitamin K1 of 10 mg, 5 min pre- skin incision followed by infusion of 0.2 mg/kg/h until skin closure. Hemoglobin, packed cell volume, platelet count, prothrombin time, partial thromboplastin time and fibrinogen were tested. Bleeding and blood transfusion were remarked.
Results: Group I demonstrated a remarkable less modifications in blood tests and less bleeding than group II. Group II demonstrated less bleeding after surgery. The average Hb in group I demonstrated a remarkable less reduction after surgery compared to group II. (p<0.005). No blood transfusion after surgery was needed in group I. Nine (15%) patients in group II needed one unit of blood transfusion during surgery.
Conclusion: Intravenous administration of Tranexamic acid with vitamin K mixture in total hip arthroplasty decreased bleeding during and after surgery and decreased the requirement for blood transfusion.
Outcome of posterior decompression by L1 laminectomy, transpedicular fixation, posterolateral fusion in burst fracture L1 with incomplete spinal cord injury
Authors: Mondol Pankoj Kanti , Alam A. M. Fasiul , Hasan M. Mehedi , Khan M. Sahidur Rahman , Sadi Sheikh M. Sheikh , Bhakta Ananta Kumar , Kabir M. Humayun , Ahmed Sabbir
Published: October 2024

Introduction: Burst fractures are more severe than compression fractures as the bones spread out in all directions and may damage the spinal cord, leading to paralysis or nerve injury. This study aims to find the surgical outcomes of Posterior Decompression by L1 Laminectomy in terms of burst fracture with incomplete spinal cord injury.
Methods: 48 adult patients with burst fractures with incomplete spinal injury came to NITR from June 2023 to May 2024. In this non-randomized clinical trial, the outcomes of decompression by L1 laminectomy were analysed by using the canal encroachment ratio, while deformity correction was assessed using the sagittal Cobb angle and the percentage of anterior vertebral height for the treatment of L1 burst fracture with incomplete spinal cord injury.
Results: The patients were followed up for an average of 12 months. The mean operation time was 154.53 minutes, mean intraoperative blood loss of 48.84 mL, and the mean incision length was 7.78 cm. The canal encroachment ratio decreased significantly, as well as the sagittal Cobb angle, and anterior vertebral percentage height increased. Oswestry Disability Index, and American Spinal Injury Association impairment scale classification were significant.
Conclusions: Posterior decompression combined with Transpedicular Fixation and Posterolateral Fusion in the treatment of Burst Fracture L1 with Incomplete Spinal Cord Injury is safe and effective.
Tackling the challenge of 90-day readmissions in hip fracture management: a retrospective study
Authors: Srinivasan Prajwal A. , Venugopal Vinayak , Selvarajan Raam M. , Dhotare Satish , Ganapathy Ranusha , Patel Shiv , Tariq Muhammad , Mahmoud Omar
Published: October 2024

Background: Hip fracture readmissions within 90 days pose a significant challenge in orthopaedics, burdening healthcare systems and affecting patient outcomes. This study, set against the backdrop of an aging population and rising hip fracture incidences, seeks to analyse the factors contributing to these readmissions and propose viable management strategies.
Methods: Conducted as a single centre study at a hospital which is part of the NHS UK, this retrospective study reviewed 1264 patients treated for neck of femur (NOF) fractures between April 2020 and December 2022. Data on patient demographics, comorbidities, surgical interventions, and readmission reasons were collected and analysed using descriptive statistics and multivariable logistic regression.
Results: The study found a 21.8% readmission rate, with the majority being for non-orthopaedic reasons such as infections and cardiovascular events. Age and comorbidities were significant predictors of readmission, while surgical factors had a less pronounced impact. A year-wise trend showed a peak in readmissions during the COVID-19 pandemic.
Conclusions: The findings emphasize the complexity of managing NOF fractures and the importance of a comprehensive, multidisciplinary approach to care. Targeted interventions, including orthogeriatric co-management and falls assessment, are recommended to mitigate readmission risks and enhance patient care, though further research is needed for more definitive strategies.
Beyond 25 millimetres makes the difference: a prospective study on tip apex distance in dynamic hip screw treatment of intertrochanteric fractures
Authors: Shah Nadir , Abhyankar Akshay M. , Ghag Niranjan S. , Ghoti Santosh , Gohil Kushal , Dakhode Shubham
Published: October 2024

