Background: Epidemiological studies suggest that people with arthritis die younger than non-arthritic aged-matched peers. However, the causal mechanism underpinning this association has not been conclusively demonstrated. One possible explanation is a lack of physical activity (PA) in those with end-stage lower limb arthritis. Given emerging evidence from large cohort studies using wearables and machine learning to estimate PA, is it time we considered arthroplasty a life-saving intervention? Methods: We conducted a harmonisation review, drawing upon recently published literature on PA and all-cause mortality (Strain et al., 2020), as well as PA and arthritis (Small et al., 2024), in the UK Biobank. The UK Biobank is a large population cohort study with 96,476 participants with wrist-worn accelerometry data, 3506 of whom have been studied independently as arthritis patients. We harmonised the literature to explore the potential mortality risk reduction conferred by arthroplasty in end-stage arthritis patients. Results: Small et al. demonstrate patients with an ipsilateral hip replacement have equivalent PA levels to their non-arthritic peers at more than 1-year post-surgery. Further, end-stage arthritis patients have significantly lower moderate-vigorous activity than non-arthritic peers. Strain et al. show that low PA and lower-intensity PA are strongly associated with all-cause mortality, suggesting that arthroplasty confers a significant all-cause mortality risk reduction. Conclusion: Extrapolation of recently published epidemiological studies using wearables and machine learning suggests that arthroplasty, through the restoration of PA, reduces all-cause mortality. Further studies are needed to evaluate the risk/benefit of early intervention vs. traditional orthopaedic considerations such as revision risk.

Introduction: Anthropometry is the science of measuring physical body parts. Very few studies are available in the literature comparing stature with lower limb anthropometric parameters. This study aims to measure and correlate height from lower limb parameters, determining the most closely associated one. Objectives: To correlate the foot length, lower limb length, and stride length with height and to derive a formula to estimate the height from lower limb measurements. Methodology: An observational study was conducted at AIIMS Guwahati, after IEC approval and informed consent. A stadiometer was used to measure the height. A sliding caliper was used to measure the foot length. The subject was advised to place both feet in a shallow tray of color water and walk on a polished floor for 20 feet distance. With a trail of footprints, stride length was calculated. Result: 100 young adults aged 20-40 years, were included after screening. The mean height of individuals and age were calculated. The Pearson Correlation Coefficient analysis was done for height, limb length, and foot length. Results showed that height had a strong positive correlation with both limb length (R=0.8) and foot length (R=0.72). Conclusion: These parameters can be used to assess an individual's height by considering their lower limb length, foot length, and stride length. These parameters might be helpful, especially for forensic anthropologists in crime scene investigations, and will help to design artificial limb implants and limb prostheses.Keywords: Height, Lower Limb length, Foot Length, Stride Length.

Heterotopic ossification (HO) is a devastating sequela in which the pathologic extracellular matrix of cartilage and bone forms abnormally in soft tissues following traumatic injuries or orthopaedic surgeries. Early treatment is essential to inhibit the progression of HO but is currently limited by the absence of sensitive and specific early diagnosis. Herein, the study exploits the enrichment of type II collagen (Col2a1) in the HO cartilage formation stage towards developing a near-infrared (NIR) probe for early HO diagnosing, namely WL-808 by conjugating a Col2a1-binding peptide (WYRGRL) and a cyanine dye (IR-808). WL-808 exhibits high specificity for targeting the cartilage in vitro and in vivo with no apparent cytotoxicity. The NIR signal of WL-808 can be detected in the HO cartilage lesions as early as 1 week after injury when micro-CT cannot show any ectopic bone formation. Moreover, the probe is rarely distributed in the normal keen articular cartilage in vivo via the intravenous administration method. Taken together, WL-808 demonstrates great potential in early HO diagnosis under NIR imaging, facilitating early HO prophylaxis and treatment in the clinic.

The purpose of the study. To show the effectiveness of the use of zoledronic
acid in the treatment of chronic recurrent multifocal osteomyelitis in children.
Currently, there is no etiotropic therapy for chronic recurrent multifocal osteomyelitis. Recently, more and more attention in the literature has been paid to the use of bisphosphonates in the treatment of chronic recurrent multi-focal osteomyelitis. Materials and methods. A group of 15 children aged 9 to 17 years with chronic recurrent multifocal osteomyelitis was recruited. All patients before the start of therapy and at each stage of treatment underwent MRI of the whole body in the STIR mode, CT of the pathological focus after 3 months, 6 months and 12 months after the start of therapy, a subjective assessment of pain on the VAS scale and the PedsQL 4.0 Generic Core Scales questionnaire.
Results. According to the immediate results (6 months- a year), all patients showed positive dynamics in reducing the number of foci by an average of 8 ± 4, reducing pain syndrome on the VAS scale by 4 ± 1 points and increasing the quality of life by 15 ± 2 according to PedsQL 4.0 Generic Core Scales.,
Conclusion. The preliminary results of our study show that the therapy of chronic non-bacterial osteomyelitis with bisphosphonates is quite promising. This research will be continued.

