Indian Journal of Orthopaedics Surgery

70-180

Authors: Maruthi CV, Shivanna

Background and Objectives: This is a prospective study of fifty cases of intracapsular fracture neck of femur in elderly patients above the age of 60 years irrespective of sex which were treated by hemiarthroplasty using Austin moore’s/ bipolar endoprosthesis, in the Department of Orthopedics at our institute. Patients were followed up and functional results were analyzed with the objectives to study the age and sex incidence of fracture neck of femur, quality of life after hemiarthroplasty, morbidity and mortality associated with the procedure, recovery of physical, social and occupational independence. Methods: Fifty cases of fracture neck of femur in elderly patients above the age of 60 years were treated by hemiarthroplasty using either Austin Moore’s, or bipolar prosthesis in the Department of Orthopedics from November 2008 to November 2013. The cases were followed up for 6 months and the short term functional results were analyzed by using modified Harris hip scoring system. Results: The patients who had fracture neck of femur and who underwent hemiarthroplasty were in the age group of 60 to 98 years with mean average age of 69.82 years. Females were predominant. Majority of the fractures were sub-capital by radiological diagnosis. In 78 percent cases the mode of injury was trivial trauma. Hypertension, diabetes mellitus and chronic obstructive pulmonary disease were the common associated medical conditions. The post-operative complications observed were bedsore, periprosthetic fracture and posterior prosthetic dislocation. A six month follow up was done. One patient expired and four cases were lost for follow up. Thus the functional results were analyzed in the remaining 45 cases. There were 22.2% excellent results and 40% good results. Results of Austin Moore and bipolar prosthesis were not compared as the data and time period of the study was not enough to reach a statistical significance. Interpretation and Conclusion: The success of hemiarthroplasty depends on preoperative planning and proper attention to surgical details to achieve the optimum biomechanical stability. The poor results (15.56%) were due to moderate to marked pain in the hip or thigh after hemiarthroplasty. We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The morbidity and mortality are minimal, complications are less disabling and early functional results are satisfactory.

137-142

Authors: Mohit M. Patel, Kaushal R. Patel, Zulfikar M. Patel, Kalpesh A. Mehta

Background: Total knee Replacement is one of the common surgery for knee Osteoarthritis. Infection after total knee replacement is uncommon but disastrous complication. Purpose: Main purpose of study is to determine functional results of two stage surgery in infected TKR, compare the results of two stage surgery with other modalities of treatment, risk factors for infections, role of laboratory and clinical markers for early diagnosis of infection in TKR. Methods: This is retrospective study of 40 patients who operated for infected TKR through two stage revision arthroplasty. Inclusion criteria: All patients operated for infected TKR by two stage revision arthroplasty. Exclusion criteria: · Less than 12 months follow up · Expired patients Results: The average age of patients was 62.1 years. With youngest patient were being 40 years old and the oldest being 82. Average BMI in our series was 27.07. It varied with a range from 19.9 to 38.67. 15 patients had diabetes mellitus (DM), 7 patients had hypertension and 1 patient had hypothyroidism. The average WOMAC score improved from 37.525 to 56.3 with a minimum pre op score of 30 and maximum of 45. The mean clinical knee society score (KSS score) improved from from 50.1 to 69.325. 97% of patients showed improvement in their preoperative pain. The mean range of movement improved from 53.75 to 90.375. Pre op minimum ROM was 30 and maximum was 100. The average extensor lag preoperatively was 6.65 degrees with a range of 0-15 degrees. Patients showed improvement with average extensor lag reducing to 2.75 degree, with range of 0-10 degrees. The failure rate of our study was 8% with persistent infection after treatment. Conclusion: · Pain is the most common indication for infected TKR. · Two stage revision arthroplasty in Infected TKR leads to significant improvement in pain, Range of motion and KSS and WOMAC scores. · Results of two stage revision arthroplasty are superior to any other treatment. · Most common organism is staphylococcus aureus. · Associated illness affects the results of treatment.

147-150

Authors: Gururaj N.G, Vinaya G, Riyaz Ahmad

Background: The aim of treatment of the distal femoral fractures has been a balance between the goal of anatomical alignment and need for early function of limb. Objective: 1. To compare the rigidity of fixation achieved. 2. To compare the restoration of anatomical joint surface. Methodology: 30 patients of distal femoral fractures admitted to Department of Orthopaedics, at Government Medical College, Rajindra Hospital, Patiala. Only those cases were selected where ORIF is indicated like in patients with displaced intra-articular fractures, multiple injuries, severe ipsilateral limb injuries, displaced extra-articular supracondylar fractures, pathological fractures and most open fractures. Results: Among 30 patients, 16 cases (54%) sustained A type and 14 cases (46%) suffered type C supracondylar fracture as per AO classification. In DCS group, most (80%) of the patients had A type of fracture. In LCP group, most (75%) of the patients had C type of fractures. Bone grafting was done in 8 (24%) cases at the time of primary fixation of fractures. In DCS group bone grafting was done in two cases and in LCP group in 6 cases. In the DCS group, we had 2 cases (6%) in which only one inter fragmentary screw and 1 case in which 2 inter fragmentary screws were fixed in the distal fragment along with DCS lag screw and plate to give additional support. Conclusion: LCP is the implant of choice in comminuted fractures of distal end of femur and in elderly patients DCS can be used in distal femur fractures only when there is an uncomminuted bone stock of atleast 4 cm above the intercondylar notch.

156-164

Authors: Gajanan Chintawar, Sanjay Deshpande, Sohael M Khan, Vasant Gawande, Anubhav Sharma, Pradeep K Singh