Background: The tip apex distance (TAD) is a key indicator of screw cut-out risk in dynamic hip screw (DHS) treatment for intertrochanteric fractures. This study sought to assess the prognostic significance of TAD in intertrochanteric fractures managed with DHS.
Methods: This prospective observational study encompassed 50 patients with intertrochanteric fractures who had DHS fixing treatment. TAD was measured on postoperative radiographs. Patients were followed clinically and radiologically for a minimum of 3 months. The primary outcome was screw cut-out.
Results: The mean TAD was 25.5 mm, with a range of 10 to 47 mm. Four screw cut-outs were seen, all in patients with TAD exceeding 35 mm. The mean TAD was 24.18 mm for successfully treated fractures, in contrast to 40.89 mm for those who experienced cut-out. No cut-outs were seen with TAD <25 mm. The inferior-central region of the femoral head was the predominant site for screw placement, occurring in 30% of cases.
Conclusions: TAD is a dependable predictor of screw cut-out risk in DHS fixation of intertrochanteric fractures. Maintaining a TAD <25 mm and screw position in the inferior-central zone of the femoral head may help minimize cut-out risk. Surgeons should aim for proper screw placement and consider TAD when treating these fractures.
Perioperative antibiotics prophylaxis for only 24 hours in orthopaedic surgeries
Authors: Patel Viren K. , Bothra Jay S. , Desai Sarvang M. , Patel Prapti V. , Dangi Parag P. , Pandya Aumkar H.
Published: October 2024

Background: The objective was to analyse the incidence of surgical site infection in patients undergoing elective orthopaedic surgeries procedure when antibiotics prophylaxis is done for 24 hours only.
Methods: Between June 2020 and January 2022, 50 cases of orthopedic trauma as well as soft tissue surgeries, who were given perioperative antibiotics for only 24 hours post-surgery at our institution, were included in the study. All 50 patients who received 24 hours antibiotics only after surgery were compared with those who received the same for longer duration. Statistics calculated on MS excel.
Results: Rate of infection in this study was 4% which is comparable to other studies but the rate of infection in the present study in cases of open reduction internal fixation was higher (12%) compared to other studies (2%).
Conclusions: 24 hours antibiotics is sufficient in key hole surgeries like closed reduction internal fixation and soft tissue surgery. However, it does not seem to be sufficient in cases of open reduction internal fixation which last for more than 1.5 hours.
Anthropometric predictors of hamstring graft size in anterior cruciate ligament reconstruction
Authors: T. P. Rinshad , Joseph Babu , Mammu Sharafuddeen , P. Uwais , Hussain K. Nejil , Pawaskar Siddarth
Published: October 2024

Background: The anterior cruciate ligament (ACL) is commonly injured in the knee joint, necessitating surgical reconstruction where quadrupled hamstring tendon autografts are frequently utilized for their favourable outcomes. Predicting the appropriate dimensions of these grafts is essential for surgical success. This study aims to investigate whether simple anthropometric measurements-height, weight, body mass index (BMI), thigh length, and circumference-can predict the length and diameter of quadrupled hamstring tendons used in ACL reconstruction.
Methods: This cross-sectional study included 45 patients undergoing ACL reconstruction with quadrupled hamstring autografts at department of orthopaedics, Renai Medicity Kerala, India. Preoperative anthropometric measurements were correlated with intraop graft dimensions using Pearson correlation and SPSS statistical software (version 22).
Results: Taller patients exhibited a positive correlation with graft diameter (p=0.028). Height and thigh length correlated positively with both gracilis and semitendinosus tendon lengths (p<0.001). Thigh circumference correlated positively with semitendinosus length (p=0.005), while weight, BMI, and other measures did not significantly correlate with graft dimensions.
Conclusions: Anthropometric measurements, particularly height and thigh length, serve as valuable predictors for hamstring graft dimensions in ACL reconstruction. These findings may assist surgeons in selecting appropriate grafts and optimizing surgical outcomes.
Functional outcome of treatment of fracture intertrochanteric femur by using proximal femoral nail antirotation II
Authors: Chhabra Sahil , Jain Pramod , Patond K. R. , Nannaware Mayur
Published: October 2024

