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Subtalar joint dislocations are very uncommon and occur following high energy injury, usually following motor vehicular accidents. They account for around 1-2% of dislocations. We present to you, a few cases of subtalar joint dislocation managed initially by closed reduction, followed by open reduction under anesthesia, with excellent functional outcome. Close to fifty percent of patients suffering from complicated injury, are frequently at risk of developing complications. Avascular necrosis of the talus is the most common complication, following dislocation. Other long-term sequelae include osteochondral fracture and subtalar joint instability. This study is presented because of its rarity in clinical practice. Keywords: Dislocation, Subtalar joint, Reduction.

Introduction: Angular deformities around the knee in children is a common finding, these deformities are from diverse group of etiologies. Most of these deformities are physiological in nature corresponding to the changes in the alignment of tibio-femoral angle from birth to adolescence. Angular deformities can also be developed due to pathological causes like skeletal dysplasias, metabolic bone disorders, Blount’s disease and trauma. Osteotomies were the mainstay of treatment for correcting deformities in both adults and children been replaced by Hemiepiphysiodesis using 8 plates having less complication rate. Materials and Methods: A total of 49 knees (35 genu valgum, 14 genu varum) of 30 patients were studied. 8 -plates were used for correction of coronal plane deformities around the knee. All cases were followed for minimum period of 12 months. Preoperative clinical and radiological measurements were compared to post-operative measurements. Results: There was statistically significant improvement in clinical and radiological outcome measures. In genu valgum group preoperative mean Tibio-femoral angle (TFA) improved from 24.16 to 8.36. Mean Mechanical axis deviation (MAD) improved from 4.26 to 1.09. Rate of correction of TFA is 1.1/month, rate of correction of MAD is 0.22/month. In genu varum group preoperative mean TFA improved from 34.58 to 21.47. Mean MAD improved from 4.92 to 0.63. Rate of correction of TFA is 0.77/ month, rate of correction of MAD is 0.12/month. Conclusion: Hemi-epiphysiodesis using 8-plate systemin the correction of coronal plane deformities around the knee is a safe and effective procedure. Keywords: Hemiepiphysiodesis, Guided growth modulation, Genu varum, Genu valgum.

Introduction: Intracapsular fracture of neck femur usually present with severe swelling, difficulty in walking reduced length of affected limb. The most common Risk factors are old age, osteoporosis, taking excessive medications, alcohol, smoking and cancer. Diagnosis can be done by using X-rays, CT scan and MRI. Materials and Methods: It is a prospective study consists of all the patients admitted to JSS hospital with intracapsular fracture neck femur treated with unipolar or bipolar endoprosthesis. Results: The selected patients were randomized and divided into two groups, Group one (I) and Group two (II). Patients were suction tube is used are categorized into Group I and in those were suction tube is not used are categorized into Group II. These two groups were studied and observed for the following, fall in haemoglobin and PCV at 48 hours post-operatively. Complications are Persistent discharge, serous discharge from the wound for more than 10 days. Discussion: When the doctors are in doubt, then they need to insert a drain was countered by Halsted (1898). Now days in orthopedic cases, closed suction drains are being commonly used to decrease the complications. Blood accumulation in and around the tissue site will raise the tissue tension and thereby reduces tissue perfusion in and around the surgical wound site. Conclusion: We consider that there is ample evidence that closed suction drains is of no benefit in primary uncomplicated hemiarthroplasty. The advantage of the drains in orthopaedic surgeries should be debated as non use of drains drastically reduces anemia and requirement of blood transfusion after surgery. In a developing and under-developing countries, the cost increases because of the blood transfusion needs and costs of drain device which will outweigh any advantages of putting a drain. Keywords: Persistent discharge, Dressing reinforcements, Superficial surgical site infections, Blood transfusion.

Objective: Patient satisfaction after total knee arthroplasty is dependent on post operative range of motion and pain. This study is an attempt to determine the influence of factors like age, sex, BMI, pre op flexion, Tibiofemoral angle on post operative range of motion. Materials and Methods: The sample size was 94, of which 4 patients were lost in follow up. The patients included were ones with similar type of implant, primary cases, similar technique and surgeon. Demographics, pre op range of motion using goniometer and tibiofemoral angle on radiographs was determined. The cases were followed up regularly for 1 year and the range was noted. Results: Factors like age, BMI, pre operative flexion, Tibiofemoral angle determine the amount of flexion post operatively. However factor like sex is not statistically significant. The p value for pre operative flexion and tibiofemoral angle is Conclusion: Proper patient counseling about the range of motion achievable post operatively balancing the factors affecting it is important for patient satisfaction. Total knee arthroplasty, range of motion, pre op flexion, tibiofemoral angle. Keywords: Total knee arthroplasty, Range of motion, Pre op flexion, Tibiofemoral angle.