Background: The concept of minimally invasive Osteosynthesis using percuatneous plate was established when it is realized that the length and alignment of proximal tibia can be restored with indirect manipulation and reduction technique. Biological fixation with percutaneous plating augments the healing process without additional risk of wound disruption and infection. Purpose: The aim of the study was to evaluate the result of proximal tibial fractures with minimal invasive percutaneous plate osteosynthesis and to assess the clinical, radiological and functional outcome of the same. Method & Material: The present study was conducted in the Department of Orthopaedics, during the period of August 2013 and August 2015, at Acharya Vinoba Bhave Rural Hospital, Wardha. The design of study was prospective cohort study. This study included 32 patients with the fracture proximal tibia of the patients and age of patient ranging from 20 to 75 years. All the patients with proximal tibia fractures were included in the study. Result: A total of 32 patients of proximal tibial fractures were treated with minimally invasive percutaneous plate osteosynthesis technique. There were 29 male and female patient, with maximum patients in the age group of 31 to 40 years. Road traffic accident evolved as most common mode of injury. Fractures were classified according to AO classification. C1 type of fracture seen in 8 (25 %) patients and A2 type in 7 (21.9%) patients. Rasmussen’s clinical and radiological scoring system was used for final evaluation of the results. The average Rasmussens clinical score was 23 .53 and average radiological score was 14.3. In present study according to Rasmussen clinical score good result were seen in 26 (81.4 %) patients and poor result seen in only 1 (3.1 %) patient. According to Rasmussen’s radiological score good results were seen in 26 (81.3 %) patients and only in 1(3.1 %) patient poor result was seen. In only 2(6.4%) patients there was implant related problem in the form of screw back out and plate prominence. The average range of knee flexion was 136.25 degree and 17 patients (53.12 %) achieved 131 -140 degrees of flexion. While 14 (43.75 %) patients achieved extension up to -2 degrees. Conclusion: Minimally invasive percutaneous plate Osteosynthesis is better technique, and should be considered as primary option for the surgical treatment of the proximal tibia fractures. Clinical outcome of MIPPO technique are favourable and comparable to world literature in terms of fracture union, early mobilization and functional outcome. MIPPO technique preserve the soft tissues around the fracture site hence healing of the fracture is early. For the same reason MIPPO can be a treatment option for the grade I compound fractures. MIPPO technique can be successfully used for the simple or grade I compound fracture of proximal tibia.

181-186

Authors: Vinay Joshi, M.P. Jain, Deepak Agrawal, Vishnu Sharma

Background: Conventional open spine surgery has several reported limitations including Hardware failure due vertebral factors, or a combination of both and loss of kyphosis correction.so by adding pedicle screw at injury level vertebrae this limitation was not occurred. Materials and methods: 50 patients of thoraco-lumbar fractures were selected between Oct 2013 to Oct 2015, with 25 randomly selected cases in each group and were managed by posterior either by conventional pedicle screw fixation (CPSF) or open short segment injury level pedicle screw fixation(SSIPSF). Results: All the patients were followed up for a period of 6 to 24 months (average was 12.2 months). The kyphotic angle in SSIPSF pre-op was 26.76±4.33°, final follow-up was 13.60±2.63° with final correction of 13.16±3.47° compared to kyphotic angle in CPSF pre-op was 29.08±8.301°, final follow-up was 21.28±6.12° with final correction of 7.80±4.60°. SSIPSF offers better intra-op and post-op advantages over CPSF like Better kyphotic angle correction and better stability with no additional compication and no hardware failure. Conclusion: SSIPSF is a good procedure for wedge compression & burst fractures of spine in patients. Open SSIPSF inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to no instrument failures, without additional complications had better and more rigid construct than CPSF.

194-198

Authors: Pradeep Choudhari, Mudit Baxi

Present-day concepts of osteosynthesis emphasize upon biological healing of fractures. This has led to advent of minimally invasive plate osteosynthesis. This technique if used when indicated leads to numerous advantages such as higher rates of union with decreased surgical time, blood loss, post-operative pain, infection rates and certain other postoperative complications. This technique is being applied commonly in fractures such as shaft of humerus, proximal and distal femur, proximal and distal tibia with several benefits over its conventional counterparts. In this review, the authors highlight upon historical aspect of development of this technique, its implementation in different fractures, various factors determining its stable application and its pearls and pitfalls.

202-204

Authors: Sathya Vamsi Krishna, Mallikarjuna Swamy B, Thomas Issac

Indian Journal of Orthopaedic Surgery (IJOS) is a peer-reviewed journal with reputable academics and experts as members of its Editorial Board. IJOS publishes information on basic and applied orthopaedics for a worldwide readership. It publishes original research papers, critical reviews dealing with all fields of Orthopaedicsand it addresses the international scientific community. Papers related to orthopaedic science on a worldwide basis are also considered. Special emphasis is given to issues that go beyond the traditional boundaries of anorthopaedic journal.Articles on the state-of-the art of orthopaedic surgeryin different parts of the world, the research activities and medical education in orthopaedic teaching, the role of orthopaedics in society, new findings from the frontiers of current researchare always encouraged. Aims & Scope: Indian Journal of Orthopaedic Surgery aims to publish all the latest and outstanding research articles and review articles in all areas of major importance to surgical techniques of orthopaedic surgery and applied research. It publishes high quality research articles, case reports and review articles on all aspects of orthopaedic research. Areas of special interest in the journal include Bone biology in disease and health, Osteoporosis, Osteomalacia, metabolic, congenital, neoplastic and degenerative conditions besides traumatology.

207-208

Authors: Hayat Ahmad Khan, Mohammad Ashraf Khan, Nazia Hassan, Naseemul Gani, Prof. Munir Farooq

Introduction: Checkrein deformity is rarely seen following fracture in the leg bones. The surgical treatments is the method of choice but the site of release at the fracture site or at the midfoot are debatable. Since the deformity is rare the literature is scarce. We evaluated six cases of such deformity after releasing the tendon behind the medial malleolus. Methods: Six patients were followed after releasing the tendon and performing Z plasty lengthening midway between the previously described procedures. Results: We achieved full correction of the deformity with satisfaction in all the six cases and had no recurrence with minimum 2 years following surgery. Conclusion: The method described is simple, effective with less learning curve however larger series is required to compare it in a randomised control manner.

1-5

Authors: Amr I. Zanfaly, Adel Abdel Azim

Background: Management of idiopathic osteonecrosis of the femoral head with arthritis in the young age group is controversial. Total hip replacement is considered the gold standard for management of arthritic hip. However, the longevity of the prosthesis and the number of future revisions are still the main source of concern about total hip replacement in this age group. The use of ceramic on ceramic bearing couples improved the longevity of the prosthesis. Patients and methods: In the period from June 2010 – to December 2012, 18 patients (22 hips) with idiopathic osteonecrosis of the femoral head were treated by cement less ceramic on ceramic total hip replacement. This study was done at Zagazig university hospitals. The mean age was 29.5 years old. There were 14 males and 4 females. The mean follow up period was 48.4 months. All cases had idiopathic osteonecrosis of the femoral head stage III and IV according to Ficat classification. The functional results were evaluated according to Harris hip score. The radiological results of the femoral and acetabular components following surgery were evaluated according to the criteria of Lins et al and Engh et al., respectively. Results: The mean Harris hip score improved from 39.36 (range 30-56) preoperatively to 89.59 (range 68-96) in the final controls (p<0.001). Fourteen cases had excellent score, four good, three fair, and one patient had poor score. Patients in the zone from good to excellent represented about 80% from total number of cases. Radiolucency was observed around two acetabular components at 36 months follow-up, it was mildly progressive at 60 months follow-up in one case and the other one developed loosening at 48 months follow up for whom, revision was done at 50 months. Two stems were associated with a radiolucent line at 48 months follow-up. Their progression was not sufficient to conclude that there was any loosening at 60 month follow-up. Conclusion: The results of cementless total hip replacement with ceramic on ceramic bearing surfaces are promising for young patients with idiopathic osteonecrosis of the femoral head at 5 years follow up. Longer - term follow up is recommended.