Background: The elderly are most frequently affected by intertrochanteric fractures, which have a major effect on the medical community and society at large. In 2003, AO introduced the proximal femoral nail anti-rotation device, which was further improved and named proximal femoral nail antirotation II (PFNA II) in 2009. 
Methods: This study was conducted from December 2020 to August 2022. The 60 cases of proximal femoral nail anti-rotation II-managed intertrochanteric femur fractures were assessed.
Results: In the present study, 24 patients (40%) had type IV (Evan’s) fractures. Right hip was involved in 30 patients (50%). Meantime for clinic-radiological union was 20 weeks. There was complication rate of 2.08% as helical blade protrusion and non-union, 2.08% as helical blade protrusion, 2.08% as blade backout, 4.17% as superficial infection and 4.17% as lateral wall fracture. Seven patients expired postoperatively within 3 months while 5 patients lost during follow Up. After a 6-month follow-up, the Harris hip grade was used to evaluate 48 instances. Of these, 8 cases (16.67%) had an excellent score, 29 cases (60.42%) had a good score, 7 cases (14.58%) had a fair score, and 4 cases (8.33%) had a poor score. Thirty-seven of the 48 cases had reached the one-year follow-up mark. Thus, of the 37 patients assessed, 11 cases (29.73%) had excellent Harris hip grades, 19 cases (51.35%) had good scores, 4 cases (10.81%) had fair scores, and 3 cases (8.11%) had poor scores at the end of a one-year follow-up.
Conclusions: Even in rural populations, PFN A-II is a better, safer implant with a low rate of complications for treating stable and unstable intertrochanteric femur fractures.
Results of distraction and ligamentotaxis in thoracolumbar fractures without decompression
Authors: Lingayat Maruti B. , Sangai Aman , Ansari Abdullah
Published: October 2024

Background: Thoracolumbar fractures are common spinal injuries often requiring surgical intervention. Traditionally, decompression surgery has been used to relieve neural pressure. This study evaluates the effectiveness of ligamentotaxis with pedicular screw fixation, which minimizes the need for decompression, in treating thoracolumbar fractures.
Methods: A retrospective cohort study was conducted at a Government Medical College, Aurangabad involving 30 patients aged 18 and older with thoracolumbar fractures treated with ligamentotaxis and pedicular screw fixation. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American spinal injury association (ASIA) impairment scale for neurological function, and forward flexion degrees for spinal mobility. Patients were followed up for 12 months post-operatively.
Results: Significant pain reduction was observed, with VAS scores decreasing from 8.5 pre-operatively to 2.5 at 12 months (p<0.001). Neurological function improved, with many patients advancing from ASIA category A pre-operatively to category D by 12 months (p<0.001). Spinal mobility showed considerable recovery, with forward flexion increasing from 0 degrees pre-operatively to 80 degrees at 12 months (p<0.001).
Conclusion: Ligamentotaxis with pedicular screw fixation is an effective treatment for thoracolumbar fractures, providing substantial pain relief, neurological improvement, and restored spinal function. While outcomes are generally positive, patient selection remains critical to avoid poor neurological results. Further research is needed to refine indications and optimize treatment protocols.
Statistical analysis of total hip arthroplasty at rural hospital in Maharashtra under MJPJAY: a prospective study
Authors: Jain P. A. , Sao Shubham , Patond K. R.
Published: October 2024

