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Introduction: The rising prevalence of osteoarthritis, associated with an ageing population, is expected to deliver increasing demand for arthroplasty services in the future. Understanding the scale of potential change is essential to ensure adequate provision of services and prevent prolonged waiting times that can cause patient harm. Methods: We set out to provide projections of future primary knee and hip arthroplasty out to 2038 utilising historical trend data (2008–2018) from the Scottish Arthroplasty Project. All analyses were performed using the Holt's exponential smoothing projection method with the forecast package in R statistics. Results were adjusted for projected future population estimates provided by National Records of Scotland. Independent age group predictions were also performed. Results: The predicted rise of primary hip arthroplasty for all ages is from 120/100k/year in 2018 to 152/100k/year in 2038, a 28% increase. The predicted rise of primary knee arthroplasty for all ages is from 164/100k/year in 2018 to 220/100k/year in 2038, a 34% increase. Based on a static 3‐day length of stay average this would see 4280 and 7392 additional patient bed days required for primary hip and knee arthroplasty patients respectively per annum. The associated additional cost is anticipated to be approximately £26 million. Conclusions: Anticipated future demand for arthroplasty will require significant additional resource and funding to prevent deterioration in quality of care and an increase in patient wait times, additional to that already required to clear the COVID‐19 backlog. Understanding presented projections of changes to arthroplasty demand is key to future service delivery. [ABSTRACT FROM AUTHOR]

Background: Limited attention has been paid to the natural history, management, and treatment outcomes related to the posterior cruciate ligament (PCL)–deficient knee joint. Purpose: To perform a comprehensive bibliometric analysis to evaluate the 50 top-cited articles in PCL research. Study Design: Cross-sectional study. Methods: We performed a keyword-based search in the Thomson Reuters Web of Science to generate a list of the 50 most cited articles relevant to the PCL. The included articles were analyzed according to journal, country of origin, publication year, total number of citations, citations per year, citation trends, and type of study (clinical vs basic science). Results: The 50 top-cited articles were published between 1975 and 2012, and the number of individual article citations ranged between 98 and 410. The listed articles were published in 7 journals, with the American Journal of Sports Medicine contributing to more than half of the articles and citations. The United States contributed the most articles (84%) and citations (n = 4873). There were 32 clinical studies and 18 basic science studies. All clinical studies had level 4 clinical evidence, and topics included the natural history of PCL tears, factors predicting the need for surgical intervention, and long-term outcomes of isolated PCL injuries and combined capsuloligamentous injuries. Most (77.8%) of the top-cited basic science articles consisted of experimental or biomechanical studies on human cadaveric knees. Conclusion: The current analysis suggests that PCL research is still evolving and needs high-quality prospective evidence to establish sound recommendations. [ABSTRACT FROM AUTHOR]

Introduction: Morphometric variations of the anterior column of the acetabulum have been described in the literature for its complex structure, which can influence the safe containment of intramedullary screw for fixation of its fractures. The purpose of this CT-based study is to present a preliminary report on the morphometric variations and safety of intramedullary screw fixation of the anterior column of the acetabulum in the Indian population.Methods: CT-based data from 102 uninjured pelves were retrospectively analyzed in iPlanⓇ BrainLab AG, Feldkirchen, Germany. Narrowest zones around acetabulum and superior pubic ramus were measured. We calculated the axis of the anterior column of the acetabulum by joining the centres of these narrowest zones. Standard screws trajectories were directed along this axis. Screw length up to the first cortical perforation, the distance of the exit point from the pubic symphysis, and the length of the anterior column up to the pubic tubercle were measured.Results: The osseous corridor of the anterior column of acetabulum had variable cross-section along its length with two constriction zones, first in the acetabular region and second in the superior pubic ramus. Only 54% of our cases allowed safe applicability of 6.5-mm-diameter screw trajectories with safety margin of 2 mm on either side of the screw. Significant morphometric and screw applicability-related differences were observed among male and female cases with males having a wider osseous corridor in general. Elimination of safety margin results in a significant increase in the screw applicability.Conclusion: The osseous corridor of the anterior column varies in its dimensions from individual to individual. Standard screws of 6.5-mm and 7.3-mm diameters may not be safe for intramedullary screw fixation in every patient and carry a risk of cortical violation when a 2 mm of width around the screw is considered as a safety margin. However, with a precise screw placement within the extents of the cortices of the anterior column, 6.5-mm screws can be applied in most of the female cases and 7.3-mm screws can be applied in most of the male cases for anterior column fixation. [ABSTRACT FROM AUTHOR]

