Introduction:Neutrophil (PMN) dysregulation after orthopedic trauma forms the basis for ARDS and MODS. Recently, a specific subset of neutrophil (CD16dim/CD62Lhigh-cells) showed in vitro T-cell suppressive capacities by direct cell-cell crosstalk. It is unclear, however, where this interaction occurs in the body. Arve-Butler (2022) revealed that neutrophils lose the capacity to suppress T-cell proliferation upon tissue migration. Therefore, we hypothesize that effective PMN/T-cells co-localization occurs in lymphoid organs, and more specifically in the splenic T-cell areas. Methods:A BALB/c-mice model of hypovolemic shock (HS) and a femur fracture was used. Animals were terminated after 2 and 6 hrs. Furthermore, a (c)ontrol and 2 sham groups were included. A group with intraperitoneal lipopolysaccharide (LPS) was used as positive control. Splenic neutrophil localization was determined by confocal microscopy. We used Ly6G/Gr-1 to identify PMNs, CD3e for T-cells. Characteristics of splenic PMNs was determined by flowcytometry.Results: A femur fracture + HS resulted in increased splenic neutrophil homing after both 2 and 6 hours (respectively 8.5% and 7.6 % PMNs/splenocytes vs. 1.6% PMNs/splenocytes (c)), P<0.05). Co-localization of PMNs with T-cells in the splenic white pulp was not seen after 2/6hrs, but upon LPS-induced inflammation. Splenic PMNs after trauma had aberrant cell-expression of L-selectin, CXCR2 and CSFR-1.Conclusion:Similar to LPS-induced, orthopedic trauma results in increased neutrophil homing in the spleen and this may allow for neutrophil-based T-cell modification. Although, T-cell proximity was not demonstrated within 6hrs after insult. Specific patterns of neutrophil receptor downregulation may form the basis for future therapeutic immune interventions upon orthopedic trauma.

Purpose: Tuberculous osteomyelitis is relatively uncommon and may present with varied clinical and radiological presentations. The aims of this study are to elaborate: How these lesions mimicked different tumours or tumour-like lesions and their successful outcome with antitubercular therapy (ATT).
Methods: We performed a retrospective review of 20 patients of tuberculous osteomyelitis presenting like tumours and tumour like lesions in the last 10 years. All these were histopathologically proven lesions. Eleven cases required curettage for the extensive lesions with sequestrations. All twenty received ATT for 12 months.
Results: There were 12 males and 8 females with age ranging from 3 to 61 years (average-22.05). Eight cases presented like bone cysts in the metaphyseal area of the long bones with one cystic lesion in the body of talus. Two mimicked chondroblastomas and one patient each like giant cell tumour and osteoid osteoma respectively. One patient had multifocal lytic lesions resembling metastasis/multiple myeloma. One patient had two lesions: involving clavicle and hand (proximal phalanx in the little finger). One lesion in metatarsal and five in phalanges of hand mimicked chondromas. All resolved well with no residual disability after receiving ATT.
Conclusions: In the endemic countries tuberculosis should always be kept in mind as one of the differential diagnoses for lytic bone lesion. The histopathological confirmation is the gold standard for the diagnosis. These can be effectively treated with anti-tubercular medication.

Introduction: Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, representing a threat for patients’ quality of life . Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration.
Methods: Sixty cases with grade II-III knee osteoarthritis according to the Kellgren–Lawrence classification were included in our prospective study. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment.
Results: At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded.
Conclusion: The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.

Objective:Distal humerus fractures (DHF) are complex injuries that necessitate operative intervention. These injuries are approached surgically via a posterior or anterolateral approach. The medial approach to DHF offers an alternative means of exposure with a true inter-nervous plane. This cadaveric study aims to identify the dangers encountered during this approach and the extent of the humerus that can be accessed during surgery for safe plate fixation.

Methods:Surgical exposure was performed on 5 formalin fixed cadavers. Nine arms dissected. All specimen positioned supine, shoulder abducted and externally rotated to access the medial aspect of the arm.

Results:The inter-nervous plane between brachialis and triceps was identified, dissected
anterior to the ulnar nerve on the anterior surface of the intermuscular septum. Dissection or transposition at the level of the elbow wasn’t required. Variable veins pass from the basilic towards the skin acting as guides to the anteriorly positioned basilic vein, brachial artery and median nerve. Tissue anterior to these branching veins was swept forward and retracted anteriorly. This plane was developed until bone was reached. The dissection was now posterior to biceps and brachialis, anterior to triceps and the intermuscular septum. Distal extent of the exposure is the medial epicondyle. Contoured plates can be placed on this. A second anterior plate can also be placed, distal extent of which is the coronoid fossa. Visualisation of the entire anterior cortex is achieved distally with Hohmann retraction.

Conclusion:The medial approach to the humerus offers satisfactory visualisation of the distal humerus without requiring ulnar nerve transposition.

