Journal of Orthopedic and Spine Trauma

Association of the Cross-Sectional Area, Muscularity, and Muscle-Fat Ratio of the Paraspinal Muscles with Chronic Low Back Pain

Roop Singh — 2025-02-28

Background: It is now a well-established fact that paraspinal muscle integrity plays a critical role in low back pain. We aimed to determine the association of the cross-sectional area (CSA), muscle disc ratio (muscularity), and muscle-fat ratio of the paraspinal muscles with chronic low back pain (CLBP) of varied pathologies and the effect of ageing and body mass index (BMI).

Methods: Fifty patients with CLBP (Group A) and 25 healthy controls (Group B) were enrolled. The Group A was further subgrouped into lumbar spondylosis, mechanical back pain, and lumbar disc herniation. All participants were subjected to magnetic resonance imaging of lumbar spine.

Results: The CSAs of the muscles did not differ significantly between the two groups except for multifidus (P < 0.05) and psoas (P < 0.001) at L1-L2 and psoas (P < 0.001) at L2-L3. There was a significant difference in CSA of the disc at L3-L4, L4-L5, and L5-S1 (P < 0.05), muscle-fat ratio (P < 0.01), and muscularity of multifidus and psoas (P < 0.05) from L1 to L5 levels. There was no correlation between age and BMI and the CSA. Ageing led to fatty infiltration in both groups. The CSAs of muscles and discs were comparable (P > 0.05) among subgroups except at a few spinal levels. Muscularity among the subgroups varied at different levels. The muscle-fat ratio was comparable (P > 0.05).

Conclusion: Muscularity and composition, rather than overall CSA of important spinal stabilizers, were found to be associated with CLBP. Age and BMI had no correlation with the CSA of paraspinal muscles. Various disc and muscle parameters did not differ much among common lumbar pathologies.

Serum Magnesium and Uric Acid Levels in Patients with Rheumatoid Arthritis: A Case-Control Study

Mohammad Ayati Firoozabadi — 2025-02-28

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, characterized by joint pain, stiffness, and deformity. Both environmental determinants and genetic factors play a role in RA development and progression. Oxidative stress due to reactive oxygen species (ROS) can aggravate these symptoms. Studies on trace elements such as magnesium (Mg) and uric acid (UA) suggest that these can be potential treatment targets. Therefore, we designed this study to compare Mg and UA levels in patients with RA and healthy individuals.

Methods: This was a case-control study with 43 patients with RA and 43 healthy controls. Patients with RA were diagnosed based on ACR/EULAR criteria and were categorized by Disease Activity Score 28 (DAS28). Blood samples were collected for laboratory tests, including UA, Mg, C-reactive protein (CRP), and anti-cyclic citrullinated peptide (anti-CCP) antibody levels.

Results: The study found no significant difference in serum UA levels between patients with RA and healthy controls. However, Mg levels were significantly lower in patients with RA. Mg levels were not significantly different according to DAS. A significant inverse correlation was found between Mg levels and CRP serum levels. A receiver operating characteristic (ROC) curve analysis revealed that anti-CCP had high sensitivity for RA diagnosis, with an optimal cut-off point of 32.5 U/ml.

Conclusion: Low Mg levels should be expected in patients with RA. Supplementing Mg may be a helpful treatment approach in this group. In contrast, UA does not appear to be influenced by RA, but its antioxidant properties cannot be entirely disregarded. Moreover, anti-CCP shows high sensitivity as a diagnostic tool for RA.

A Comparative Study between Minimally Invasive Plate Osteosynthesis versus Open Reduction and Internal Fixation for Distal Third Tibia Fractures

Reza Zandi — 2025-02-28

Background: Despite the array of surgical and non-surgical approaches available for treating distal tibia fractures, managing unstable fractures continues to pose a challenge. This study compares the advantages and clinical outcomes of minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in managing distal third tibia fractures.

Methods: Our study focused on 60 cases selected based on age and fracture type. A comparative analysis was performed between two groups, examining factors such as age, gender, AO Foundation and Orthopedic Trauma Association (AO/OTA) fracture type, length of hospital stays, surgical duration, complication rates, time to return to daily routines, and adherence to the criteria set by the American Orthopedic Foot and Ankle Society (AOFAS).

Results: The blood loss during surgery was significantly more in the ORIF group (142 ± 56.83 ml versus 81.83 ± 37.63 ml) (P < 0.05). The rate of complications was significantly higher in the ORIF group compared to the MIPO group (P < 0.05). Time for back to routines was significantly shorter in the MIPO group (17.63 ± 7.86 weeks versus 22.36 ± 8.81 weeks) (P < 0.05). No significant differences were found in surgery duration, hospitalization time,, time of hospitalization, and AOFAS score between the MIPO and ORIF groups.