11-18

Authors: Madhukar. K.T, Debasubhra Mitra, Abhey Wasdev, Susmita Bhattacharya

The likelihood of experiencing an episode of low back pain increases with age, and 85% of people will have at least one episode in their lifetime. Prevalence of low back pain is next only to headache. Total 50 patients (28 male and 22 female) who met the inclusion and exclusion criteria underwent epidural steroid injection. Patient pain scaling is done before performing the procedure, after 48 hours, after 2 weeks, after 3 months of the procedure. The proposed pain scale to be used is Numerical Rating Scale. Out of total 50 patients, after 48 hours it was found 30 patients had mild pain (NRS 1-3 ),18 patients moderate pain (NRS 4-6) and 2 patient continued to have severe pain (NRS 7-10). After 2 weeks it was found 24 patients to be mild pain, 24 patients with moderate pain and 2 patient with severe pain. After 3 months it was found 14 patients had mild pain, 32 patients had moderate pain and 4 patients had severe pain. The effect of epidural steroid injection decreases with time. The local effect of steroids has been shown to last at least 2 to 3 weeks at a therapeutic level. Epidural Steroid Injection is a safe, effective, & economical treatment modality for LBP. It reduces the period of hospitalization, analgesic intake & facilitates the institution of early rehabilitative programs.

27-34

Authors: Arpit Tiwari, Rahul Sinha,, Mustafa Johar, Akanchha

Background: Proximal humerus fractures account for approximately 4-5% of the fracture attendance at the hospital. The management of proximal humeral fractures has always been an enigma because of numerous muscles attachment and paucity of space for fixing the implant. The objective of the present study was to compare different modalities of fixation in proximal humerus fractures. Methods: This is a retrospective study done on 112 patients of acute proximal humerus fractures treated surgically. Follow up was done for 12 months and results were analysed using Neer’s scoring system. Results: Radiological union occurred at average time of 10.1 weeks. As per Neer's scoring system, 36% patients had excellent results while 31% patients had satisfactory results. They were all pain free and successfully returned to their pre-injury work. 25% patients had unsatisfactory and 8% failure result. 2 patients required revision surgery. Conclusion: Treatment options depend on fracture pattern, bone quality, patient's goals and surgeon’s familiarity with the technique. Patients who have two part greater tuberosity avulsion fracture are best treated by closed reduction and percutaneous screws fixation. Patients who have metaphyseal comminution and/or three-part fracture with appreciable displacement of the greater tuberosity are more appropriately treated by open reduction and Internal fixation with a plate.

42-47

Authors: Shamim Ahmad Bhat, Raja Rameez, Adnan Zahoor, Tabish Tahir, AsifNazir Baba, Khurshid Ahmad Kangoo

Supracondylar fractures of humerus are common skeletal injuries in paediatric age group comprising 50-60% of elbow injuries. They are often associated with complications and are very notorious for neurovascular injuries between 5 to 10 years of age. Our objective was to evaluate the functional outcome with closed reduction and percutaneous cross k wire fixation. 60 patients of Gartland type III fractures admitted and treated in our hospital were taken for study. The results were assessed as per FLYNN CRITERIA. There were 48 excellent, 6 good,4 fair and 2 poor results. Fair results were due to poor compliance to follow up and postoperative rehabilitation. There were 8 cases with pintract infection, 2 with elbow stiffnes and 1 with cubitusvarus. Closed reduction and percutaneous K wire fixation is very effective and minimally invasive way of treatment of displaced supracondylar humerus fractures. Crossed K wire seems biomechanically better way of stability of fracture reduction.

52-63

Authors: Anubhav Sharma, Pradeep K Singh, Sohael M Khan, Shounak Taywade, Ankit Chintawar, Sparsh Naik

Background: Back pain has been known since the start of written history, probably the first report of back pain and sciatica can be found in an ancient text, the so-called Edwin Smith Surgical Papyrus presumably written around 1550 B.C.1 Although backache (with or without sciatica) is a benign often self -limiting condition (Macnab). 2 The cost of both time lost from work (with loss of productivity) and medical care, as well as the cost of litigation and disability claims, make back pain an industry unto itself. Purpose: The main purpose of this study was to evaluate the clinical, radiological outcome of the lumbar disc patients managed surgically and to compare the results of different surgeries performed. Methods: This study was prospective, non-randomized, cohort study it was carried out in the Department of Orthopaedics, Acharya Vinoba Bhave Rural Hospital, Wardha, between August 2013 – 2015. Patients with more than 18 years were included with persistent bothersome sciatic pain, despite conservative management for a period of 6-12 weeks. All the patients with progressive neurological involvement during a period of conservative treatment. All the patients with cauda equina syndrome or impending cauda equina syndrome. Results: Out of total 67 patients the mean age was 49.85±8.75 years ranging from 40 to 72 years. Male gender was predominantly forming 66% of the sample size whereas 34% of females. All the patients had radicular pain, 26 out of 67 patients had left sided radiculopathy and right-sided radiculopathy was observed in 21 patients whereas 20 patients had bilateral radiculopathy. After MRI 34 patients had extrusion of disc, whereas 17 patients showed sequestrated disc, protrusion of disc was observed in 12 patients, whereas disc bulge was observed in 4 patients. 42% of patients were operated by laminectomy, 33 % patients were operated by microscopic discectomy and minimum 25% of patients were operated with microendoscopic discectomy. L4-L5 level was the most common level to get involved. Mean Pre-operative VAS score for male patients was 6.64 and female patients was 6.78, which was reduced to 3.14 and 3.48 respectively after 6 months of operative management. Mean Pre-operative Oswestery score for male patients was observed to be 44.05 and female patients was 44.87, which was reduced to 24.95 and 27.83 respectively after 6 months of operative management. Complications in all three surgeries were observed. Conclusion: Minimally invasive techniques in all areas of surgery have gained momentum in recent years. Spinal surgery has been no exception. Unfortunately, minimally invasive techniques have often been equated with minimally effective procedures. We understand that the micro endoscopic discectomy and microscopic discectomy techniques are superior to the standard discectomy technique for the treatment of single level lumbar disc herniation’s with regard to pain relief, clinical outcome and functional outcome, volume of blood loss, systemic repercussions, and duration of hospital stay. However, technical expertise and learning curve of the technique could be the limitation. Minimally invasive surgeries are cost-effective treatment for lumbar herniated discs. Results and complications were comparable with those associated with standard discectomy techniques. Patient satisfaction was high, and a cost savings was realized.

