Asian Journal of Orthopaedic Research

Total Hip Arthroplasty Following Failed Internal Fixation of Hip Fractures: Clinical and Radiological Outcomes in a Retrospective Study of 14 Cases

Moutaoukil Walid — 2026-06-05

Background: Total hip arthroplasty (THA) is the reference salvage procedure for failed internal fixation of hip fractures. This revision surgery is technically demanding and carries a higher complication rate than primary THA.

Aim: The aim of this retrospective study was to evaluate clinical and radiological outcomes at short-to-medium term follow-up.

Methods: A retrospective single-center study including 14 patients who underwent THA after failed internal fixation of femoral neck, trochanteric or acetabular fractures (June 2017 – January 2021) at Mohamed V Hospital, Tangier. The mean follow-up was 18 months. Functional assessment was performed using the Postel-Merle d'Aubigné (PMA) score.

Results: The patient’s mean age was 63 years Old; the mean operative time was 130 minutes. Six patients required blood transfusion. One intraoperative complication occurred (periprosthetic fracture, 7%). No postoperative dislocation or deep infection was recorded. The radiological outcomes were satisfying, 93% of acetabular cups were correctly positioned within the 40–45° inclination range Heterotopic ossification was observed in 2 patients (14.3%). Excellent PMA score was achieved in 71.5% of patients. Our results, consistent with the international literature, confirm that conversion THA is the only reliable salvage option for failed hip fracture fixation, permitting restoration of ambulatory capacity and pain relief.

Conclusion: THA after failed hip fracture fixation is a technically challenging but effective salvage procedure. With adequate preoperative planning and appropriate implant selection, it allows restoration of hip function in the vast majority of patients and should be considered the only valid salvage option over re-osteosynthesis.

A Multisensory Feedback Framework for Prosthetic Gait Rehabilitation: Analysis of Gait-synchronized Vibrotactile and Thermal Stimuli

D. Dharshini — 2026-06-03

Lower-limb prosthetic rehabilitation increasingly emphasizes the restoration of sensory feedback to compensate for the loss of natural proprioceptive and tactile perception following amputation. Recent developments in multisensory human–machine interfaces have demonstrated the potential of integrating complementary feedback modalities, such as vibrotactile and thermal stimulation, to improve gait stability, user embodiment, and motor adaptation during prosthetic-assisted ambulation. Lower-limb prosthetic users often experience impaired gait symmetry, reduced proprioceptive awareness, and elevated cognitive load during ambulation. Sensory substitution and augmentation have emerged as promising strategies to restore afferent feedback lost due to amputation. This paper presents a comprehensive multisensory feedback framework integrating gait-synchronized vibrotactile and thermal stimuli to support prosthetic gait rehabilitation. The proposed system maps real-time gait events to spatially and temporally congruent vibrotactile cues, augmented with controlled thermal feedback to reinforce stance-phase awareness and load perception. A detailed system architecture, signal processing pipeline, control strategies, and experimental protocol are described. Quantitative gait metrics and qualitative user-reported outcomes are analyzed to evaluate efficacy. Results indicate improvements in temporal gait symmetry, stance stability, and perceived embodiment, suggesting that multimodal sensory feedback can enhance motor learning and rehabilitation outcomes for lower- limb amputees.

Patient Satisfaction with Spine Outpatient Clinic Visit at the National Orthopaedic Hospital Dala Kano, Nigeria: A Cross-Sectional Study

Kawu Ahidjo Abdulkadiri — 2026-07-11

Background: Patient satisfaction is a critical indicator of healthcare quality and is increasingly used to evaluate service delivery, particularly in outpatient settings, where patient-provider interaction is central to care. However, satisfaction levels in specialised spine clinics in Nigeria remain poorly characterised.

Aims: This study assessed patient satisfaction with spine outpatient clinic visits at the National Orthopaedic Hospital Dala, Kano, Nigeria.