Background: Intra-articular injection of human mesenchymal stem cells (MSCs) for knee osteoarthritis (OA), RT-PCR assays indicated that the increase in expression of some of the genes was larger than the values obtained from the microarrays. The gene expression of human PTHLH increased 516-fold as early as day 1. On day 3 the increase in PTHLH was 443-fold. We aimed to correlate clinical presentation and therapeutic response to stem cell therapy with allelic variants in knee OA patients. Materials and methods: A randomized controlled trial was conducted with 52 cases of OA knee divided into 2 arms namely arm 1 with 26 diagnosed cases of OA knee who underwent stem cell therapy and arm 2 with 26 diagnosed cases of OA knee without any treatment. In all patients, 4 ml of venous blood was collected and subjected to DNA extraction and polymorphism studies using ARMS PCR and estimation of calcium and parathormone using E-CLIA. Results: The strength of association between polymorphism, and clinical and prognostic assessment of PTHLH rs267606985 gene between both the arms is 1.72 with 95% CI (1.19 to 2.49). A Kruskal-Wallis H test showed that there was a statistically significant difference with PTHLH rs267606985 gene polymorphism and calcium & parathormone χ2(2) = 8.520, p = 0.014. Spearman rank order correlation coefficient testing showed statistical significance (rs(8) = 0.669, p = 0.035). Conclusion: PTHLH rs267606985 gene polymorphism correlates clinical presentation and therapeutic response to stem cell therapy with allelic variants in knee OA patients.

Introduction: Compression screw fixation is done either as sliding compression or length-stable fixation according to the threads and orientation of the screws. This study aims to compare biomechanical properties of inverted Triangle (Sliding compression configuration) and BDSF & 4 cannulated lag screws (Length stable configuration) by Finite Element Analysis for Pauwels type-III FNF. Methods: DICOM format images of sawbone was used to build the 3-D geometric models which is hypermeshed to create models of Pauwels type-III FNF with angle of 65º. CAD models of screws are created as per AO specification and analyses for stress & displacement distribution of bone & implant, relative displacement between fracture planes & stiffness. Results: The peak stress near calcar region measured the yield of bone at fracture was found low in 4CLS, favouring fracture healing [ ▼CCS (95.45Mpa) > BDSF (90.64 MPa) > 4 CLS (79.69MPa)]. 4 CLS Configuration with less implant stress has lower risk of failure [ CCS▼ (322.5MPa) > BDFS(262.8 MPa) > 4CLS (153.6Mpa)]. Less displacement of the fracture surface suggests better length stability in 4CLS. [CCS▼ (1.006mm) > BDSF (0.637mm) > 4CLS(0.35mm)]. The highest construct stiffness was found in 4CLS confirming stable & rigid construct. [ CCS▼ (612.78N/mm) < BDSF (802.13N/mm) < 4CLS (1004.78N/mm)]. Conclusion: 4 CLS showed superior biomechanical properties in term of low stress, minimal displacement and lower relative displacement of fracture surface with high construct stiffness over other configuration. 4 CLS should be preferred configuration for Pauwels 3 FNF.

Introduction/Background: Historically, 96% of shoulder dislocations have been attributed to a traumatic episode with anterior dislocation accounting for 97% of these. Traumatic dislocation of the glenohumeral joint is the most common joint dislocation with an incidence of 8.2 to 23.9 per 100,000 per year. Acute Shoulder dislocations can lead to neurological injury and could possibly be missed on a single view Xray.

Aim: The aim of our audit was to check that shoulder dislocations of skeletally mature individuals are managed according to British Elbow & Shoulder Society (BESS) guidelines

-To Check whether there is documented Neuro-vascular(NV) examinations pre and post shoulder reduction

-To Check whether 2 standard X-ray views are done post shoulder reduction to assess the joint congruity

Materials and Methods: Our audit included 46 skeletally mature patients presenting to A& E with shoulder dislocation over period of 6 months from February 2021 until August 2021.

Results: In terms of Neuro-vascular(NV) documentation only 15 patients(32.6%) had both pre &post reduction NV status documented. 41 patients(89.13%) had both views X rays done post reduction.

Conclusion: Although there was good compliance with post-reduction 2 view X rays the compliance with NV documentation was less.