69-76

Authors: Hanumantharaya GH, Kamala GR

Introduction: Avascular necrosis is defined as a group of symptoms, dominated by pain, loss of function and bony collapse caused by anoxemia and other deficiency in arterial nutrition of the head of the femur, prolonged enough to result in the marked degeneration, even necrosis of bone. Methodology: Data collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, and treatment protocol. Results: It was also noticed that 9 hips (28.13) with stage III, 8 hips (25%) with stage II and 2 hips (6.25%) associated with stage I disease. There was one hip (3.13) of Stage V and VI each. This was according to classification by Steinberg et al. Conclusion: Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key.

83-87

Authors: Sameer Wooly, Anand Kumar.B.S

Background: Clubfoot occurs approximately 1 in 1000 live births and is one of the most common congenital birth defects. There have been many reports of successful treatment of idiopathic clubfoot with Ponseti method in the western world, but there are only few studies done in the developing country like India. So the present study was undertaken with the following objective. Objective: To evaluate the efficacy of Ponseti method in the treatment of idiopathic clubfoot. Methodology: A study was conducted from August 2013 to August 2014 in our Hospital attached to PESIMSR. 25 patients (36 clubfoot) were evaluated in our study. All patients were treated by manipulation and casting as described by Ponseti. Main outcome measures included in the study were, the degree of correction of the deformity and the effect of different variables in the course of management. Results: In our study, we treated 25 babies with idiopathic clubfoot by Ponseti method, among them 11 had bilateral affection. The mean age of the babies was 14 weeks. Out of the 25 babies, 30 of the 36 feet had deformity of a severe grade i.e., Pirani score of 5. The mean number of casts required was 5.8. Tenotomy was required for 26 feet. The average number of casts required were increased as age of presentation increases indicating increasing difficulty and delay in correction of babies who presented late. The results were excellent in 64% (16 out of 25) and good in 28% (7 out of 25).The average Pirani score for the group at the presentation was 5.47 (4.5 to 6) and the mean Final Pirani score was 0.25 (0 to 0.5) which was statistically significant. Conclusion: Ponseti method is a very safe, efficient and economical treatment for the correction of clubfoot which radically decreases the need for extensive corrective surgery. The results are excellent when treatment begins early.

93-95

Authors: Shirish Virupanna Tumbal

Indian Journal of Orthopaedic Surgery (IJOS) is a peer-reviewed journal with reputable academics and experts as members of its Editorial Board. IJOS publishes information on basic and applied orthopaedics for a worldwide readership. It publishes original research papers, critical reviews dealing with all fields of Orthopaedicsand it addresses the international scientific community. Papers related to orthopaedic science on a worldwide basis are also considered. Special emphasis is given to issues that go beyond the traditional boundaries of anorthopaedic journal.Articles on the state-of-the art of orthopaedic surgeryin different parts of the world, the research activities and medical education in orthopaedic teaching, the role of orthopaedics in society, new findings from the frontiers of current researchare always encouraged.

102-109

Authors: Maruthi CV, Shivanna

Background & Objectives: Back pain, the ancient curse is now appearing as a modern epidemic. 80% of the population is affected by this symptom at sometime of life. Impairments of the back and spine are ranked as the most frequent cause of limitation of activities in people of all age groups. Lumbar discs are responsible for well over 90% of all organic symptoms attributable to low backache. Here we have done a clinical study, which includes sixty cases of lumbar intervertebral disc prolapse in the age group of 20 to 70 years, irrespective of sex, with clinical symptoms, signs and radiological evidence treated either conservatively or surgically with discectomy in the Department of Orthopaedics at our institute. All cases were followed up and functional results were analysed. The objective was to study the clinical presentation, evaluate outcome of both conservative and surgical management and to compare the results of both modes of treatment. Methods: Out of 60 patients included in the study, 30 were treated conservatively & another 30 underwent laminotomy discectomy in the Department of Orthopaedics at our institute between October 2007 & September 2013. The short-term follow-up results in patients who were followed up for a minimum of 6 months after treatment were evaluated by using the Japanese Orthopaedic Association scoring system through clinical examination and questionnaire. Results: Prevalence of disc prolapse was in age group of 20 to70 years, while peak incidence was between 30-40 years of age. Incidence of disc prolapse in males was almost twice as much as in females (in our series 65% male cases were noted). 56.67% cases had disc prolapse at L4-L5 level, which being the commonest site of disc prolapse followed by L5-S1 of about 41.67% and 1.67% at L3-L4 level. In the short term follow-up of 6 months, the outcome was good in 90% & excellent in 6.67% of surgically treated patients with 3% complication rate. Conservatively treated group of patients showed 46.67% good, 43.33% fair & 10% poor results. Interpretation & Conclusion: Short term outcome of standard discectomy in our study was favourable and comparable to other studies. With the execution of appropriate selection criteria and appropriate pre & post treatment planning, a good to excellent outcome was seen in nearly 97% in surgical study. In conservatively treated group, 90% patients showed fair to good result. Therefore lumbar discectomy is still a simple, safe & effective treatment with rapid relief for patient while conservative treatment if given to properly selected cases also gives effective results. Patients undergoing surgery for lumbar disc herniation achieved greater improvement in outcome than conservatively treated patients.

115-118

Authors: Devendrappa. H, Santosh, Prabhanjan Kumar

Background: Calcaneum fractures account for 2% all fractures. Intra-articular fractures account for approximately 75% of calcaneal fractures and historically have been associated with poor functional outcome. These fractures are uniformly caused by an axial load mechanism, such as a fall from Height or a motor vehicle accident. The current preference in the surgical treatment of calcaneus fractures is open reduction and internal fixation. However, there were some unsatisfactory results from this technique such as flap necrosis, deep infection and non-union. In selected cases, it is possible to obtain reduction with a percutaneous approach with the Essex-Lopresti Technique using an axial pin. The technique of closed reduction and percutaneous fixation was introduced by Westheus and popularized by Gissane. But the credit for describing the technique goes to Essex-Lopresti. The effectiveness of this technique in the restoration of Böhler’s angle and calcaneal height in tongue shaped is well documented. Aim: To evaluate the outcome of Essex Lopresti technique in intraarticular tongue shaped calcaneal fractures. Material and Methods: 20 patients with tongue shaped intraarticular calcaneum fractures were admitted and treated with closed reduction and pin fixation (Essex Lopresti technique) in vijayanagar institute of medical sciences, Bellary. Patients follow up done for 1year. Outcome of the study was evaluated using Creighton Nebraska Health Foundation Assessment sheet for calcaneum fractures. Results: Incidence was common in 30 to 45years old male patient with most common mechanism of injury being fall from height. 20% of the patients were associated with other side communited calcaneum fracture and 30% patient were with other bones fracture. 80% of patient had good results and 20% had fair result with no poor results. Conclusion: Essex Lopresti technique is effective technique for tongue shaped intraarticular calcaneum fractures with excellent outcome and acceptable complications.