Methods: A cross-sectional study was conducted at the spine outpatient clinic from January to March 2025. A total of 348 patients were recruited, of whom 342 completed the questionnaire, giving a response rate of 98.3%. Data were collected using a validated, interviewer-administered questionnaire adapted from the Picker Out-Patient Experience Survey. Satisfaction was measured across five domains: waiting time, doctor-patient communication, staff attitude, facility environment, and overall care.

Results: The mean age of respondents was 49.2±15.7 years, and 71.3% were attending follow-up visits. Overall patient satisfaction was 62.3%. Waiting time was the domain with the lowest satisfaction (28.9%), followed by facility environment (51.2%), whereas doctor-patient communication had the highest satisfaction (78.6%). Factors significantly associated with satisfaction included consultation duration (p<0.001), waiting time (p<0.001), and the patient’s perception of being listened to by the doctor (p<0.001). The doctor-patient ratio, estimated at 1:150 per clinic session, was identified as a major contributor to prolonged waiting times.

Conclusions: Patient satisfaction at the spine outpatient clinic was moderate, with significant deficiencies in waiting time and facility environment. Addressing staffing shortages, implementing appointment systems, and improving communication could enhance patient experience and outcomes.

Retained Fractured Epidural Catheters: A Case Series and a Proposed Management Algorithm

S. C. Satpal — 2026-06-01

Retained fractured epidural catheter fragments are a rare but potentially serious complication of neuraxial anaesthesia, with reported incidences ranging from 0.002% to 0.055%. Despite their infrequency, management remains controversial, particularly in asymptomatic patients, due to the balance between risks of surgical retrieval and potential long-term complications such as migration, infection, granuloma formation, and neurological compromise.

Methods and Objective: This was a 2 -centre retrospective study of nine patients with retained epidural catheter fragments following lumbar epidural anaesthesia from 2023-2025. The objective of the study is to describe and evaluate the outcomes of treatment and to design a management guideline.

Results: Computed tomography (CT) scan successfully localized the retained fragments in all cases, with fragment lengths ranging from 0.9 cm to 15 cm, and locations including intra-canal, interlaminar, and paraspinal regions. Seven patients underwent surgical removal within 2–5 days of the incident, while two were managed conservatively. Surgical outcomes were rather favorable.

Conclusion: Our findings support CT scan as the primary imaging modality for accurate localization of retained catheter fragments. Clinical decisions should be guided by symptomatology, fragment location, length, and age factors. Based on expert consensus, we propose a structured management algorithm emphasizing early imaging, risk stratification, and shared decision-making. This approach aims to standardize care, reduce morbidity, and address medicolegal considerations in both tertiary and resource-limited settings.

A Six-case Series of Pelvic Bone Tumor Resection with Limb Preservation: Prosthetic Reconstruction, Osteosynthesis, and Conservative Surgical Approaches

Hamza Betmi — 2026-06-11

Background: Pelvic bone tumors are rare, complex lesions whose management is challenging due to delayed diagnosis, intricate anatomy, and proximity to critical neurovascular structures, requiring multimodal imaging, biopsy confirmation, and individualized surgical resection with reconstruction when needed.

Aims: To report the diagnostic and therapeutic features of six patients managed for pelvic bone tumors in a Moroccan tertiary orthopedic unit, highlighting surgical approaches, reconstructive choices, functional outcomes, and specific challenges in a resource-limited setting.

Study Design: Retrospective descriptive case series.

Place and Duration of Study: Department of Orthopedic Surgery and Traumatology, Mohammed VI University Hospital, Tangier, Morocco, January 2023 – December 2025.

Methodology: Six patients (5 women, 1 man; mean age 35.7 years; range 16–67) operated for histologically confirmed pelvic bone tumors. Data on clinical presentation, multimodal imaging, histological diagnosis, neoadjuvant and adjuvant treatments, surgical resection type (Enneking–Dunham classification), reconstructive strategy, complications, functional outcomes (MSTS score), and follow-up were collected via REDCap database.