Background: Total hip arthroplasty (THA) is one of the most common orthopedic surgeries globally, particularly in Western countries. In India, its prevalence has increased over the last two decades. However, most data on THA are from Europe and the United States. This study analyzes the clinical and demographic characteristics of patients undergoing uncemented THA at a rural hospital in Maharashtra, India, under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).
Methods: A prospective study was conducted in the Department of Orthopedics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from January 2020 to October 2022. A total of 123 patients (130 hips) who underwent uncemented THA, were included. Patients were categorized by age, gender, and primary indication for surgery. Preoperative evaluations, radiographic analysis, and postoperative follow-ups assessment of pain, range of motion, and complications were done.
Results: The mean age of patients was 40.32±12.53 years, with males (85.36%) outnumbering females (14.64%). Bilateral hip involvement was seen in 56.9% of cases and osteonecrosis of the femoral head was the most common indication (89.23%), with 57.6% idiopathic, 12.3% alcohol-related and 6.1% steroid-induced. The complication rate was 3.8%, with dislocation being the most frequent (2.1%). Revision surgeries performed in 2.1% of cases.
Conclusions: THA under MJPJAY demonstrates comparable clinical outcomes to international standards. Idiopathic osteonecrosis remains the leading cause, with a male predominance. Standardized protocols for the Indian population are needed.
Bilateral total knee arthroplasty-analysis of risk factors for blood loss and blood transfusion
Authors: Ramakrishnan Hitesh , Srivastav Shekhar , Sen Biswarup
Published: October 2024

Background: Total knee arthroplasty in general is a safe and successful surgical procedure for end stage arthritis of the knee joint to relieve pain, correct the deformity and restore function in the joint. However, it is often associated with significant blood loss. In such cases, blood transfusion is not uncommon.
Methods: 100 patients who underwent simultaneous bilateral TKA from April 2022 to December 2022 at Sant Parmanand Hospital, New Delhi were taken up for the study.
Results: In this study among 100 patients who underwent simultaneous bilateral total knee replacement, 9% of the cases required blood transfusion. Preoperative haemoglobin (<12.64 gm/dl) continues to be a predictor in blood transfusions. A haemoglobin level of less than 10.34 gm/dl preoperatively, a postoperative haemoglobin day 1 level of less than 8.56gm/dl and a postoperative day 3 level of less than 7.49 gm/dl increases the necessity for blood transfusion in simultaneously performed bilateral TKAs.
Conclusions: Asthma, Diabetes mellitus and patients on blood thinners are three major comorbidities than can cause increased blood loss. Age, gender, BMI and comorbidities are not related to the need for blood transfusion. Patients on blood thinners are at an increased risk for blood transfusion if they have a lower preoperative haemoglobin. Checking haemoglobin values on postoperative day 1 and day 3 are significant in terms of the need for blood transfusion.
Comparing the subvastus and medial parapatellar approaches in total knee replacement
Authors: Lingayat M. B. , P. V. Vimal , Nawkhare Raj , Sharma Ramkripal , Lakde Shubham , Rashinkar Omkar K.
Published: October 2024