124-126

Authors: Ravindra Chauhan, Naveen BM, HS Agarwal

About the Journal Indian Journal of Orthopaedic Surgery (IJOS) is a peer-reviewed journal with reputable academics and experts as members of its Editorial Board. IJOS publishes information on basic and applied orthopaedics for a worldwide readership. It publishes original research papers, critical reviews dealing with all fields of Orthopaedicsand it addresses the international scientific community. Papers related to orthopaedic science on a worldwide basis are also considered. Special emphasis is given to issues that go beyond the traditional boundaries of anorthopaedic journal.Articles on the state-of-the art of orthopaedic surgeryin different parts of the world, the research activities and medical education in orthopaedic teaching, the role of orthopaedics in society, new findings from the frontiers of current researchare always encouraged.

197-204

Authors: Girish Sahni, H.S. Mann, Ranbir Singh, Tajinder Bhalla

Background: In modern era high speed vehicular traffic accidents fractures of the tibial shaft are common injuries among the long bones and mainly affect young adults, i.e. individuals at their peak of physical and work capacity. The present study was a comparative study between interlock nailing and Dynamic compression plating (DCP) in the treatment of fractures of tibia. The purpose of the study was to determine the outcome and comparing the two different modalities of the treatment. Material methods: The Study includes sixty consecutive patients with fracture tibia [ closed and open Gustio & Anderson grade 1 only] treated with Dynamic compression platting and interlock nailing 30 in each group and were assessed clinically and radiologically and followed up to three years. Results: 90% patients had good to excellent results with 10% having fair results and no poor results. In DCP group there were 10 excellent, 15 good and 5 fair results whereas in interlock nailing group 15 patients had excellent, 14 patients had good results and 1 patient showed fair result. Conclusion: We conclude that DCP is a better mode of fixation for proximal and distal tibial facture and interlock nailing is ideal implant in diaphysial and segmental fractures.

215-220

Authors: Rahul Kumar, Vinay N

Introduction: Lateral epicondylitis/lateral epicondylalgia, or tennis elbow is a common pathology of both athletes and non-athletes, affecting 1 to 3 % of the population at large. The choice of treatment options for this condition is even more controversial. There are many treatment options available to the clinician, but their use is often based on anecdotal evidence. Various treatments ranging from conservative to more invasive measures have been described with varying degrees of success, with no conclusive scientific evidence to support any particular treatment protocol. Methodology: A minimum of 30 patients each for single injection and peppered injection technique were included in the sample. The Single Injection Technique –was performed by penetrating the skin at the identified area of maximum tenderness. The Peppered Injection Technique also began with penetration of the skin at the area of maximal tenderness. The outcome was measured by VAS, Tenderness and grip strength. Results: In our study The mean VAS score in single injection group was, 2.80 at 3 month, 2.83 at 6 month and 3.37 at 12 month. In peppered injection group, mean VAS score was, 1.30 at 3 month, 0.90 at 6 month and 1.13 at 12 month. Conclusion: Peppered Injection Technique is advantageous than single technique.

226-230

Authors: Maruthi CV, Venugopal N

Introduction: German surgeon by name Albert Hoffa in 1904 described the condition which was producing severe anterior knee pain was called Hoffa’s fat pad disease. This disease is commonly encountered in athletes after the second decade. The lowest age present in the literature with symptomatic Hoffa’s fat pad disease is ten years. Most common pathology in Hoffa’s fat pad disease is impingement of fat pad between anterior margin of tibia and intercondylar notch of femur. Here we are done an attempt to know the aetiology, diagnosis and management of the Hoffa’s fat pad disease. Materials and methods: 150 cases of knee joint pain were evaluated in our institute. 107 cases were suffering from medial margin pain, twenty nine cases from lateral margin, seven over and adjacent to ligamentum patella, three from inferior pole of patella, three from tibial tuberosity and one had pain at superior pole of patella. We studied seven patients suffering from Hoffa’s fat pad disease from April 2011 to December 2014 in our hospital. Inclusion criteria were age group between ten to sixty years irrespective of sex suffering from anterior knee pain with tenderness and swelling over and adjacent to the ligamentum patella. The exclusion criteria were age less than ten and more than sixty, pain at the suprapatellar region, inferior pole, superior pole of patella, at tibial tuberosity only, along medial and lateral margin of knee, popliteal fossa were excluded from our study. We have done a study to know the causes, how to diagnose the problem and management. Conclusion: Hoffa’s disease is common after second decade, rare in children. Usually it is seen in athletes. Squatting, running, climbing stairs, trauma and postsurgical scarring are the causes encountered in our study. Diagnosis is by history, clinical examination and radiological investigations like X-ray and Magnetic resonance imaging. Conservative management is the first line of treatment for three to four months and if it fails most of them were treated by complete excision of Hoffa’s fat pad through anterior arthrotomy.

236-240

Authors: Anand Kumar BS, Prasad Soraganvi,Sathyrup D

Background: Supracondylar fractures of humerus are the commonest injury, constitutes about 65.4% of all fractures around the elbow in children. Displaced supracondylar fracture of humerus demand great respect and challenging one to treat, since it requires accurate anatomical reduction and internal fixation to prevent complications. We reported the results of open reduction and internal fixation with K-wires of the displaced (Gartland’s type III) supracondylar humeral fractures in children. Objectives: To study the anatomical and functional results of treatment of supracondylar fracture of humerus by open reduction and internal fixation with K-wires. Methods: 25 cases of displaced (Gartland’s type III) supracondylar fractures treated by open reduction and internal fixation with K-wires were studied between September 2011 – August 2013 at PES Institute of Medical Sciences & Research and followed for an average of 24 months. Results: In our study of 25 patients, all were closed Gartland’s type III fractures with mean age of 6.3 years, 13 patients sustained fracture due to fall while playing, 18 had on left side, with posteromedial displacement in 16 patients. 2 patients had associated distal end radius fracture. Majority of patients operated on 2nd day and discharged on 3rd postoperative day. 3 patients had superficial pin tract infection, 2 had traumatic median nerve palsy, 2 had migration of K-wire, 1 had cubitusvarus deformity and 1 had loss of motion >150. Conclusion: Open reduction and internal fixation with K-wires gives more stable fixation, better anatomical reduction with negligible complication and can be accepted asthe best method of treatment for irreducible type 3 supracondylar humerus fracture.