Results: Histological subtypes: Ewing sarcoma (n=3), chondrosarcoma (n=1), intraosseous cavernous hemangioma with aneurysmal changes (n=1), bone metastasis from breast carcinoma (n=1). Mean diagnostic delay: 17 months. All patients underwent limb-sparing surgery. Reconstructions: ilio-femoral ice-cream cone prosthesis (n=1), plate osteosynthesis (n=2), cement + T-plate (n=1), hernia mesh filling (n=1), no reconstruction (n=1). Four patients (67%) in complete remission (7 months to 2 years follow-up). One death from Ewing sarcoma metastatic relapse. One locoregional recurrence (metastatic carcinoma). Functional recovery satisfactory in survivors.

Conclusion: Limb-preserving pelvic surgery is achievable across diverse histological subtypes and reconstructive needs in a resource-limited Moroccan tertiary center, though conclusions are necessarily limited by the small and heterogeneous sample size. The 17-month mean diagnostic delay remains the primary obstacle in the Moroccan context. Multidisciplinary tumor boards, improved imaging access, and national referral networks are essential.

Orthopaedic Management in Cerebral Palsy: A Narrative Review

Made Agus Maharjana — 2026-06-03

Background: Cerebral palsy (CP) is a permanent disorder of movement and posture caused by a non-progressive injury to the developing brain. Despite the static nature of the neurological insult, musculoskeletal complications often progress with growth, leading to spasticity, contractures, skeletal deformities, hip instability, gait abnormalities, and spinal deformities that may significantly limit function and quality of life.

Aims: This review aims to summarize key principles of orthopaedic management in CP and highlight practical approaches for clinical assessment, surveillance, and treatment planning to optimize function and prevent secondary deformities.

Methods: A narrative review was conducted using published literature focusing on the definition and classification of CP, diagnostic evaluation, hip surveillance, gait assessment, and orthopaedic interventions. Both conservative and surgical strategies were included, with emphasis on decision-making frameworks used in contemporary clinical practice.

Results: Orthopaedic management in CP is best delivered through a multidisciplinary approach. Non-operative measures such as physiotherapy, orthoses, serial casting, and spasticity control are essential to maintain range of motion, improve alignment, and enhance functional performance. Surgical intervention is indicated for fixed deformities, progressive hip displacement, severe gait dysfunction, and scoliosis, with single-event multilevel surgery increasingly applied to correct multiple deformities in one operative session. Ongoing clinical evaluation, standardized hip surveillance, and gait analysis support timely intervention and improved outcomes.

Conclusion: Orthopaedic care plays a central role in improving mobility, reducing pain, and enhancing quality of life in children with CP. Individualized treatment based on functional classification, careful surveillance, and appropriately timed conservative or surgical interventions is critical to achieve optimal long-term outcomes.

Contemporary Diagnostic and Therapeutic Strategies for Knee Meniscal Injuries: A Review

Mamajonov Shavkat Taxirjanovich — 2026-06-17

Meniscal injuries represent one of the most prevalent and clinically consequential musculoskeletal conditions encountered in orthopaedic and sports medicine practice, affecting a broad demographic spectrum ranging from young competitive athletes to elderly patients with degenerative joint disease. The menisci fulfil indispensable biomechanical roles within the tibiofemoral joint, including load transmission, shock absorption, stabilisation, and lubrication, and their preservation is increasingly recognised as fundamental to the long-term health of the knee. Over the past two decades, the management of meniscal injuries has undergone significant evolution, driven by robust clinical trial evidence that has challenged longstanding surgical conventions and redirected practice towards conservative, tissue-preserving approaches. This review critically appraises current knowledge across the full spectrum of meniscal injury, encompassing pathoanatomy, tear classification, clinical diagnosis, imaging assessment, and the complete range of therapeutic strategies from structured rehabilitation to arthroscopic intervention, allograft transplantation, biological augmentation, and emerging tissue engineering technologies. Particular attention is given to randomised controlled trials demonstrating the equivalence of exercise-based rehabilitation to arthroscopic partial meniscectomy for degenerative tears, and to the growing evidence base supporting meniscal repair as the preferred surgical strategy for appropriate lesions. The roles of platelet-rich plasma, mesenchymal stem cell therapy, scaffold-based implants, and three-dimensional bioprinting in meniscal regeneration are reviewed alongside the current limits of the clinical evidence. The article identifies critical gaps in knowledge and proposes future research priorities to guide practice in this rapidly advancing field.