Background: Proprioception is a specialized sensory modality encompassing the movement of the joint and its position in space. Reconstruction of the anterior cruciate ligament (ACL) does not always yield expected outcome, suggesting that successful reconstruction depends on not only the ultimate strength of the graft but also recovery of proprioception. Treatment delay is a significant concern in developing countries, e.g., in Asia. Thus, presence of mechanoreceptors is one of the factors having paramount importance for successful outcome. We conducted this study to identify mechanoreceptors via immunohistochemical staining and correlate their presence with duration of injury.Materials and Methods: A total of 38 injured native ACL stumps were harvested from patients undergoing ACL reconstruction and stained with neurofilament protein stain to detect functional mechanoreceptors.Results: Of the specimens, 44.7% stained positive for monoclonal antibody. No association was found between duration of injury and presence of mechanoreceptors (p = 0.897). No correlation was seen between age and side.Conclusions: No correlation was found between duration of injury and presence of viable mechanoreceptors, hence it is beneficial to preserve the native ACL stump irrespective of the time interval between injury and surgery.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: To evaluate results of a technique for treating neglected epiphyseal injuries of the distal radius with ulnar impaction.Materials and Methods: This retrospective study involved six cases (four males; two females), all of whom sustained the primary injury during childhood (range 9-12 years of age). All presented with wrist deformity and ulnar-sided wrist pain. They were managed with osteotomy of the distal radius, osteotomy and shortening of the ulna, harvesting the bone grafts, and distal radioulnar joint (DRUJ) reduction performed simultaneously through a dorsal midline approach. Mean follow-up was 30 months (range 24-36).Results: Deformity correction and pain relief was observed in all patients. Flexion arc increased from an average of 60° to 102.5°, supination from an average of 31.67° to 67.50°, and pronation from an average of 30.83° to 61.67°. The mean preoperative DASH score was 87.5, which improved to 18.72 postoperatively.Conclusion: Neglected epiphyseal injuries of the distal radius are difficult to manage and many variations are described for handing each of the associated problems. Our technique provides an option for managing this injury with an easy surgical approach, single incision, and cost effectiveness. All the four components of the surgery, which include osteotomy of the distal radius, osteotomy of the ulna, harvesting the bone grafts, and DRUJ reduction were done through a single incision and in a single sitting. Level of evidence IV. [ABSTRACT FROM AUTHOR]

Introduction: Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the society. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition in the surgeons' armamentarium to deal with these fractures. It creates an angular stable construct, which will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. We compared DHS with PFLCP in AO type 31A1 and 31A2 intertrochanteric fractures. Materials and Methods: A randomized prospective study was carried out between June 2011 and June 2013. 26 cases each of DHS and PFLCP were included. Results: Functional and radiological outcome was similar in both groups. Conclusion: Both DHS and PFLCP are good choices for stable intertrochanteric fractures, and both lead to excellent functional outcomes, but non-union might be more common with PFLCP. [ABSTRACT FROM AUTHOR]

Purpose: To compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children. Methods: This prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded. Results: The most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate ( p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group. Conclusion: Although the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities. [ABSTRACT FROM AUTHOR]

Background: Extra-articular proximal tibial fractures account for 5-11 % of all tibial shaft fractures. In recent years, closed reduction and minimally invasive plating and multidirectional locked intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures. Materials and methods: This randomized prospective clinical study was conducted on 58 skeletally mature patients with a closed extra-articular fracture of the proximal tibia treated with minimally invasive proximal tibial plating (PTP) or intramedullary nailing (IMN) by trained surgeons at a tertiary trauma center. Results: Postoperative hospital stay ( p = 0.035), time to full weight-bearing, and union time ( p = 0.004) were significantly less in the IMN group than in the PTP group, but there was no clear advantage of either technique in terms of operative time ( p = 0.082), infection rate ( p = 0.738), range of motion of the knee ( p = 0.462), or degrees of malunion and nonunion. Conclusion: Both implants have shown promising results in extra-articular proximal tibial fractures, and provide rigid fixation that prevents secondary fracture collapse. Level of evidence: Level 2, randomized controlled trial. [ABSTRACT FROM AUTHOR]

Patellar tendon rupture are rare injuries that are easily missed in acute phases if careful clinical examination is not carried out. The delayed condition is further difficult to treat and augmentation of end to end repair is generally required. However, literature presents no such case of delayed presentation with presence of infection. We here present one such case of delayed presentation of patellar tendon rupture at three weeks in a 52-year-old male patient. Usual techniques were not sufficient to allow early rehabilitation. Technique of suture anchors was planned for repair after thorough debridement. After this intervention, patient was put on aggressive rehabilitation protocol and he gained excellent range of motion. Patient was followed for one year and he showed no loss of movement or signs of infection. We thus recommend using anchor suture repair of patellar tendon that provides a stable and rigid fixation with possibility of early active rehabilitation even in delayed setting. [ABSTRACT FROM AUTHOR]

Posterior subtalar dislocation is an exceedingly rare entity. Clinically, the appearance of the foot can simulate a complex fracture dislocation. It is important to recognize that not all posterior subtalar dislocations are true posterior dislocations. We report a true posterior subtalar dislocation in a 34-year-old female, managed promptly with closed reduction and resulting in an excellent functional outcome. A chronic dislocation or an irreducible dislocation may need open reduction. [ABSTRACT FROM AUTHOR]