Introduction: Intertrochanteric Femur fractures comprise approximately more than half of hip fractures caused by low energy mechanism seen more commonly in geriatric people, women,osteoporosis,a history of fall and gait abnormality. There are surgical managments available for this kind of fractures but still there are some failures. Above mentioned factors are responsible for failures. For that revision surgery is required. Here we are going to search outcomes of DCS in failed PFN in IT fractures. Materials and Methods: A retrospective study of 10 patients, treated with dynamic condylar screw (DCS) for implant failure after doing PFN in Intertrochanteric fracture were stastastically reviewed from march 2017 to march 2018. Observation and Results: Out of 10 cases 4 were young (60years). 4 out of 4 young patients and 3 out of 6 elder patients were united properly. Nonunion was seen in 1 patient. Delayed union was seen in 1 patient and Implant failure was seen in 1 cases (10%). Restricted weight bearing status post-operatively was associated with significantly lower incidence of implant failure.Using the DCS, the results were good in the young patients with high-energy injuries. However, the implant failure rate is high in elderly patients who suffer low-energy fractures. The DCS should not be used if weight bearing cannot be minimized in this group. Conclusion: The dynamic condylar screw is a safe and reliable implant for the management of Periimplant Subtrochanteric fractures in previously operated with PFN with predictable results when principles of open reduction and internal fixation is followed as compare to other methods of fixation in developing country. Keywords: Proximal femur nail, Dynamic condylar screw, Intertrochentric fracture, Revision surgery.

Introduction: Distal radius reconstruction every time needs aggressive operative intervention is still a debate among researchers and upper extremity surgeons. There is a role of nonoperative treatment in geriatric population and unfit patients. Novel techniques and revolution of implants advocated the best clinical outcome. Materials and Methods: We conducted a prospective study of 25 patients having AO OTA type A, B & C distal radius fractures treated with volar locking plate at our institute between 2015 to 2017. We include all close injuries in skeletally mature patients between ages 20-60 years. Outcome of the study was evaluated by using the Gartland and Werley score modified by Sarmiento & Patient Rated Wrist Evaluation (PRWE) score. Results: 6 patients had AO OTA type A, 11 patients had type B and 8 patients had type C fractures. Mean palmar flexion was 77 degrees. Dorsi flexion was 82 degrees observed. Average supination and pronation were 85 & 80 degrees respectively. Radial & ulnar deviations average 11 and 25 degrees were observed. 80% of the patients had loss of radial inclination less than 9 degrees. All the patients had less than 6 mm radial shortening. Loss of palmar tilt less than 6 degrees was observed. More than 90% of the patients had excellent to good outcome based on Gartland and Werley score. Conclusions: Volar plating is a proven method of choice in majority of distal end radius fractures regardless of comminution and fragments separation. Keywords: Distal radius fractures, Internal fixation, Volar plate, AO OTA fractures.

Introduction: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are the life-threatening complications which can occur in patients undergoing elective Total Knee Arthroplasties (TKA). Incidence in western population appears high in published Literature. While the Indian population it appears to be variable. The difference might be due to different Genetic makeup, social lifestyles of both populations.1 The study intends to find an incidence of symptomatic DVT and PE in postoperative TKA patients on the prophylactic drug regimen. Aim: To study the incidence of symptomatic DVT and PE, in post-TKA patients in Indian population. Materials and Methods: Retrospective Study conducted from 1st may, 2017 to 1st may 2018 in BIRRD (T) Hospital. All patients who underwent TKA are included, after following inclusion and exclusion criteria. These patients were evaluated for symptoms during the hospital stay and after discharge for 3 Months. Result: Total number of patients who had TKA were 2292(N=2292). The symptomatic DVT was found in 6(n=6) patients. All 3 patients were managed with a therapeutic regimen. Four patients developed PE (p=4) during the study period, three patients developed pulmonary embolism in first 24 hours postoperatively and expired in spite of ICU management. One patient expired on the 4th-week postoperatively, with PE at home. Two patients presented with symptoms on 2nd and 4th postoperative days, one underwent fasciotomy on 4th postoperative day. All other patients were on a prophylactic regimen. Conclusion: Our results suggest incidence of DVT and PE are low in the Indian population with a prophylactic regimen. Keywords: Deep vein thrombosis, Pulmonary embolism, Prophylaxis, Total knee arthroplasties, Venous thromboembolism.