Therapeutic Strategies Targeting the Gut-Bone Axis: The Role of Probiotics and Faecal Microbiota Transplantation

Mohamed Khaled Talaat Youssef Hassan — 2026-06-18

The gut microbiota is an important modulator of skeletal homeostasis through immune regulation, microbial metabolite production, intestinal barrier integrity, endocrine signalling and mineral handling. Dysbiosis may contribute to bone loss by increasing intestinal permeability, promoting systemic low-grade inflammation, enhancing osteoclastogenic cytokine activity and reducing bone-protective metabolites, particularly short-chain fatty acids. This narrative review synthesises mechanistic, preclinical and clinical evidence on microbiome-directed strategies targeting the gut-bone axis, with emphasis on probiotics, prebiotics, synbiotics and faecal microbiota transplantation. Experimental studies suggest that selected probiotic strains may influence bone remodelling by increasing short-chain fatty acid production, improving gut barrier function, modulating Treg/Th17 balance and reducing inflammatory bone resorption. Prebiotics and synbiotics may further support skeletal health by enhancing calcium absorption, stimulating beneficial microbial activity and promoting metabolite-mediated regulation of osteoblast and osteoclast function. Human studies provide preliminary evidence for modest improvements in bone mineral content, preservation of bone mineral density and reductions in biochemical markers of bone resorption. However, most trials remain limited by small sample sizes, heterogeneous formulations, short follow-up periods and reliance on surrogate outcomes rather than fracture endpoints. Faecal microbiota transplantation provides useful experimental insight into the causal relevance of microbial communities in host metabolic and skeletal physiology, but its application to osteoporosis remains investigational because donor variability, recipient compatibility, pathogen transmission, long-term ecological stability and regulatory oversight remain unresolved. Overall, targeting the gut-bone axis is biologically plausible and may complement established skeletal care, but current evidence supports further investigation rather than immediate clinical replacement of standard osteoporosis therapies.

Comparison of Clinical Outcomes Between Arthroscopic and Open Repair for Lateral Epicondylitis: A Systematic Review and Meta-Analysis

Maria Anastasia — 2026-06-29

Background: Lateral epicondylitis (LE) refractory to non-operative care is commonly treated using either open or arthroscopic debridement/repair. However, the comparative effectiveness and safety of these approaches remain debated. This systematic review and meta-analysis aimed to compare clinical outcomes, complication rates and reoperation rates between arthroscopic and open surgery for LE.

Methods: A systematic review and meta-analysis of comparative studies was conducted in accordance with PRISMA principles. PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library were searched for eligible studies comparing arthroscopic and open surgical treatment for refractory LE. Reference lists of relevant studies and previous reviews were also screened manually to identify additional eligible studies. Adult patients with LE undergoing arthroscopic versus open debridement and/or repair were eligible. The primary outcomes were patient-reported function, measured using QuickDASH or DASH, and pain, measured using the visual analogue scale (VAS). Secondary outcomes included grip strength, flexion-extension range of motion (ROM), complications and reoperation. Mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Fixed-effect or random-effects models were applied according to statistical heterogeneity. Risk of bias was assessed using RoB 2.0 for randomised trials and MINORS for non-randomised comparative studies.

Results: Six comparative studies were included. Pooled analyses demonstrated no significant differences between arthroscopic and open approaches in QuickDASH score (MD -1.47; 95% CI -5.65 to 2.71; p = 0.49), DASH score (MD -1.22; 95% CI -6.30 to 3.86; p = 0.64), VAS pain score (MD -0.18; 95% CI -0.64 to 0.28; p = 0.44), grip strength (MD 0.73 kg; 95% CI -1.36 to 2.83; p = 0.49) or flexion-extension ROM (MD -0.36°; 95% CI -2.19 to 1.47; p = 0.70). Reoperation rates (RR 0.93; 95% CI 0.71 to 1.22; p = 0.61) and complication rates (RR 1.06; 95% CI 0.65 to 1.74; p = 0.82) were also comparable. The observed between-group differences were small and below commonly accepted thresholds for clinically important differences.