Background: This study aimed to compare the outcomes of the subvastus and medial parapatellar approaches in total knee replacement (TKR), focusing on postoperative pain, knee function recovery, quadriceps strength, hospital stay, complications, and patient satisfaction.
Methods: This prospective comparative clinical trial was conducted over 18 months at a tertiary care hospital. A total of 120 patients, aged 50-75 years with knee osteoarthritis, were divided into two groups, group A (subvastus approach) and group B (medial parapatellar approach). Pain, range of motion (ROM), quadriceps strength, length of hospital stay, complications, and patient satisfaction were evaluated postoperatively at 1, 3, 6, and 12 months. Data were analyzed using SPSS, with significance set at p<0.05.
Results: Group A showed significantly lower pain at 1 and 3 months, with VAS scores of 4.1 and 2.8, respectively (p<0.05). ROM was significantly greater in Group A at 1 and 3 months (105.2° and 120.8°, p<0.05). Quadriceps strength improved faster in group A at 3 months (MMT score: 4.0, p=0.04). Group A also had a shorter hospital stay (4.5 vs 5.8 days, p=0.01). Complications and long-term satisfaction were similar across both groups.
Conclusion: The subvastus approach offers advantages in early recovery, including reduced pain, quicker ROM recovery, and shorter hospital stays. However, long-term outcomes are comparable between both approaches.
Prevalence of spin reporting bias in hip labrum reconstruction: a qualitative assessment of systematic reviews and meta-analyses
Authors: Gulbrandsen Matthew T. , Cannon Damien , M. Ong Meng-Yung , Ruckle David , Yalamanchili Dheeraj , Essilfie Anthony , Phipatanakul Wesley , Liu Joseph Nairne
Published: October 2024

Hip labral reconstruction is an evolving technique to treat labral pathology. Spin is a recent concept that is defined as a reporting bias that misrepresents research. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding acetabular labral reconstruction. Electronic libraries were queried for meta-analyses and systematic reviews regarding hip labrum reconstruction. The nine most severe types of spin found in abstracts were used as an evaluation tool. Two reviewers each performed a blinded assessment of each article for spin. A third reviewer was used to address any discrepancies between the original reviewers. Other variables evaluated include number of citations, journal impact factor, reported conflicts of interest (COI), adherence to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodologic quality according to a measurement tool to assess systematic reviews (AMSTAR-2). The electronic database search resulted in 1,148 articles, of which 10 met inclusion criteria. Of these 10 articles, 70% (7/10) were found to have at least one form of spin present, 20% (2/10) contained 3 different types of spin, 30% (3/10) contained 2 different types of spin, and 20% (2/10) contained 1 type of spin. The most common type of spin found was type 5, “conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in the primary studies,” which was found in 60% (6/10) of the articles. When assessing AMSTAR-2 score, 90% (9/10) of the articles were found to be ‘low quality’ or ‘critically low quality.’ Spin was present in 70% of the abstracts of meta-analyses and systematic reviews pertaining to hip labrum reconstruction. Recognition of spin is crucial for orthopaedic surgeons. Improved guidelines should be considered to reduce the prevalence of spin in orthopaedic literature.
A systematic study on the elevated risk of ankylosing spondylitis in adolescents engaged in intense physical exercise
Authors: Lawankar Rajendra
Published: October 2024

This study investigates the link between intense physical activity during adolescence and the onset of ankylosing spondylitis (AS), particularly in individuals having the human leukocyte antigen (HLA)-B27 antigen, a known genetic marker for AS. The systematic literature review included studies published between 2014 and 2024. . Keywords and search terms included combinations of "ankylosing spondylitis," "HLA-B27," "adolescence," "intense physical exercise," and "genetic predisposition. Inclusion criteria focused on studies involving adolescents aged 15-24 years with genetic predispositions such as HLA-B27. Exclusion criteria included studies with unrelated outcomes such as individuals not within the target adolescent age range, non-peer-reviewed articles, and those with insufficient data on the target population. Findings revealed that adolescents with the HLA-B27 antigen who engaged in heavy weight exercise were at a heightened threat of developing AS. The mechanical stress from intense physical activity potentially triggered or exacerbated inflammation at entheses in genetically predisposed individuals. However, the onset of AS was not universally observed in all HLA-B27 positive individuals who participated in strenuous exercise, suggesting other genetic and environmental factors’ involvement. The study suggests that strenuous exercise during adolescence may act as a significant contributing factor to the onset of AS in individuals having a genetic predisposition such as HLA-B27. While not all individuals having HLA-B27 develop AS, genetic and environmental factors’ combination, including intense physical activity, may accelerate disease progression.
Functional evaluation of unstable intertrochanteric fractures treated with proximal femoral nailing
Authors: Habeeb Fatima Heba , Bharath Bellamkonda , Chaitanya D. Shanoj , Ramana B. V.
Published: October 2024