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare benign lesion also referred to as Nora's lesion. It typically affects adults in their 20s-30s. Due to its tendency to develop aggressive features, it can be confused with malignant tumors like Chondrosarcoma. BPOP can be diagnosed initially radiographically, whereas definitive diagnosis is confirmed with an excisional biopsy. Nora's lesion reportedly has a high recurrence rate within the first two years post-excision. Hence excision of the pseudo capsule, periosteal tissue and any abnormal areas of the cortex can aid in reducing the recurrence rate.
We report a rare presentation of a BPOP case which occurred in the second proximal phalanx encasing the flexor tendon as well as the neurovascular bundles of the second digit in a male patient in his 40s. He presented with an enlarging swelling over the plantar aspect of the second metatarsal head and a reduced range of motion. X-ray demonstrated an ossified lesion containing a chondral matrix. CT scan revealed a well-marginated, heavily calcified lesion of the medial cortex of the second digit proximal phalanx with no definite continuation to the medulla, along with a mild focal area of cortical thickening at the same level.
MRI images showed a lesion encasing the flexor tendon of the second digit with evidence of surrounding subcutaneous soft tissue edema and fat stranding, most likely due to the pressure effect, however, without extension to the tendon.
Excisional biopsy followed, and histopathology confirmed the diagnosis. No evidence of recurrence was noted on short-term follow-up.

INTRODUTION: Fassier Duval (FD) are considered the gold standard for Orthopedic treatment of Osteogenesis Imperfecta, however high rates of complications have been related. METHODS: Thirty-two patients with OI, mean age of 8.0±3.6 years and minimum one year follow-up, were included, with 17 boys (53%) and 15 girls (47%). Five patients were classified as Type I Sillence, fourteen as Type III, eight as Type IV and 5 unknown. Eighty-four surgical corrections were performed, 50 in the femurs and 34 in the tibias. Failures were evaluated related to clinical variables (gender, ethnicity, Sillence and age), surgical variables (immobilization, bisphosphonates use, previous synthesis, follow-up time). Radiographic variables were measured in the preoperative, immediate postoperative period, six months,one year and in the last available evaluation. Diaphysis angulations, proximal and distal joint inclinations, and positioning of the rod in the epiphyses were evaluated.
Failure criteria were diaphyseal angulation >20° in at least one plane or the need for revision. Survival curve was determined using the Kaplan-Meier method. RESULTS: Failures occurred in 45 segments (53%), with distal migration in 26 cases (58%), followed by eight fractures (18%). Tibia nailling failed more than femur (73% vs 40%; p< 0.01). Femur failure more in boys (p=0.042), and in the tibias, in younger patients (p=0.007). Increased failure diaphyseal angulation and eccentric nail positioning in epiphysis (p≤0.01). The anterior distal tibial angle (ADTA) presented higher values in the group with failure (p=0.01). The 4-year surgical survival was 66% in the femur and 20% in the tibia.

There are limited reports comparing reconstruction methods for fingertip amputation. We retrospectively reviewed 245 consecutive cases of soft tissue defects in the fingers treated with local flaps between 2017 and 2022, and included 39 cases (20 reverse flap, 19 perforator flap) with single-fingertip amputation of Ishikawa subzone 1 or 2, and with at least 6 months of follow-up. We compared the level and condition of injury, flap size, complications (necrosis, reoperation), postoperative finger range of motion (% total active motion: %TAM), flap sensation (Semmes-Weinstein test: SWt), and nail deformity between the two groups. five cases in reverse flap group were subzone 1, and 13 cases in perforator flap group were subzone 1. The condition of injury was more severe in reverse flap group. In order of the reverse flap and the perforator flap groups, the flap sizes were 4.2 and 2.9 cm², the complete flap survival rates were 95% and 100%, the mean number of reoperations was 1.1 and 0.2, the mean total active motion was 89 % and 93 %, and SWt was 1.5 g and 1.3 g. Nail deformity was observed more often in the perforator flap group. There were no significant differences in flap survival rates, complications, %TAM, or SWt, but there were significant differences in injury level, flap size, hospitalization days, reoperations, and nail deformity. Considering the advantages and disadvantages of each flap, the choice of reconstruction method should be determined.

An estimated 500,000 tibial fractures occur annually in the United States alone, making it the most common long-bone fracture. The burden is even higher in low- and middle-income countries (LMIC) where high-impact trauma and osteoporosis are increasingly prevalent. Regardless of fracture type or location within the tibia, intramedullary (IM) nails are chosen for tibial fixation approximately 85% of the time primarily due to their effectiveness in supporting patients return to active lifestyles more quickly compared to other fracture fixation techniques such as external fixation and plating. Given that IM nails are currently manufactured in discrete lengths, a hospital must stock more than 100 sizes to ensure availability of the correct length for the patient needing the procedure. However, due to high costs and low inventory, IM nailing is not available for many surgeons and patients around the world. Worse yet, complications of malunion or nonunion occur in 5% of all tibial fractures treated with an IM nail, one major contributing factor being a poorly fitting nail, either too long or too short. To address issues of inventory costs and patient fit, our organization, Adaptable Ortho Innovations LLC, has developed a novel adjustable-length tibial nail that successfully meets ASTM standards in the United States and shows promise for further market investigation and clinical application. The implications of adjustable technology in IM nailing could be most profound in remote areas of the developed world and LMICs where issues of inventory, cost, and patient fit are most common.