Conclusion: Arthroscopic and open surgery for refractory lateral epicondylitis provide comparable improvements in pain, function, grip strength, ROM and safety, with no significant difference in reoperation rates. Procedure selection should therefore be individualised according to patient characteristics, suspected intra-articular pathology, surgeon expertise and resource availability. Future multicentre randomised trials with standardised operative, rehabilitation and outcome-reporting protocols are warranted.

Tibial Plateau Fractures: A Narrative Literature Review

I Made Yedi Wisnawan — 2026-07-09

Aims: To provide an updated narrative review of tibial plateau fractures, including clinically relevant anatomy, biomechanics, epidemiology, classification, radiographic assessment, acute management, fixation strategies, rehabilitation, prognosis, complications, limitations of current evidence, and future directions.

Study Design: Narrative literature review.

Methodology: A narrative literature search was performed using PubMed, Google Scholar, and major orthopaedic reference sources for publications relevant to tibial plateau fractures. Search terms included tibial plateau fracture, Schatzker classification, three-column classification, posterolateral tibial plateau fracture, computed tomography, soft-tissue injury, surgical approach, fixation, conservative treatment, rehabilitation, prognosis, and post-traumatic osteoarthritis. English-language articles, reviews, clinical studies, book chapters, and imaging-based studies published mainly from 2007 to 2025 were considered, with emphasis on recent literature from 2023-2025 and landmark references needed to explain classification and treatment principles.

Results and Discussion: Tibial plateau fractures are complex intra-articular injuries of the proximal tibia that may result from low- or high-energy trauma. They account for approximately 1% of all fractures, and recent epidemiological studies continue to show variation according to age, trauma mechanism, bone density, and local injury patterns.^1-6 Fracture morphology is influenced by knee position, axial load, varus-valgus force, bone quality, cartilage support, and subchondral bone strength. Schatzker, AO/OTA, and three-column classification systems provide complementary information for describing fracture morphology and selecting surgical approaches. Standard radiographs remain the first-line imaging method, but computed tomography is essential for complex fractures and for identifying posterior-column fragments. Management should be individualized according to fracture displacement, soft-tissue condition, associated meniscal or ligament injury, neurovascular status, compartment syndrome, and patient-related factors.

Conclusion: Tibial plateau fractures require structured evaluation of fracture morphology, soft-tissue condition, limb alignment, articular congruity, and patient factors. Conservative treatment is appropriate for selected stable fractures, whereas surgery is indicated for displaced, unstable, open, bicondylar, or soft-tissue-complicated injuries. Current evidence supports CT-guided planning, careful soft-tissue management, column-specific fixation when required, early controlled motion, and individualised rehabilitation, with the aim of reducing the risk of stiffness, malunion, non-union, neurovascular injury, compartment syndrome, and post-traumatic osteoarthritis.

Revision Anterior Cruciate Ligament Surgery Using MacIntosh Technique with Patellar Tendon Reconstruction via Contralateral Patellar Tendon Graft: A Case Report

O. Memdouh — 2026-06-01

Background: ACL reconstruction using the Kenneth Jones bone-patellar tendon-bone technique is a well-established procedure with excellent functional outcomes, although rare complications such as patellar tendon rupture may occur. In revision settings, alternative reconstructive approaches like the MacIntosh technique can provide effective management for complex postoperative failures.

Aims: To report a rare case of early patellar tendon rupture following ACL reconstruction using the Kenneth Jones bone-patellar tendon-bone technique, and to describe the iterative surgical management using the MacIntosh technique combined with simultaneous patellar tendon reconstruction via a contralateral patellar tendon graft.

Presentation of Case: A 22-year-old male patient (BMI 29) presented with complete loss of active knee extension in the immediate postoperative period following open ACL reconstruction using the Kenneth Jones technique. MRI confirmed complete rupture of the right patellar tendon and absence of the ACL. Revision surgery was performed combining ACL reconstruction using an ipsilateral fascia lata graft (MacIntosh technique) and patellar tendon reconstruction using a contralateral patellar tendon graft.