In this study the functional outcome of proximal femoral nailing (PFN) in patients with unstable intertrochanteric fractures is studied and outcome is assessed with Modified Harris Hip Score. A post-operative analysis of unstable intertrochanteric fractures treated with PFN is done for its functional assessment. Various national & international studies are taken into consideration and our institutional study is compared with them. Between September 2020 to March 2022, 20 patients with unstable intertrochanteric fractures of the hip joint who were operated with PFN were functionally and clinically evaluated as per the Modified Harris Hip Score. Patients who satisfied the inclusion criteria were included in the study and follow-up was done up to 9 months. Fracture pattern, operative details and post-operative complications were documented. This study of 20 patients of unstable intertrochanteric fractures fixed with PFN showed excellent results in 9 patients (45 %), good functional outcome in 6 patients (30 %) and fair functional outcome in 3 patients (15 %). 2 patients showed a poor outcome accounting for 10%. The study showed that PFN is a reliable and effective device for the treatment of unstable intertrochanteric fractures. It provides a satisfactory fixation, but success is dependent mainly on fracture type, bony architecture, operative technique, postoperative care and rehabilitation. In view of the fewer post-operative complications, early union of fracture, early weight bearing and early return to work, we concluded the PFN to be a versatile, stable and acceptable implant in fixation of unstable intertrochanteric fractures which leads to a better functional outcome.
Impact of ayurvedic panchakarma therapy on osteoarthritis
Authors: Kshirsagar Jyoti , Lakariya Asha , Khan Sadik
Published: October 2024

Osteoarthritis is the leading cause of chronic pain and disability in adults, imparting a substantial economic burden on both society and individuals. This case series explored the impact of Ayurvedic Panchakarma therapy on knee osteoarthritis. Data from procedures conducted between March 2022 and January 2024 at a clinic in Maharashtra, India was collected. Patients of either gender who were clinically diagnosed with osteoarthritis grade 2 and underwent Knee Rejuvenation Therapy were included in this analysis. Follow-up was conducted after 1 month and at 90 days. Baseline data was compared with follow-up data. A total of 16 patients with mean age of 57.63 ± 10.20 years were included in the study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) score (day 1: 20.31±11.18, after 1 month: 49.94±10.85, day 90: 71.31±5.89, p=0.00), pain (day 1: 25.44±14.03, after 1 month: 57.81±10.66, day 90: 80.63±5.78, p=0.00), symptoms (day 1: 30.69±14.59, after 1 month: 55.75±12.94, day 90: 83.00±6.04, p=0.00), sports (day 1: 2.81±6.84, after 1 month: 25.31±15.05, day 90: 39.69±15.76, p=0.00), function  (day 1: 31.25±16.69, after 1 month: 58.94±12.34, day 90: 78.81±7.98, p=0.00), and quality of life (day 1: 14.13±14.83, after 1 month: 52.00±10.78, after 1 month: 73.50±4.50, p=0.00) increased from baseline to the 90-day follow-up. Ayurvedic treatment is effective in improving the KOOS score and reducing the severity of arthritis in diagnosed osteoarthritis patients.
Osteochondroma of the distal tibia with associated varus deformity of ankle
Authors: Kapadiya Shubham S. , Shah Rushit M. , Patel Nilkumar R. , Shah Malkesh D. , Nayak Hardik J.
Published: October 2024