Background: The follow-up observational study between TENS and PLATE group in Displaced Midshaft Clavicular fracture conducted in the Department of Orthopaedics, Sir Takhtsinhji Hospital, Bhavnagar, after getting permission from ethical committee. Materials and Methods: All patient coming to Sir Takhtsinhji General Hospital, Bhavnagar with midshaft clavicular fracture and who admitted for surgery and met the criteria was included in this study. Patients with fractures older than 4 weeks or with pathological fractures or those having associated head injury or having bilateral fracture was excluded from the study. After explaining the purpose of the study, a written informed consent was taken from all the participants before data collection. The data were recorded in a predesigned and pretested proforma. Data was collected from past records, and in subsequent 6 weeks, 3 and 6 months postoperative follow up. Result: At the end of the study, we had 15 patients in the Plate group and 15 in the TEN group for comparison. In the Plate group, we had 08 male and 07 female patients, whereas there were 09 male and 06 female patients in the TEN group. The Duration of Surgery was 71.346.67 in the Plate group and 485.60 in the TEN group. The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended The functional outcome at 3 months was good in 14 cases (46.66%), adequate in 16 patients (53.34%). Out of all the good outcomes, 9 cases (60%) were from TEN group while 5 patients (33.3%) from plate group. Conclusion: All patients were evaluated at 6 weeks, 3 and 6 months with follow up radiologically by xrays. In our study Road Traffic Accident was the most common cause for clavicle fractures. Fall on out stretched hand was the commonest mechanism of injury. We studied the fracture pattern (intra operatve finding) based on mode of injury and mechanism of injury. From this AO 2B2 (comminuted mid shaft fracture) is associated with high

The knee joint being very commonly injured secondary to road traffic accidents, contact sports activities and repetitive activities, in such cases especially in acute conditions its difficult to rely to arrive at a accurate clinical diagnosis depending only on the clinical tests to diagnose meniscal injuries because of the painful knee so the patient is subjected to many noninvasive imaging modalities like x-ray sonography and magnetic resonance imaging and later invasive procedures like diagnostic arthroscopy to detect the proper diagnosis. So we conducted a prospective in JSS hospital study to compare all the three modalities like clinical examination, MR imaging and diagnostic arthroscopy to know the meniscal injuries of the knee joint. There were 30 patients with 26 male and 4 female patients age ranging from 18 to 55 years. History of fall with twisting injury was most common. The sensitivity and specificity of clinical examination and MR imaging with respect to arthroscopy was 83.3% and 77.78% and 91.67% and 55.56% respectively. So diagnosing meniscal injuries is of great significance to decrease the morbidity of the patient. Keywords: Clinical examination, MRI, Arthroscopy, Meniscal injuries.

Introduction: The present study was done to perform foot examination using Amit Jain’s Triple Assessment screening tool on in-patients in surgical wards. Materials and Methods: A descriptive retrospective study was done at Gajra Raja Medical College, Gwalior (M.P.) in department of surgery during a period from April 2018 to June 2018 on patients of diabetic foot admitted in all six units of surgical wards. Results: A total of 72 patients were included in this study as per search in case records. Majority of patients had diabetes of more than ten years duration and males were more commonly affected. All patients had diagnosis of diabetic foot with varied spectrum of associated lesions alone or in combination. Surgical debridement (66.66%) was the commonest procedure done in these patients. The affected foot of all patients was examined, with component assessment of feeling pedal pulses done in 86.11% cases and testing for sensation was done in 25% cases. In contralateral foot 58% patients were examined, in similar percentage pedal pulses were examined and foot sensations were not tested in any of them. Conclusion: Despite foot examination being of paramount importance it is often incomplete and inadequate in diabetic foot subjects as is also evident from observations of present study. Amit Jain’s Triple assessment of diabetic feet is a rapid inexpensive screening tool for obtaining basic foot information in order to segregate at risk feet and offer preventive care against amputation. Keywords: Amit Jain, Assessment, Triple, Diabetic foot, Trio-pathy, Screening, High risk foot.