Discussion: Patellar tendon rupture following ACL reconstruction represents a rare but serious complication. Mechanical, histological, and vascular alterations of the residual two-thirds of the harvested patellar tendon are implicated in this risk. The MacIntosh technique provides a reliable alternative in revision settings, with favourable functional outcomes.

Conclusion: This case underscores the importance of rigorous surgical technique, careful postoperative surveillance, and thorough informed consent — encompassing the risk of patellar tendon rupture, donor-site morbidity, and the potential need for revision surgery — prior to ACL reconstruction using the Kenneth Jones procedure.

Mirror Chondroblastoma of the Distal Femur and Proximal Tibia: A Rare Case of Synchronous Epiphyseal Lesions with an Occult Tibial Component on MRI

O. Msahli — 2026-06-10

Background: Chondroblastoma is a rare benign but locally aggressive epiphyseal bone tumor that primarily affects adolescent males, most commonly involving the distal femur, proximal tibia, and proximal humerus. Although MRI is valuable for evaluating these lesions, small synchronous lesions may remain occult, and no previous reports have described “mirror” chondroblastoma involving both sides of the same joint.

Aims: To report an exceptionally rare case of synchronous "mirror" chondroblastoma affecting both the distal femoral medial condyle and the proximal tibial plateau, with the tibial lesion remaining occult on preoperative MRI.

Presentation of Case: A 16-year-old male presented with a 9-month history of progressive right knee pain and partial functional impairment. A surgical biopsy performed 6 months prior at another institution had confirmed chondroblastoma of the distal femoral medial condyle. Preoperative MRI, performed one month before surgery, revealed the femoral lesion but failed to identify a synchronous tibial plateau lesion. Intraoperatively, a second chondroblastoma was discovered at the medial tibial plateau — a so-called "mirror" lesion not visible on MRI. Both cavities were treated by extended curettage and filling with calcium phosphate cement (CPC).

Discussion: Synchronous chondroblastoma involving both sides of the same joint (mirror lesions) is an unreported finding in the literature. MRI limitations in detecting small or early epiphyseal lesions are discussed. The surgical management of both lesions was achieved in a single operative session.

Conclusion: This case highlights the importance of thorough intraoperative inspection of all articular surfaces in chondroblastoma surgery, and raises the question of systematic arthroscopic exploration. Mirror chondroblastoma may represent a novel, previously undescribed entity.

Concurrent Posterosuperior Hip Dislocation and Ipsilateral Diaphyseal Femoral Fracture: Staged Surgical Management and Twelve-Month Outcome

Y. Sebai — 2026-06-22

Background: Concurrent posterosuperior hip dislocation with ipsilateral femoral diaphyseal fracture is a rare, high-energy orthopaedic injury in which the femoral shaft fracture may mask the associated hip dislocation, increasing the risk of delayed reduction and femoral head vascular compromise.

Case Presentation: A 54-year-old previously healthy male pedestrian presented to the emergency department at 21:30 hours after being struck by a motorcycle. Examination showed shortening, external rotation, inability to bear weight, and intact distal neurovascular status. Radiographs confirmed a closed right mid-diaphyseal femoral fracture with concurrent right posterosuperior hip dislocation, without plain radiographic evidence of femoral neck or posterior acetabular wall fracture. Urgent closed reduction was performed under general anaesthesia using a modified Allis technique, with the proximal femoral fragment used as a traction handle because shaft continuity was lost. Fluoroscopy confirmed concentric reduction. Definitive fixation of the femoral shaft fracture was then completed in the same operative session using an antegrade centromedullary interlocking nail.

Outcome: Rehabilitation progressed from initial non-weight-bearing mobilisation to partial weight-bearing at 6 weeks and full weight-bearing at 12 weeks. At twelve months, radiographs showed complete femoral fracture consolidation, preserved femoral head sphericity, and no radiographic evidence of avascular necrosis. The Harris Hip Score was 91.