251-254

Authors: Shivanna, Maruthi.C.V

Background: A prospective analysis of a case series of diaphyseal forearm fractures in children treated with titanium elastic nails is presented. Methods: Between 2012 and 2014, 45 children aged 5-15 years with displaced diaphyseal forearm fractures underwent titanium elastic nailing. Both bones were fractured in 32 patients, ten fractured only the radius, and three experienced ulna fracture. Eighteen children had unstable irreducible fractures, twenty had loss of reduction, and seven had open fractures. Titanium elastic nails were used to stabilize the fractures. All fractures were immobilized postoperatively with an above-elbow plaster slab for 2 weeks till the swelling is completely resolved followed by encouraging range of motion exercises. Results: Closed reduction and TENS was successful in 33 cases, including 25 double-bone fractures and eight single-bone fractures. Open reduction was unavoidable in seven fractures of both bones, and in five single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. Conclusion:Titanium elastic nails fixation of pediatric forearm fractures revealed several advantages, a small incision for insertion, a low rate of complications, unhindered bone healing, and good clinical and radiological results.

261-264

Authors: Hanumantharaya GH, Kamala GR, Ramesh K

Introduction: Avascular necrosis of the hip bone is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. The disease affects mostly young adults within their 3rd and 5th decade, the majority of the patients being men. The aim of this paper is to present the findings of stages and modes of treatment of patients diagnosed with avascular necrosis of the femoral head, admitted in the Orthopaedics Department of the Clinical and Emergency Hospital. Material and method: A descriptive study was conducted among 20 patients diagnosed with avascular necrosis of the femoral head and who were admitted in the Orthopedics Department of the Clinical and Emergency Hospital. The obtained findings were processed statistically to correlate clinical and laboratory data of patients diagnosed with this condition. Results: The majority of our cases were in the 4th decade. It was also noticed that 9 hips (28.13) with stage III, 8 hips (25%) with stage II and 2 hips (6.25%) associated with stage I disease. Total Hip Replacement was done in 2 cases (10%). Two patients (10%) were referred to other centers for further evaluation. Conclusions: The results of the study presented in this paper correspond with related research results found in the consulted literature.

273-278

Authors: SreerangaN, LakshmeeshaT, Shankara K, Vishanth K

Background: Kaplan’s lesion is a rare injury of the metacarpophalangeal joint, which commonly involving the index finger. It is also one of the complex dorsal dislocations of the hand. Proper identification is required to provide appropriate treatment. Though the lesion clinically appears small it is not amenable to closed reduction. Open reduction is the treatment of choice. Two approaches-volar & dorsal have been described. Volar approach is widely used & written about. However the risk to neurovascular bundle is high. Method and Material: At Hassan institute of medical sciences we treated 5 patients with Kaplan’s lesion surgically by using dorsal approach. Our Aim was to analyse the effectiveness, accessibility & ease of this approach in treating these lesions & also note the complications. Results: All patients underwent open reduction by dorsal approach and regained their pre-functional status by 8 weeks period without any neurovascular injury. Conclusion: This approach definitely offers better advantage in visualising the volar plate & joint, relatively safe in preventing neurovascular injury & will also be able to fix the associated fractures with ease. The relative disadvantage of longitudinally splitting of the volar plate did not interfere in the healing or stability of the lesion.

282-285

Authors: Sriram Thanigai T, Deviprasad S, Sathik Babu MB, Nithin PS

Purpose: Chronic plantar fasciitis is a commonly faced problem and can be challenging to treat. The purpose of the study was to prospectively analyze the effectiveness of platelet-rich plasma (PRP) in patients with chronic plantar fasciitis. Methods: We included 56 patients with unilateral chronic severe plantar fasciitis who underwent a single injection of autologous PRP under ultrasound guidance. The patients were followed up at regular intervals of 3, 6, 12, and 24 months. The results were evaluated with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale. Results: The average pretreatment AOFAS score of 56 increased to 96 at 3 months, was 94 at 6 months, and was 92 at 12 months, with a final score of 92 at 24 months. The average pretreatment VAS score of 8.1 decreased to 1.8 at 3 months, was 1.9 at 6 months, and was 2.1 at 12 months, with a final score of 2.0 at 24 months. Conclusion: From our prospective study, we found that a single injection of PRP is a safe and effective method for the treatment of chronic severe recalcitrant cases of plantar fasciitis.

291-295

Authors: Maruthi CV, Venugopal N

An unusual condition of the hip joint seen in the children between ten to sixteen years of age group is slipped capital femoral epiphyses. Chronic unstable type III is rareone. The management is usually in-situ fixation. Here we studied three cases between June 2008 to April 2013 in our institution by managing the slip by closed reduction and internal fixation using single cannulated cancellous screw. The follow up, done at one, three, six, twelve and twenty-four months for clinical and radiological evaluation. And at the end of two years we observed complete healing of the slip without any complications like avascular necrosis and or chondrolysis. All the patients evaluated using modified Harris hip score and all were in excellent outcome. We conclude that chronic unstable type III slips can be managed by closed reduction and internal fixation using single cannulated cancellous screw. According to the Harris hip score we achieved excellent results. With, scores of 95, 97 and 97 in our study. Our study is statistically significant. The p value is 0.015 by chai squire test and it is statistically significant.

132-137

Authors: Sachin Jain, Dinesh Sonkar, Sunil Rajan

Objective: To assess short-term functional results in 2 types of syndesmotic fixation, comparing the traditional rigid quadricortical syndesmotic screw fixation with a more dynamic tricortical screw fixation. Method: PATIENTS: Thirty nine patients (Age group: 20 to 50 yr) with closed ankle fractures in which the syndesmosis was found to be unstable clinically, radiographic and confirmed intra operatively. INTERVENTION: The unstable syndesmoses were fixed with either one cortical screw through both tibial cortices (n = 18) QSF or two cortical screws engaging only 1 cortex of the tibia (n = 21) TSF. The quadricortical and the tricortical screws were removed only in the case of discomfort. However, all quadricortical screws were removed at 6 month follow up. Rehabilitation was the same in both groups. DESIGN: Prospective, randomized single blinded clinical study. SETTING: Department of orthopaedics and traumatology MGM Medical College & M Y Hospital Indore. And G.R. Medical College & Jayarogya Hospital, Gwalior. Results: At the end of three months mean OM score was 65.35 (55 to75) For TSF group as compared to59.58 (55 to65) in QSF group. Mean values were similar between the two groups with respect to pain, swelling, support, running and jumping. The overall difference noted in two groups was due to difference in Mean value for functional parameter like stair climbing, Squatting and activities of daily living. At six months there was no significant difference in any parameter of OM score. Hence the overall scores were with non-significant difference {TSF76.42 (70 To 80) and QSF72.42 (65 to 80). A three months DID was 12.07 (9to17) in TSF and 9.75 (6to13) in QSF with significant difference in two groups. At six months difference was non significant 4.75 for TSF and 4.42 for QSF Group. The one set of tricortical screws and two Quadricortical were removed in patients due to infection. Quadricortical group was re-operated in 3 (16.66 %) cases for screw removal in case of screw breakage before 6 month follow up. While one set of tricortical screws were removed due to loosening. All removal was done after 4 months as all fractures shown clinical and radiological union at 3 months. Conclusions: In this study confirmed that Syndesmosis fixation with 2 tricortical screws is safe and improves early function. After 6 months, however, there were no significant differences between the 2 groups in functional score, pain, and dorsiflexion.