Osteochondroma or exostosis is a bony developmental anomaly, which arises from exophytic outgrowth on bone surfaces characteristically. The most common site is the distal femur followed by the proximal humerus and proximal tibia. It is made up of a bony protrusion that is covered by a cartilage cap. Osteochondroma is asymptomatic and grows away from the nearby joint. It is very common in kids and young adults. Sometimes patient comes in 2nd decade with complaints of pain and swelling. This paper reports a presentation of osteochondroma present over the right distal tibia.
Rare case of medial Hoffa fracture with ipsilateral femur shaft fracture with unusual mechanism of injury
Authors: Katariya Jeetendra , Khatri Anup
Published: October 2024

Hoffa’s fracture is a rare fracture which involves coronal fracture of the distal femur involving one or both the condyles. We report a rare combination of Hoffa fracture with ipsilateral femur shaft fracture with an unusual mechanism of injury. This case report will help increase awareness about such combined fracture pattern and eventually avoid missing these important intra-articular injuries- Hoffa’s fracture. In a patient with ipsilateral femur shaft fracture and in polytrauma patients, diagnosis of Hoffa’s fracture is very challenging because of presence of other long bone fracture and injuries. Missed Hoffa’s fracture in a patient with ipsilateral femur shaft fracture may restrict post-operative knee range of motion, knee pain, increased risk of early arthritis and joint deformity and stiffness.
Biological knee joint reconstruction using patella following giant cell tumor excision: a case report
Authors: Dangi Parag P. , Bothra Jay S. , Pandya Aumkar H. , Shah Purvi D. , Patel Viren K. , Patwa Yashvi S.
Published: October 2024

A 20-year-old female patient presented to us with a large expansile swelling over right knee diagnosed clinically and confirmed histopathological and radiologically to be Giant Cell Tumor of upper end of Tibia involving both condyles with a breach in the posterior cortex. In this case report we tried to retain the joint function by biological reconstruction using the Patella after the wide excision of the tumor mass. A radical excision of the upper end of the Tibia was done. The Patella was used as an articular surface supported by ipsilateral Fibula and cortico-cancellous bone chips from the ipsilateral iliac crest as struts and complemented with synthetic bone graft pieces. Thus, the joint was reconstructed biologically. The case was followed for 1 year. The tumor was excised in toto, the knee joint was restored by the Patella and the bone graft struts. The results were discussed in detail.
Rescuing the knee: arthroscopic extraction of a long-neglected glass fragment: a case report
Authors: Gulia Anil Kumar , Kumar Sanjeev , Mittal Prabhat , Mohit  , Kumar Rakesh
Published: October 2024

The knee joint frequently encounters penetrating injuries and has ample space to harbor foreign objects. While foreign bodies in the knee joint are unusual, especially those not originating from surgical procedures, extensive literature exists on the extraction of loose bodies and metallic objects from this articulation. However, documentation on uncommon intruders remains scarce. This case study delves into the experience of a 22-year-old male who suffered persistent pain due to a neglected foreign object in his knee joint. After its removal, a complete resolution of symptoms was achieved. It highlights the importance of prompt arthroscopic intervention for optimal outcomes. Here we present a unique case involving a 22-year-old male who underwent arthroscopic retrieval of a neglected glass fragment from his knee joint. The patient sought medical attention five months after the initial injury due to sudden and severe pain onset. Arthroscopy stands as the favored minimally invasive method for extracting foreign bodies from the knee joint, especially from its deeper and less accessible regions. Utilizing pre-operative radiological imaging enhances understanding of the anatomical placement, facilitates surgical orientation, and reduces operation time. A keen sense of suspicion and thorough history-taking are crucial in achieving an accurate diagnosis.
Hip preservation in crisis: total hip replacement for osteoid osteoma-induced degeneration in a young adult
Authors: P. Uwais , Athmaram M. , Mammu Sharafuddeen , Pawaskar Siddarth M. , V. H. Nidhin Chacko
Published: October 2024