Conclusion: This case supports systematic pelvic imaging in high-energy femoral fractures and prioritisation of urgent hip reduction before definitive fracture fixation.

Acute Primary Total Hip Arthroplasty Combined with Open Reduction and Internal Fixation of the Posterior Acetabular Wall for Ipsilateral Femoral Neck Fracture Following a High-energy Fall: A Case Report

Otmane Msahli — 2026-06-30

Aims: To report a rare case of combined ipsilateral femoral neck fracture and posterior acetabular wall fracture following a high-energy fall, managed acutely with simultaneous open reduction and internal fixation (ORIF) of the posterior acetabular wall and total hip arthroplasty (THA) via a Kocher-Langenbeck approach.

Presentation of Case: A 49-year-old male with no significant past medical history presented after a 3-metre fall and sustained a comminuted right distal radius fracture, managed with an external fixator at admission, together with an ipsilateral femoral neck fracture and posterior acetabular wall fracture. The patient underwent acute primary uncemented THA combined with posterior acetabular wall fixation using a reconstruction plate via a Kocher-Langenbeck approach in a single surgical session. At 12-month follow-up, the patient demonstrated satisfactory functional recovery with stable implant fixation, no evidence of loosening, osteolysis or dislocation, and progressive return to daily activities, with a Harris Hip Score of 88 (compared with 42 in the immediate postoperative period) and a pain-free hip range of motion of 0–100° flexion.

Discussion: This injury combination is rare and surgically challenging. Simultaneous ORIF of the acetabular wall and acute THA may avoid the risks of avascular necrosis, non-union and secondary arthroplasty procedures associated with isolated osteosynthesis of such complex fracture patterns.

Conclusion: Acute primary THA combined with posterior acetabular wall fixation is a viable one-stage surgical solution in selected patients with ipsilateral femoral neck and posterior acetabular wall fractures following high-energy trauma, enabling early functional recovery and avoiding staged procedures.

Management of Subacute Osteomyelitis of the Tibia with Concurrent Prosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report

Nyoman Gede Grenata Nanda Ustriyana — 2026-06-30

Background: Osteomyelitis and periprosthetic joint infection (PJI) following total knee arthroplasty are significant musculoskeletal infections associated with substantial morbidity, prolonged treatment, and increased healthcare utilisation. Despite advances in surgical techniques and antimicrobial therapy, the management of subacute osteomyelitis and TKA-associated PJI remains challenging because of biofilm formation, diagnostic complexity, and the risk of recurrent infection.

Aims: To report a rare case of early methicillin-resistant Staphylococcus aureus (MRSA) periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) associated with contiguous subacute tibial osteomyelitis and to describe a prosthesis-preserving management strategy.

Presentation of Case: A 37-year-old man with post-traumatic osteoarthritis secondary to a malunited tibial plateau fracture and multiple previous reconstructive procedures underwent primary left TKA using a fully constrained hinged prosthesis. Early postoperative cultures grew MRSA. One month later, he presented with pain, purulent discharge, and sinus formation over the proximal tibia. Inflammatory markers were elevated, whereas the leucocyte count remained normal. The findings were consistent with acute postoperative PJI with contiguous subacute tibial osteomyelitis. Treatment consisted of implant retention with extensive open debridement through the previous approach, tibial polyethylene insert exchange, and pulsatile irrigation. The tibial sinus tract was explored to bone, with sampling of seropurulent material and bone. Tibial guttering, limited osteotomy of devitalised bone, and packing with vancomycin-loaded bone cement were performed. Targeted antimicrobial therapy included intravenous vancomycin and oral rifampicin. The patient showed a good early clinical response, with controlled pain, dry wounds, and preserved distal neurovascular status.

Discussion: Persistent drainage after TKA may reflect a dual infectious process involving both the prosthetic joint and adjacent bone. In selected early infections with stable implants and acceptable soft tissue conditions, debridement, antimicrobial therapy, implant retention, modular component exchange, and local antibiotic delivery may preserve both limb and prosthesis.