146-148

Authors: Ganesan Ganesan Ram, V. C. Anil Chander, Srinivasan Rajappa

Background: Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice. As extremity injuries are evaluated, each of four functional components (nerves, vessels, bones, and soft tissues) must be considered individually and together. If three of these four elements are injured, the patient has a “mangled extremity”. In this article we are going to assess the quality of life of patients who had crush injury to the leg. Methods: Both retrospective and prospective study of 60 patients who had Grade III b and Grade IIIc open fractures of the lower limb. Study was done in Sri Ramachandra Medical College between Jan 2012 and Jan 2015. Patients who had crush injury to their lower limbs with Mangled Extremity Severity Score of seven and above were included. We followed Gustillo and Anderson classification system for fractures classification. Mangled Extremity Severity Score for all the patients were calculated. SF12 quality of life questionnaire was used to assess the patients during follow-ups. Results: The Mean PCS (physical component summary) score in SF 12 quality of life questionnaire for Amputation group and Limb Salvage group were 39.05 and 29.91. The Mean MCS (mental composite summary) score for Amputation group and Limb Salvage group were 43.10 and 36.05. Conclusion: The quality of life of patients who underwent amputations was statistically significant when compared to patients who had their limb salvaged.

153-158

Authors: SPS Gill, Manish Raj, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Prateek Rastogi

Introduction: Compound fracture of the tibia is the one of the most common injury encountered by orthopaedic surgeon these days. Diaphyseal compound fractures are well managed by primary interlocking nails with good to excellent results. Metaphyseal juxtraarticular and intraarticular compound fractures of upper and lower end of tibia are not good indication for intramedullary nails due to limitation of short proximal and distal fragment and marked communition at these areas, also mostly intra articular extensions. Till now these fractures were mostly managed by External fixators or rind fixators. Primary conventional open plating in compound fracture is not a preferred method of management till now due to fear of infection and soft tissue complications and risk of plate exposure. We managed these fractures by minimally invasive plating using locked plate and result evaluated. Material and Method: In this study we have taken compound metaphyseal fractures of the tibia for primary plating using locked anatomical plate using minimally invasive technique. Ninety four (94) cases of tibia out of which 50 cases of proximal tibia and 44 cases of distal tibia compound fracture up to grade IIIA were taken for study. In all cases primary skeleton traction were applied followed by wound management using through irrigation using low pressure pulse levage and debridement. Plating was done using MIPPO method within 7 days of injury. Cases were followed up at regular interval and functional outcome assessed by using knee society score for proximal fractures and foot and ankle score for distal tibia fractures. Results: Primary bone was achieved in 88 of 94 cases within usual duration. Low grade infection at fracture site seen in 8 cases and out of these 8 cases union achieved in 5 cases by continuation of same primary fixation. 3 cases required revision surgery with removal of implant and antibiotics cement beads followed by other method of fixation to achieve union. Good to excellent outcome achieved according to knee society score in 93.8% of proximal cases and again good functional outcome achieved according to Foot and ankle score in 85% of distal tibia cases. None of these cases showed any serious complications like amputation or severe life threatening infection. Conclusion: With our study we can concluded that compound fractures of proximal and distal tibia can also be well managed by primary plating using minimally invasive technique. This is single staged procedure with minimal financial burden of rural population. One has to take care in proper selection of cases, avoid further soft tissue damage and care should be taken not to leave bone and plate exposed to environment. Wound can be closed by other secondary procedure within next few days without any negative consequences.

164-167

Authors: Sriram Thanigai T, Sathik Babu M. B

Introduction: With rapid increase in day-to-day traffic, incidences of high-energy trauma are also increasing with the same speed. Open fractures of the tibial shaft are important for the reason that they are common & controversial. Our aims and objectives were to assess the time to bone union and functional outcome in cases of open fractures of the tibial shaft treated with reamed interlocking intramedullary nailing. Methods: Thirty patients who had 30 open fractures of the tibial shaft were treated with wound debridement and primary interlocking intramedullary nailing with reaming during the period from June 2012 to March 2014. The patients were followed up for a period of 6 – 14 months. Results: There were 9 (30 %) Type I fractures, 8 (27%) Type II fractures and 13 (43%) Type IIIA fractures. Mean time to union was 20.25 weeks for Grade I fracture, 22.5 weeks for Grade II, 24.71 weeks for Grade IIIA fractures. Deep infection occurred in 2 patients. Aseptic nonunion occurred in one patient. Malunion was noted in one patient. Interpretation and Conclusion: The results in the current study and other data support the view that reamed locked intramedullary nailing is a safe and effective technique for the management of open tibial fractures.

171-175

Authors: Jayant Sharma, Avinash Jain, Pooja Gupta Jain, Prashant Upadhyaya

Introduction: Anterior bridge plating with minimally invasive technique in shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plate over an average follow-up period of 22 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome. Materials and Methods: Eleven patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between Jan 2013 and April 2015 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function. Results: Of the Eleven patients in the study, eight were males and three were females. The mean age was 34.3 years (range 20 to 53 years). Eight out of eleven patients (72.7%) had the dominant side fractured. Mean surgical time in minutes was 79.5 (range: 60–100 minutes) and mean radiation exposure, in terms of one sec for each c-arm exposure was 95 seconds (range: 70–160 seconds).The mean fracture union (radiological) time was 13.7 weeks (range: 10–18 weeks). One patient (9.1%) develops infection for which premature plate removal and debridement was done at 5 months and managed then conservatively. However Shoulder function was excellent to good in 9 cases (81.8%) and fair in 1 case (9.1%) on the UCLA score. Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. It is a safe and less time consuming method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

183-185

Authors: Ganesh Singh Dharmshaktu

The Lisfranc’s joint fracture dislocation involves the articulation between medial cuneiform and base of second metatarsal, which is considered as keystone to the mid foot integrity. The articulation has stabilization effect on longitudinal and transverse arches of the mid foot. Non operative or suboptimal treatment has grave complications and aftermath. Lisfranc’s joint includes tarsometatarsal complex and injury to the region is a rare occurrence. Neglected or undertreated injury to Lisfranc joint complex leads to secondary arthritis and significant morbidity and disability. This uncommon pattern of injury is often missed on initial or poorly done radiographs. We present a report of six weeks old neglected Lisfranc’s joint injury with surgical management and satisfactory functional outcome.