Introduction: Most of the hip fractures are managed in supine position on a fracture table with foot attached to foot plates and biplanar fluoroscopy supervision under c-arm. But this procedure has its own difficulties in managing especially comminuted subtrochanteric fractures, where in different fragments and segments are being pulled by strong muscles around hip, and getting good reduction and alignment is difficult due to displaced bony fragments being held in traction on fracture table and cannot be manipulated easily. This leads to prolonged operative time, opening of fracture site, increased bleeding, increased chances of infection and over all increased anaesthesia time adding up to risk factors. The purpose of this study was to report how these difficulties can be overcome by operating on a simple radioluscent top operating table in lateral position without a fracture table. Materials and Methods: 74 cases of subtrochanteric fractures with or without comminution were operated in lateral position on simple ordinary radioluscent top table with lesser attachments and adjustments to operating table during the study duration were included in the study. We used long Proximal Femur Nail (PFN) (length more than 25cms 34, 36, 38, 40cms long) to fix these fractures. Results: In the present study, age group of patients was 25yrs to 74yrs. Male patients (83.7%) were more than female patients (16.3%) An average of less than 150 ml in closed surgery. The average operative time for all cases was 80 minutes. Union time varied from 16 weeks in simple fractures to 26 weeks in comminuted fractures. Clinical function of hip and knee was excellent with full range of movements. Conclusions: Reduction and fixation of proximal femoral fractures in the lateral position with fluoroscopy or portable radiography in the anteroposterior view for small set ups and rural hospitals that lack a fracture table or advanced fluoroscopic devices may be executable and probably safe. Keywords: L

Introduction: Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. The purpose of the study was to evaluate the functional outcome of arthroscopic rotator cuff repair in rotator cuff tear patients. Materials and Methods: This prospecutive study included 22 cases of rotator cuff tear patients of either sex fitting the inclusion criteria at the orthopedic department of Sanjay Gandhi Institute of Trauma and Orthopedics, Bangalore from September 2016 to December 2017. Patients included were between 18 to 70yrs of age with MRI proven rotator cuff tear who underwent all arthroscopic rotator cuff repair and willing to participate in study. Exclusion criteria included associated shoulder lesions, revision rotator cuff repair, irreparable tears, acj arthritis and rotator cuff tear arthropathy. Patients admitted with MRI proven Rotator cuff tear after meeting the inclusion and exclusion criteria are selected for the study. They will undergo detailed history, clinical and radiological evaluation. Arthroscopic rotator cuff repair by single row or double row technique using suture anchors by a single trained surgeon. Postoperative rehabilitation as per standard protocol. Postoperative evaluation done at, 3rd month, 6th month and 1 year. Range of motion, UCLA and ASES scoring done at preoperative and postoperative follow-ups. Results: A Prospective study with 22 patients is undertaken to study the functional outcome of Arthroscopic rotator cuff repair. The mean age in our study is 53.5 years majority are in the age group 40 to 60yrs. Out of 22 patients, 13 were male, 9 were female. Major part of our study contained partial thickness tears (59.1%) rather than full thickness tears (40.9%). 81.8 % (18) patients in our study had traumatic tears and 18.2%(4) patients had degenerative tears. There is significant

Introduction: Treatment of intertrochanteric fracture in elderly is not only to mobilise early but also to avoid complications and morbidity. With available treatments it is difficult to address all the issue with same surgical option. A recent advance for treatment of senile unstable intertrochanteric fracture is PFN antirotation which may help in early mobilisation with less complications. The purpose of this study is to compare the outcome of PFNA and hemiarthoplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty group from January 2016 to January 2017 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthoplasty groups have better harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA provide less morbidity to patients with early mobilisations and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture. Keywords: PFNA, Bipolar, Intertrochanteric fracture, Hemiarthroplasty, Harris hip score, Replacement.