Recommendation: To improve compliance with documentation of NV status (both pre & post reduction ) and two view post-reduction check X ray .

Disclosure: No conflicts of interest.

Inner meniscus tear is a challenging problem in orthopedics. Focus on surgeon preference, injectable or biphasic hydrogel which can be applied via arthroscopic surgery has been developed as a meniscus scaffold. This study aims to develop high molecular weight silk fibroin (SF) for use as SF based injectable hydrogel by microwave assisted (MA) technique and fabricate the SF based injectable hydrogel to be used for meniscus tissue engineering. It was shown that SF extracted from MA technique demonstrated significant higher molecular weight (444,592 kDa) than from conventional method (25,457 kDa). The different ratios of SF (40, 50 and 60 %W/V)from MA methods were used to synthesized SF-g-GMA using an epoxy ring opening reaction. Gel fraction of SF-g-GMA using 40%, 50% and 60% of SF were 98.12%, 98.56% and 95.66%, respectively. The highest compressive strength and compressive modulus of the hydrogel was obtained from SF-g-GMA using 50 % of SF (11.67 kPa and 53.20 kPa). The human chondrocyte stem/progenitor cells (HSPC) were seeded in SF-g-GMA using 50%SF injectable hydrogels and culture in Dulbecco’s modified Eagle’s medium (DMEM) to study the cell viability by live dead staining at 1, day 3 and day 7. SF-g-GMA injectable hydrogels demonstrated 78.80 % of cell viability at day 1 and increased to 89.80% at day 3 and 93.23% at day 7. The superior gel fraction, compressive strength and compressive modulus of the SF-g-GMA using 50% SF with the high viability of HSPCs demonstrates its potential application to use for scaffold in meniscus tissue engineering.

Introduction: Pelvic malignancy always induces terrible prognosis. For the advanced disease, limb salvage is impossible and hindquarter amputation (HQA) could be an alternative choice. Pelvic reconstruction in HQA was reported necessary and feasibility of reconstruction with autologous tibia was seldomly reported before. Method:We retrospectivel reviewed the patients who underwent hindquarter amputation from April 2013 to June 2019. Total sixteen patients were included and divided into two groups. Patients’ characters, perioperative management details and complications were recorded. The limb function was evaluated through the Musculoskeletal Tumor society Rating Scale (MSTS) and the quality of life was through the World Health Organization quality of life questionnaire—brief version. Chi-square test and Mann-Whitney U test was used to compare the categorical variable parameters and count variable parameters, respectively. Results: The mean follow-up was 28.1 months in group A and 26 months in group B (P>0.05). No significant difference in the blood loss, surgical time, transfusion and hospitalization days between group A and group B (P>0.05). Median MSTS score was higher in group A with 18.00 than that in group B with 14.00 (P<0.05). Average QOL score in group A with 81.83 and 71.70 in group B (P>0.05). Complications were comparable between two groups (P>0.05). Conclusion: Autogenous tibia can be a feasible material in reconstructing the pelvic ring after hindquarter amputation, especially in the case that a suitable autologous femur is unavailable.

Due to limited undergraduate musculoskeletal education, students pursuing orthopaedics do not develop foundational orthopaedic knowledge until their first year of residency. To enhance learning on clinical rotations and ease the transition to residency, we designed OrthoACCESS (Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills), a free, 16-week curriculum on fundamental orthopaedic topics for senior medical students. We sought to evaluate this curriculum’s effect on students’ orthopaedic knowledge. OrthoACCESS consists of weekly lectures, case discussions, and learning resources. Lectures were presented in-person for students at participating institutions with pre-recorded lectures available for others. Faculty-led case discussions were hosted on Zoom consisting of three case presentations and breakout rooms for discussion. Learning resources (e.g. Anki Cards, scut sheets) were posted to the website (bit.ly/orthoaccess). Registration was open to trainees internationally. The curriculum was evaluated using pre-curriculum, post-case discussion, and post-curriculum surveys. OrthoACCESS was held from June-October 2023 with 226 student registrants. 15% of students were from outside the U.S. 40 students attended at least 8 case discussions. After OrthoACCESS, 68% reported “quite” or “extremely” strong orthopedic knowledge, compared to 23% beforehand (p < .001). Post-case discussion surveys revealed significant increases in knowledge for each lecture and case discussion (p < 0.5). Student-reported benefits included broad coverage of orthopedic topics (n=41) and learning how to think like an orthopaedic surgeon (n=20). In conclusion, the OrthoACCESS curriculum improved medical student foundational orthopaedic knowledge internationally. This curriculum may be valuable for students across the world with limited exposure to orthopaedics.