194-196

Authors: Rajendra Kumar Ahire, Harshal sakale, Vinit K Jain

Penetrating injuries are dangerous and deserve emergency treatment due to the risk of injuring vital structures. We present an unusual case of a young male patient who sustained piercing injury of thigh with a tree branch due to fall from the tree. Careful planning, proper evaluation of such patient is required before extracting such foreign bodies.

1-3

Authors: Sudhir Singh

Indian Journal of Orthopaedic Surgery (IJOS) is a peer-reviewed journal with reputable academics and experts as members of its Editorial Board. IJOS publishes information on basic and applied orthopaedics for a worldwide readership. It publishes original research papers, critical reviews dealing with all fields of Orthopaedics and it addresses the international scientific community. Papers related to orthopaedic science on a worldwide basis are also considered. Special emphasis is given to issues that go beyond the traditional boundaries of an orthopaedic journal. Articles on the state-of-the art of orthopaedic surgery in different parts of the world, the research activities and medical education in orthopaedic teaching, the role of orthopaedics in society, new findings from the frontiers of current research are always encouraged.

11-21

Authors: Choudhari P, Chhabra S, Kiyawat V

Back ground: Haemangioma arising in the knee is a rare cause of knee swelling. The diagnosis frequently is delayed for long. Method- We are presenting the case series of 3 cases of synovial haemangioma of knee joint. All the three case presented to us with pain and swelling in the knee joint. Conclusion: The aim of presenting this case series is to create awareness about the possibility of a haemangioma arising from a joint which although rare should be kept as a differential diagnosis.

27-31

Authors: Hayat Ahmad Khan, Younis Kamal, Adil Bashir Shah, M Ashraf Khan, M Shahid Bhat, Naseemul Gani,

Introduction: Spinal fractures are often seen in the accident and emergency department. These usually result from the Road traffic accidents in young or due to fall from height in elderly. These fractures are sometimes associated with other injuries as well. Artificial denture ingestion as associated with spine fracture is not been reported in literature. We present a case of elderly male patient who had such association and was picked up early and managed uneventfully. Case Presentation: Following fall from height, Patient was brought to us with pain back with difficulty to stand. Patient was initially stabilised and on examination he had tender neck and lumber spine. Foreign body was suspected on x rays besides a wedge compression fracture at L1. Patient was subjected to hypo laryngoscopy and artificial dentures were removed. Conclusion: This case highlights the need for looking artificial dentures by the emergency care physicians while dealing with the trauma patients. The history should be asked in elderly patients who turn up with fractures following fall to rule out any artificial teeth ingestion. Early diagnosis can prevent morbid complications.

37-42

Authors: Mohammad Farid, Sanjiv Kumar, Atil Kumar lal, Sudhir Singh

Cysticercosis is a common human infestation in the developing world. Cysticercosis is an infection caused by the larvae of the tapeworm, Taenia solium. Neurocysticercosis is the most common clinical presentation of cysticercal infestation in the human body, but it may be rarely encountered in other body parts like skeletal muscle, subcutaneous tissue and eye. A 17 yr old female presented in the orthopedics department with complains of swelling over the right forearm since 4 months. It was diagnosed as a cysticercosis on MRI and ultrasonography of forearm and it revealed a scolex, the aim of this case report was to document a rare presentation of cysticercosis cyst in forearm. It was treated by albendazole 400mg for twice a day dose daily for 1 month. The patient came for follow up after 6 weeks and no swelling was palpable and MRI and USG reports did not reveal any cystic lesion..

50-56

Authors: Avinash Jain, Jayant Sharma

Introduction: Injuries to the bones forming knee joint particularly tibial plateau fractures can result in functional impairment and also one of the most challenging to treat. Proximal tibia fractures constitute about 8% of all fractures in elderly. Improvements in surgical techniques and implants, has favoured a trend towards surgical managements, with objectives including precise reconstruction of the articular surfaces, stable fixation, early mobilization and repair of all ligamentous and soft tissue lesions1. However success of the surgical management needs revaluation. Materials and Methods: It is a prospective analytical study of 2 year duration. A total of 50 patients with tibial plateau fractures were selected and managed surgically. Results: In our study of 50 patients, 13 were managed by CRIF with PCCS, 37 were managed by ORIF with Buttress plate and Bone grafting. Post-operative assessment for an average period of 12.56 months done. And the results were analysed in terms of aetiology, sex ratio, age group, classification type, dominant side, complications like OA, knee stiffness, etc. Conclusion: The management protocol of tibial plateau fractures is challenging. Fracture type is the chief determinant for the choice of procedure. The aim is to achieve anatomical reduction and rigid fixation to restore articular congruity, facilitate early knee motion by reducing postoperative complications and thus achieving optimal knee function at the earliest. These fractures, still pose a challenge to the surgeon, they need to be evaluated, planned and treatment executed in the best of experienced hands.

60-63

Authors: Ramesh Krishna. K, Aradhana. T. R, Preetham. N

Introduction: Olecranon osteotomy provides a good exposure of the fracture site for distal humerus fracture fixation. However, it is not without its potential disadvantages of delayed union, non-union at osteotomy site and other implant related complications. Triceps reflecting approaches are known to avoid these complications. The aim of our study was to compare the outcomes in the two surgical approaches by assessing the radiological union, the functional outcome by MEPI score and complications associated with each approaches. Methods: 40 consecutive patients were alternatively allotted into two groups. Group A had 20 patients treated surgically by trans-olecranon approach. Group B had 20 patients treated surgically by triceps reflecting approach. Patients were followed up for period of 24 months. Patients were assessed for stability of fixation, radiological union, the functional outcome using MEPI, and the complications in each group were reported. Results: Regardless of the fracture and implant type, functional mobility, elbow function, patient satisfaction, and quality-of-life assessments were comparable between the groups at three and twelve months. No significant differences were found in the functional outcome. But olecranon osteotomy approach group were associated with more complications Conclusion: Trans-olecranon and triceps reflecting approaches are similar in their functional outcomes but complication rates are higher in trans olecranon approach.

75-78

Authors: Mohammad Farid, Kumar Satyendra, Lal Atil Kumar, Rai Tushar, Singh Sudhir

Synovial chondromatosis is a rare benign condition arising from the synovial membrane of the joints, synovial sheaths or bursa around the joints. The purpose of this case report is to document this condition in younger age group as compared to age group of 30-50 yrs where it has been seen relatively more commonly, and of attachment of multiple loose bodies to anterior cruciate ligament which was treated by arthroscopic synovectomy and removal of loose bodies was done in a 22 yr old male.