Aim: To evaluate the outcome of open reduction and internal fixation using locking compression plate for proximal humeral fractures, done at a tertiary care referral teaching super specialty hospital in Andhra Pradesh, India from 1st may 2015 to 31st may 2017. Materials and Methods: The study consists of 53 patients diagnosed with proximal humerus fractures which were treated by open reduction and internal fixation with locking compression plate in a week after trauma, with in the age group of 20-60 years were selected. All patients were preoperatively evaluated with radiographs and CT 3D reconstructions. Post operatively their prognosis assessed by 100 point Constant- Murley scoring system. After attrition, to loss of follow-up, 49 patients followed for minimum 1 year. Their results were analyzed including complications. Results: At the end of one year, sixteen patients (32.65%) had excellent outcome with scores between 86- 100, twenty five patients (51.02%) were functionally good with scores between 70 and 85. Seven patients (14.28%) had scores between 56 and 70, which according to the literature is a fair result. One patient (2.04%) had scores less than 55 points and was graded poor. The Mean Constant-Murley shoulder score was 82.85, thereby falling in the good outcome category. Conclusion: The Proximal humerus Locking Compression plating (LCP) technique gives moderate to excellent results in cases with proximal humerus fractures, depending on the fracture pattern. Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. Good surgical results can only be obtained by vigorous physiotherapy imparted by an expert team and strong motivation from the patient side. The results obtained with using Locking Compression Plates (LCP) were comparable to Proximal Humerus InterLocking System (PHILOS) plates except for varus collapse being common complication while using former fo

The purpose of this study is to compare the findings of magnetic resonance imaging with arthroscopy in internal derangements of knee and to assess the sensitivity, specificity and accuracy of magnetic resonance imaging in comparison to arthroscopy. Methods and Materials: Fifty six patients with history of suspected internal derangement of knee were evaluated prospectively with MRI and compared with arthroscopy during a one and half a year period from January 2016 to June 2017 at Katuri Medical College & Hospitals, Chinakondrupadu, Guntur. 1.5 Tesla MRI machine using a closed extremity coil is used. Commonly used sequences in MRI of the knee include Turbo-spin echo (TSE), FFE (Gradient echo) and Short Tau Inversion Recovery (STIR) sequences in Axial, Sagittal and Coronal planes using a slice thickness of 3 mm with a 0.3 mm slice gap. Arthroscopy of the knee with standard anteromedial and anterolateral portals with the patient in supine position done in all the cases. Observations: The diagnostic sensitivity, specificity and accuracy of MRI in detecting cruciate ligament and meniscal injuries as compared to arthroscopy is as follows: Anterior Cruciate Ligament (ACL): 97.29%, 89.47%, 94.64% ; Posterior Cruciate Ligament (PCL): 100%, 100%, 100%; Medial Meniscus (MM): 100%, 93.33%, 98.21% and Lateral Meniscus (LM): 93.10, 92.59, 92.85. Most common lesions found were ACL and Medial Meniscal tears (posterior horn of MM being the most common site). Summary and Conclusion: MRI is a useful non-invasive modality having high sensitivity, specificity and accuracy in diagnosing cruciate ligament and meniscal injuries. MRI should be considered as the first line of investigation in all patients with suspected internal derangements of knee. MRI being easily available and non-invasive is useful as a pre-operative screening modality, thus improves the quality of diagnostic and therapeutic arthroscopies and further reduces the morbidity. Arthroscopy is the gold standard in diagnosing c

Aim: To compare the effectiveness of peppering technique with single injection technique by using steroid along with local anaesthetic injection in the treatment of chronic lateral epicondilitis(LE) of Elbow. Materials and Methods: In this prospective randomized study, conducted among 66 patients. All patients were divided into two equal groups: peppering technique group (PRI) and single injection technique group (SNI), based on the injection technique. The patients in both groups were treated with local injection of a steroid(1ml Methylprednisolone) and local-anesthetic agent(1ml lignocaine). The effect was measured by change in elbow pain intensity as per Visual Analogue Scale (VAS) for pain. We included patients with Chronic LE of at least 6months duration while patients who have taken previous local steroid injections and uncontrolled diabetes were excluded. Patients were followed up at 2weeks, 6weeks and 6months. The Statistical Package for the Social Sciences (SPSS) version 24 software was used for all statistical calculations. Results: In this study, 66 patients were included (34 male & 32 female) with the most affected between 30-60 years. In our study, there was considerably lesser VAS score at 2 weeks, at 6 weeks and at 6 months follow-ups in both the groups comparing to the pre-injection VAS. At 6-months, the good results were 90%(n=30) in the PRI group compared to 72%(n=24) in SNI group. Thus the success rate for Peppering technique is significantly higher than the single-injection technique. Conclusion: In our study we conclude that peppering injection technique is better than single injection technique in terms of reduced pain which was assessed by VAS in the treatment of chronic lateral epicondylitis of elbow in the long-term follow up. Keywords: Tennis elbow treatment, Local injection, Corticosteroid, Chronic lateral epicondylitis, Peppering technique