Conclusion: The optimal method for managing distal tibia fractures remains uncertain due to discrepancies between the outcomes of MIPO and ORIF. We favor MIPO due to its potential for early bone union, quicker return to normal activities, and reduced risk of wound complications.

Evaluation of Functional Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Autograft

Mansi Patel — 2025-02-28

Background: The anterior cruciate ligament (ACL) is an intra-articular, extra-synovial structure present in the central complex of the knee joint, which, along with other structures in the knee joint, controls, limits motion, and maintains the static and dynamic equilibrium of the knee joint. The knee joint is the most frequently injured joint, with the ACL being the most commonly affected ligament. The most commonly used grafts are hamstring autograft and bone-patellar tendon-bone graft. In this study, we are highlighting anatomical ACL reconstruction by hamstring autograft. This study was undertaken to evaluate the results of arthroscopic anatomical ACL reconstruction with hamstring autograft using the Lysholm Knee Scoring Scale.

Methods: This is the study of 40 cases of arthroscopic ACL reconstruction using hamstring autograft in our institute with a minimum follow-up of 6 months.

Results: Results in this study are calculated according to the Lysholm Knee Score. 55% of patients showed excellent results, 40% showed good results, and 5% showed fair results. Average Lysholm Score was 90 in 40 patients.

Conclusion: Anatomical ACL reconstruction using hamstring autograft technique has yielded excellent to good results in almost all patients with minimal complication and provided stable knees.

Surgical Outcomes Following Instrumented Fusion in Low-Grade Spondylolisthesis: A 26-Month Retrospective Analysis

Hindalahally Krishnegowda Karthik — 2025-02-28

Background: Spondylolisthesis is characterized by the anterior or posterior displacement of a vertebra relative to the adjacent inferior vertebra. Patients with grade I-IV spondylolisthesis are initially treated by conservative measures, but surgical intervention becomes necessary for those with persistent symptoms. Surgical options range from pars repair in spondylosis to various fusion techniques, including instrumented reduction and fusion, or instrumented in situ fusion. The study aimed to evaluate the functional outcomes of surgical instrumentation in low-grade spondylolisthesis.

Methods: This retrospective study included 30 patients with low-grade spondylolisthesis who underwent surgical instrumentation. Pain and functional outcomes were evaluated using the Visual Analog Scale (VAS) and modified Oswestry Disability Index (ODI) at baseline and follow-up intervals.

Results: The baseline mean VAS score of 7.4 improved significantly at 6, 12, and 24 months (P < 0.01). The baseline mean ODI score of 66.8 also improved significantly at these intervals, with a final mean score of 12.51 at 24 months. Complications occurred in 3 patients, including neurological deficits and bone graft retropulsion.

Conclusion: Surgical instrumentation leads to significant improvements in pain and function in patients with low-grade spondylolisthesis, offering excellent outcomes for those unresponsive to conservative treatment.

Clinical and Radiographic Outcomes of Femoral Head Fractures: Insights from a Single-Center Retrospective Analysis

Reza Zandi — 2025-02-28

Background: This study evaluates the radiologic and functional outcomes of femoral head fractures (FHFs), focusing on the correlations between radiologic parameters and postoperative complications.

Methods: We conducted a retrospective analysis of 26 Pipkin fractures. Complications and outcomes were documented, with measurements taken for head-neck ratio, surface ratio in multiple planes, and head volume for further analysis.

Results: Associated injuries were observed in 65.38% of cases. Osteoarthritis (OA) developed in 61.53%, avascular necrosis (AVN) of the femoral head in 50%, and heterotopic ossification (HO) in 26.92%. According to the Epstein scale, among the 26 patients, seven (26.92%) rated their outcomes as excellent, 11 (42.30%) as good, five (19.23%) as fair, and three (11.53%) as poor. Our findings indicated that head volume ratio, differences in head-neck ratio, and surface ratios in various planes correlated with late complications. Specifically, OA was associated with the sagittal surface ratio (P = 0.026) and coronal surface ratio (P = 0.034) in type II fractures, while in type IV fractures, it correlated with the axial surface ratio (P = 0.023), head volume (P = 0.020), and differences in head-neck ratio (P = 0.017). HO was linked to head volume ratio (P = 0.028) in type II, and to coronal surface ratio (P = 0.017) and differences in head-neck ratio (P < 0.001) in type IV fractures. AVN correlated with differences in head-neck ratio (P = 0.041) in type IV, and with head volume ratio (P = 0.012) and sagittal surface ratio (P = 0.012) in type II fractures.

Conclusion: Head-neck ratio, head volume ratio, and surface ratios are predictive of late complications following FHFs.