Conclusion: Early MRSA PJI associated with subacute tibial osteomyelitis may be managed using a prosthesis-preserving approach when meticulous debridement, modular exchange, and combined systemic and local anti-staphylococcal therapy are applied.

Immediate Postoperative Evaluation of Bilateral Carpal Tunnel Syndrome Release Augmented with Human Amniotic Membrane and Secretome: A Case Report

Made Bramantya Karna — 2026-07-01

Carpal tunnel release is an established surgical treatment for carpal tunnel syndrome; however, postoperative pain, scar formation and perineural adhesion may affect functional recovery in some patients. This case report describes the early clinical and functional outcome of simultaneous bilateral open carpal tunnel release augmented with human amniotic membrane, with additional secretome application on one side. A 50-year-old woman with bilateral carpal tunnel syndrome underwent bilateral open carpal tunnel release under general anaesthesia. Both median nerves were decompressed by division of the transverse carpal ligament. Human amniotic membrane was applied bilaterally. Secretome was additionally applied around the right median nerve, whereas the left median nerve received human amniotic membrane with 0.9% saline; therefore, the left hand should not be interpreted as an untreated or standard-care-only control. Clinical and functional outcomes were assessed using the Visual Analogue Scale, Boston Carpal Tunnel Questionnaire Symptom Severity Scale, Boston Carpal Tunnel Questionnaire Functional Status Scale, QuickDASH score and grip strength before surgery and at 3 months postoperatively. Preoperatively, both hands showed comparable impairment, including a Visual Analogue Scale score of 5, Symptom Severity Scale score of 4.0, Functional Status Scale score of 3.5, QuickDASH score of 54.5 and grip strength of 10.5 kg. At 3 months, both hands showed clinical and functional improvement. The right hand showed a Visual Analogue Scale score of 0, Symptom Severity Scale score of 1.0, Functional Status Scale score of 1.0, QuickDASH score of 2.3 and grip strength of 27.5 kg. The left hand showed a Visual Analogue Scale score of 3, Symptom Severity Scale score of 2.5, Functional Status Scale score of 2.0, QuickDASH score of 22.7 and grip strength of 23.5 kg. The observed difference between hands is an associative finding from a single, non-randomised bilateral case and cannot establish the superiority or efficacy of secretome augmentation. This case is hypothesis-generating and supports the need for larger prospective studies with standardised biologic material characterisation and longer follow-up.

Surgical Management of Neglected Elbow Fracture-Dislocation: The Role of Soft Tissue Interposition Arthroplasty

Maria Anastasia — 2026-07-07

Background: Neglected elbow fracture-dislocations are uncommon but clinically challenging injuries associated with pain, deformity, stiffness, periarticular fibrosis, heterotopic ossification, and articular damage. When anatomical reconstruction or prosthetic replacement is not feasible, soft tissue interposition arthroplasty may be considered as a salvage option.

Case Presentation: A 59-year-old right-hand-dominant woman presented with persistent right elbow pain, progressive deformity, and severe movement restriction four months after a fall onto her right elbow while collecting firewood. She had initially undergone several manipulation sessions with a traditional bonesetter before referral to a tertiary orthopaedic centre. Clinical examination demonstrated swelling, angular deformity, diffuse tenderness, severely limited elbow movement, preserved wrist and finger motion, and intact distal neurovascular status. Radiographs and three-dimensional computed tomography confirmed a neglected closed fracture-dislocation with radial head and coronoid comminution, loss of joint congruence, heterotopic ossification, and secondary degenerative change.

Management and Outcome: Because chronic fibrosis, comminution, articular destruction, financial constraints, and implant availability made anatomical reconstruction and total elbow arthroplasty unsuitable, autologous fascia lata interposition arthroplasty was performed. Postoperative management included short-term immobilisation, indomethacin prophylaxis, active-assisted physiotherapy, and dynamic splinting. At 12 weeks, pain control, elbow motion, and light daily activity performance had improved.

Conclusion: This case highlights the consequences of delayed care and supports selected use of soft tissue interposition arthroplasty as a bone-preserving salvage approach in neglected elbow fracture-dislocation.