Introduction: The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. Arthroscopic reconstruction of torn ACL has become the gold standard in treating ACL tears. The surgical reconstruction of the anterior cruciate ligament with auto graft represents an attempt to reestablish knee kinematics. Materials and Methods: This is a prospective type of study conducted at NRI Medical College & General Hospital, Chinna Kakani, Guntur, Andhra Pradesh. During the period of December 2015 to November 2017 in ACL injuries, reconstruction of ACL using autologous quadruple hamstrings graft. All the cases were operated electivley on regular operation theatre days. Results: The present study consists of 30 cases of complete ACL tear treated surgically with arthroscopic ACL reconstruction. In age distribution, 10 (33.3%) patients were between 18-24 years, 13(43.3%) were between 25-31 years and 7(23.3%) were between 32-38 years. In sex distribution, there were 27 (90%) males and 3(10%) females. Left lower limb was involved in 12 (40%) cases and right lower limb in 18 (60%) cases. All the cases were operated electivley on regular operation theatre days. ACL associated with medial meniscus injury in 8(26.6%) and ACL associated with lateal meniscus injury in 2(7.2%). Chronic ACL injury in 22(73.33%) and acute ACL injury in 8(26.6%). Post operative complications like Anterior knee pain in three patients(10%) treated with analgesics, Infection (Superficial)in one (3.3%) treated with intravenous antibiotics, deep Infection in one (3.3%) treated with intravenous antibiotics+ debridement finally hardware removal and extensor lag in one (3.3%) treated with rehabilitation. Conclusion: Clinical outcome after arthroscopic anterior cruciate ligament reconstruction using autologous quadrupled hamstrings graft with post operative rehabilitation is excellent to good and patients will have near normal pre injury activity level. Keyw

Introduction: Periarthritis shoulder is unique condition, in sense that same pathology does not affect any other joints in particular other than shoulder.2 Spontaneous occurrence of pain in shoulder unrelated to injury, but at times associated with injury in 20-30% of cases.2 Main aim of treatment is symptomatic pain relief followed by restoration of normal joint movements. Manipulation under General Anesthesia (MUA) appears to be mainstay of treatment for people who do not benefit by physiotherapy and universal shoulder mobilization exercises.3 Aim of Study: To study effect of manipulation under general anesthesia on Periarthritis shoulder. Objective: To study improvement in Range of Movements, Pain and Short DASH score. Materials and Methods: Study was carried out in Pushpagiri Institute of Medical Sciences and Research Centre during September 2010 to September 2012. 40 patients were selected for the study, underwent MUA with intra-articular steroid injection (40mg/ml methyl prednisolone), 2% Lignocaine (5ml) and Hydrodilation (40ml cold normal saline). They were started physiotherapy immediately and continued. Result: Among the 40 patients 6 patients never returned for follow-up. Data analysis of remaining 34 patients shows improvement in shoulder range of movement. Quick DASH score decreased from 83.72(S.D + 7.1) to 27.66 (S.D + 7.0). VAS score improved from 7.29 (S.D + 1.03) to 1.71 (S.D + 0.84). Conclusion: Periarthritis shoulder, treated with MUA with intra-articular steroid (steroid+Lignocaine) and hydrodilation (with normal saline) result in good immediate pain relief postoperatively and easy breakage of adhesions during the procedure. This followed by immediate physiotherapy decreases pain, adds good functional recovery and early return to daily activities of living. Physiotherapy and universal shoulder mobilization exercises should be continued thereafter to prevent recurrence of symptoms. Keywords: Frozen shoulder syndrome, Adhesive capsulitis, Periarth

Introduction: Knee injuries are commonly associated with anterior cruciate ligament (ACL) avulsion fractures and its management is controversial ranging from conservative treatment to arthroscopic fixation. The purpose of our study was to assess the clinical and radiological results of arthroscopic staple fixation in the management of ACL avulsion fractures. Materials and Methods: This study included twenty-two patients (17 males and 5 females) who were analyzed after undergoing arthroscopic staple fixation for displaced ACL avulsion fractures. The mean age was 32.2 years (15-55 years. The mean follow up was of 21 months (6-36 months). The patients were assessed clinically by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores. Radiological union was assessed in the follow up radiographs. Results: The mean Lysholm score was 95.4 (83-100) and the mean IKDC score was 91.1 (77-100) at the final follow up. Anterior drawer’s test was negative in 20 patients at the end of final follow up while two patients had grade I laxity. Seven cases had associated knee injuries. The final outcome was not greatly influenced by the presence of associated injuries when treated simultaneously. It was found that all the patients when examined at their final follow up were able to return to their pre-injury occupation. Conclusion: The procedure of arthroscopic staple fixation in the management of displaced ACL avulsion fractures was found to be safe and reliable method for producing clinical and radiological outcome. Keywords: ACL avulsion, Arthroscopy, Staple.