The Results of Management of Distal End Radius Fractures by Various Modalities

Mansi J Patel — 2025-02-28

Background: Distal end radius fractures constitute 16%-20% of all fractures. Extra-articular fractures are managed with closed reduction and casting, while intraarticular fractures require more invasive treatment due to instability and conservative treatment complications. Despite extensive research, the optimal treatment for distal end radius fractures remains unclear, prompting ongoing comparative studies.

Methods: 40 patients were treated and followed up for 3 to 14 months. Each patient underwent detailed clinical and radiological examinations of the affected wrist using AO classification. Radiographs were routinely taken to evaluate extra-articular deformities and articularincongruences.Treatmentdecisions‒plating,externalfixation,orconservativemanagement‒werebasedonfracturetypeand patient physiology. Follow-ups occurred at various intervals, with assessments including hand grip strength comparison, radiographic measurements, and clinical evaluation of fracture union using Green and O’Brien scoring and Sarmiento radiological criteria.

Results: 40 patients with distal end radius fractures, averaging 40.62 years old, were included in the study. Treatment distribution was eight patients with reduction cast/slab, 18 with external fixators, and 14 with plating. Plating showed 57.28% excellent, 28.57% good, and 14.28% fair outcomes. External fixators had 33.33% excellent, 33.33% good, 16.67% fair, and 16.67% poor outcomes. Conservative management had 25% excellent, 37.5% good, 25% fair, and 12.5% poor outcomes.

Conclusion: Conservative management with a reduction pop slab/cast is suitable for extra-articular fractures in elderly patients. External fixation is effective for osteoporotic or comminuted fractures. Plating is recommended for intra-articular fractures in young patients.

Idiopathic Thoracic Spinal Cord Herniation with Neurological Involvement in Operated Lumbar Spine Surgery: A Case Report

Kumar Shetty — 2025-02-28

Background: Idiopathic spinal cord herniation (ISCH) is a rare, often misdiagnosed condition without clear pathogenesis with slowly progressive thoracic compressive myelopathy. There are less than 200 cases documented in the literature. As the diagnosis is often delayed, the patient may undergo unnecessary investigation, which may lead to irreversible, progressive neurological deterioration before confirming the diagnosis. In delayed diagnosis, even after surgical intervention, patient prognosis is guarded.

Case Report: We present a case of a 56-year-old woman with gradually worsening myelopathy with mainly lower limb sensory-motor symptoms.

Conclusion: Early diagnosis and treatment with surgical intervention in the patient with ISCH with a neurologic deficit results in a good prognostic outcome.

Cervicogenic Dizziness after Humeral Fracture: A Case Report

Fateme Bokaee — 2025-02-28

Background: Cervicogenic dizziness is a nonspecific sensation of disequilibrium in the space. Abnormal proprioceptive inputs from the cervical spine and neck muscles may induce cervicogenic dizziness. Trigger-point activation of the suboccipital muscles may be related to cervicogenic dizziness. This case study aimed to present a case of cervicogenic dizziness after humerus fracture.

Case Report: The present case report describes a 38-year-old man who was referred for physiotherapy to restore the motion of his right shoulder after surgery for a humerus fracture. The patient reported dizziness after the shoulder surgery. The patient had no medical problems that could induce dizziness. Physical examination revealed a trigger point activation of the suboccipital muscles. Myofascial release and chin-tuck exercises were performed, and the patient reported improvement in dizziness. Trigger point activation of the suboccipital muscles in this patient may be related to abnormal head posture during shoulder surgery and/or impaired scapulohumeral rhythm and overactivity of the cervical muscles participating in shoulder elevation.

Conclusion: The possibility of cervicogenic dizziness should be considered after humeral fractures.

Dorsal Spine Extradural Hemangioma with Neurodeficit, Mistaken Pott’s Paraplegia: A Case Report

Amit Awachat — 2025-02-28

Background: Vertebral hemangiomas are the most common primary vertebral tumor of the spine, usually with vascular origin (capillary and venous malformations), and are detected incidentally in most cases. The occurrence of vertebral hemangiomas is more common in women than men and is more symptomatic in the fourth decade of life. The exact etiology is not well understood. An increase in daily living activity leads to vertebral hemangioma becoming painful. The proliferation of hemangiomas causes erosion of bone and, in some cases, causes encroachment into the spinal canal.

Case Report: We present a case of a 37-year-old man with gradually progressive paraplegia and a D2 level infiltrative mass causing compression on the spinal cord.

Conclusion: A patient with vertebral hemangioma with spinal cord compression, if diagnosed correctly and treated early with surgical intervention, results in a good prognostic outcome.