Osteoid osteoma is a small, benign tumor known for causing severe pain, especially at night. Intra-articular osteoid osteomas are rare and often misdiagnosed due to overlapping symptoms with other joint disorders like osteoarthritis or synovitis. These tumors require advanced imaging for accurate diagnosis and may necessitate surgical intervention when conservative treatments fail. A 22-year-old female presented with a four-year history of left hip and loin pain, initially treated with NSAIDs. Her symptoms progressively worsened, leading to imaging studies that revealed a sclerotic lesion in the hip joint. A biopsy confirmed osteoid osteoma, and due to the extent of joint damage, total hip replacement (THR) was performed. Postoperative recovery was excellent, with full functional restoration and no complications. This case illustrates the diagnostic and therapeutic challenges of intra-articular osteoid osteomas. THR proved to be a successful treatment in restoring function and alleviating pain, underscoring the need for early diagnosis and individualized surgical management in advanced cases.
Fiberglass cast application in immediate post-operative period after an ankle fracture surgery: review of safeguards
Authors: Tomar Lavindra , Govil Gaurav
Published: October 2024

An ankle fracture after stabilization may normally need post-operative support immobilization in a cast in the early phase to allow for the associated soft tissue ligamentous injury to recover. The cast may allow for an early rehabilitation of the operated ankle fractures with protected weight bearing potential. A cast immobilization in the immediate post-operative period following an ankle surgery has used gypsum plasters with great caution and care. The concerns of poor wound healing, infection, pressure ulcer, skin maceration due to soakage, development of compartment syndrome and thrombosis may present in the immediate post-operative period for ankle fractures following a cast application. The technique for fiberglass cast application in the immediate post-operative period may provide an advantage. The cast application needs an emphasis to understand the safeguards, avoid any abnormal pressure and do monitoring of wound care to attain a favorable desired outcome. The aspects of cast application have been reviewed to present the necessary safeguards.
Fibrodysplasia ossificans progressiva: a comprehensive review
Authors: S. Tamilselvan , A. Subhashini , R. V. Raveena
Published: October 2024

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder that causes heterotopic ossification of soft tissues, leading to abnormal bone growth in muscles, tendons, and ligaments. First identified in the 17th century, FOP was classified in 1968 and is linked to a mutation in the Activin A receptor type I gene (ACVR1) which affects bone morphogenetic protein (BMP). The autosomal dominant condition FOP has the potential to lead to aberrant bone development. At birth, FOP individuals appear normal, except for characteristic malformations of the great toes. FOP patients develop painful, inflammatory soft tissue swellings during the first decade of life, often precipitated by soft tissue injury. Minor trauma can trigger new flare-ups and leads to progressive heterotopic ossification. Most FOP sufferers are wheelchair-bound by their third decade and needs lifelong assistance with daily living tasks. Bone morphogenetic proteins (BMPs) are bound by the transmembrane kinase receptor ALK2, which is encoded by the (ACVR1/ALK2 gene). FOPs induce heterotopic bone formation in skeletal muscle and can be caused by mutations in the activin A receptor type I (ACVR1) and activin-like kinase 2 (ALK2) gene. Clinical therapy focuses on preventing and controlling inflammation, with ongoing research focusing on specific therapies targeting receptor activity, aberrant pathways, or cellular components influencing bone neo-formation.
Hip fractures redefined - ERAS protocol’s impact: the Indian scenario
Authors: Ganesh Arjun , Sameer M. Mohamad
Published: October 2024

This article delves into the profound impact of enhanced recovery after surgery (ERAS) protocols on the management of hip fractures within the Indian healthcare landscape. Hip fractures, particularly prevalent among the elderly, represent a significant clinical challenge, often leading to high rates of morbidity and mortality. The integration of the geriatric fracture center (GFC) model with ERAS protocols offers a sophisticated, multidisciplinary approach that prioritizes early surgical intervention, comprehensive geriatric care, and standardized, evidence-based practices. This synergy has the potential to significantly enhance patient outcomes by reducing hospital stays, minimizing complications, and expediting recovery.