The approach of surgical management of distal intraarticular radial fractures is gaining popularity in the current scenario, and there is no concluding evidence as to which method of surgery fares better than the other, this article attempts to compare the radiological and functional outcome of trinary surgical treatment (percutaneous pinning, ligamentotaxis and plate and screw fixation) for distal end radius intraarticular fractures. Materials and Methods: It was a prospective study involving 90 patients who presented with distal end intra-articular radius fractures, each of these patients were randomly assigned to be treated by ligamentotaxis and plate and screw fixation, percutaneous pinning, (n = 30) each who were operated between January 2016 to May 2017 and their data with respect to functional and radiological outcome were collected over one year. Results: In this research paper out of the 90 patients, the excellent scores were in 13 patients accounting 14.4%, good scores 47.8% in 43 patients and fair and the poor scores 25.6% and 12.2% functionally were seen in 23 and 11 patients respectively, The Cramer s V value was not found significant, the values noted are 0.84. A significant association between groups and Volar tilt, Radial angle and Radial shortening. Cramer’s V was found to be significant (P- value 0.0001) radiologically. The outcome with respect to radiology and the function was measured using werley and gartland scoring and the lidstorm scoring system. Conclusion: In this study the open reduction and internal fixation with plate and screws gave a restored radiological outcome compared to the ligamentotaxis and percutaneous pinning group but the functional outcome remained the same in all the three treatment groups. Keywords: Distal radius Intra articular fractures, Volar locking plate, Percutaneous Kirshner wire fixation, Ligamentotaxis.

Aim: To evaluate the functional outcome of supracondylar femur fracture treated by locking compression plate. Materials and Methods: Our study consists of 20 cases of supracondylar femur fracture operated at Sanjay Gandhi institute of trauma and orthopaedics from November 2015 to march 2017.Functional outcome was assessed through Neers scoring system. All the cases in the study were posttraumatic. Mean duration of follow up was 11 months Results: There were 7 male patients and female were 13.Average age of the patients was 40.5 years with age ranging from 18 years to77 years.14 cases involved the right femur whereas 7 left sided femur fracture occured. The study included only one case of compound type 1 femur fracture and 19 cases were closed supracondylar femur fractures. The mode of injury was RTA for 12 cases and 8 cases had history of self-fall. Only 3 cases had associated injuries. In patients with associated injuries early rehabilitation were delayed but results were comparable with other cases of the study. In our study Muller type A3 was the most common fracture presentation which consists of 7 cases followed by 5 type A1 fractures. There were 4 cases of type C1 fractures, 2 cases of type C3 fracture and one case in each type A2 and C2 group. 5 cases were operated under MIPPO technique which were extraarticular fractures. Further all fractures which had articular involvement were operated on standard open approach. Average surgical procedure timing was 101.5 minutes in our study. Most of the patients had excellent postoperative knee flexion with average knee flexion of 119 degrees. Average duration of radiological union was 19.3 weeks and average duration of weight bearing was 20.3 weeks.1 patient in the study had delayed union, 2 cases had a extensor lag of 5 degree while 1 patient had an extensor lag of 10 degrees. 10 cases in the study had fracture union without any complications. Stiffness was present in 7 cases, Knee pain was reported in 3 cases. 1 cases had shortening of 1cm .Superficial infections were reported in two cases which responded to intravenous antibiotics based on pus culture report. There was no incidence of deep surgical site infection in our study. In our study there was one case of implant failure requiring revision surgery. The patient had a episode of fall 3 months after primary surgery. Radiograph showed implant failure with varus deformity at the fracture site and no signs of callus formation. Keywords: LCP, Supracondylar femur fracture, Distal femur fracture, Functional outcome

Intracapsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. 2-3% of all femoral neck fractures occurs in adults younger than 50 years and is often the result of high-energy trauma. Femoral neck fracture continues to be considered as an unsolved fracture in view of poor prognosis and variable outcome reported after different procedures. In developing countries the fracture often remains untreated as the patients do not seek treatment due to non availability of treatment facility or may be treated primarily by osteopaths or operated under suboptimal theatre conditions with poor quality implants. We prospectively studied the outcome of 54 patients managed with non vascularised fibular graft and cancellous screws between 2010-2015. ANOVA test was used as a test of significance and functional results were assessed by Modified Askin and Bryan criteria. To conclude, in patients younger than 60 years of age with neglected femoral neck fracture, non vascularised fibular graft acts as a reliable biological implant for revascularisation and gives excellent functional outcome. Keywords: Neglected neck, Femur fracture.

Introduction: Due to modern lifestyle changes, the incidence of distal femur fractures has risen and more so in association with shaft fractures of femur because of fast world and high velocity trauma occurring in road traffic accidents. Dilemma arises when we face distal third shaft and associated supracondylar or inter-condylar fracture of femur. The aim of this study is to remove the hesitancy of performing retrograde nailing by long IMSC nail without any complications. Materials and Methods: A prospective study of 150 patients with fracture of femur shaft and supracondylar fractures was done. They were treated by using this technique, from January 2003-2017. These patients were followed up till fracture union & evaluated further postoperatively for finding its benefits. Results: In our study, the mean age of patients was 35 years. 65.3% were males and 34.7%% were females. The mode of injury in case of majority of the patients had RTA (road traffic accident) 93 patients (62%). In the present, surgical and technical related complications were encountered in 10 patients (6.7%). Our patients had a mean value of 80 points according to Neer score. Conclusions: We conclude that retrograde long IMSC nail is reliable as an alternative for conventional procedures like ante-grade nailing and plate fixation in femoral fracture shaft and supracondylar region. It is especially beneficial in conditions like osteoporosis, pregnancy & previous implant or prosthesis on ipsi-lateral side and ankylosed hip. Retrograde nailing can be done on simple radio-luscent top operating tables which are commonly available everywhere. Keywords: Femur shaft fractures, Supracondylar femur fractures, Retrograde long IMSC nailing, Fracture union.

Introduction: The anatomy of the joint makes it very unstable in cases of fractures or ligamentous injuries of the ankle, because the whole body weight is transmitted through the ankle and locomotion depends upon the stability of the ankle joint. In the post-operative period, the protocol of mobilization of the ankle has been a topic of conflict. The goals of treatment include achieving sound union of fracture and an ankle that moves and functions normally without pain. Materials and Methods: This is prospective consecutive case series of 60 patients of bimalleolar ankle fracture, undergone internal fixation in the form of plate fixation over posterior surface of fibula for lateral malleolus and cancellous screw fixation for medial malleolus. Data collection was done using history sheet, clinical examination, and radiological examination at intervals while functional outcome was assessed at follow up visits using Weber’s assessment protocol. Results: 50 (83.3%) cases radiological union is achieved by 6 weeks while 10(16.7%) cases union time was 10 weeks. Average time for union was 6.7 weeks. The final outcome as per the Weber’s assessment protocol was 50% as excellent, 40% as good and 10% as poor result which showed good correlation with level of reduction achieved graded from immediate post-operative radiographs. Conclusion: Accuracy of reduction and rigid fixation was found to be a major determinant of functional outcome irrespective of the type of fracture. Posterior plate fixation gives bicortical screw purchase leading to secure fixation, no intra- articular penetration, decreased complications, hardware prominence and wound dehiscence. Keywords: Bimalleolar ankle fracture, Weber’s assessment, Lateral malleolus, Kristensen grade, Lauge-hansen classification.

Introduction: Anterior Cruciate Ligament (ACL) is the most frequently injured knee ligament. Combination of valgus force with internal rotation is the most common mechanism involved in ACL injury. Both modifiable and non-modifiable risk factors are responsible for the ACL injury. Purpose: To determine the risk factors causing ACL injury by comparing lower limb anatomical features, ACL size and body mass index (BMI) between ACL deficient and ACL intact knees. Materials and Methods: Mechanical axis deviation from vertical axis, tibiofemoral angle, hip neck-shaft angle, posterior tibial slope, notch width index were compared using radiography. BMI and ultrasonographic (USG) diameter of ACL were also measured for comparison. Results: Among the anatomical lower limb parameters mechanical axis deviation from vertical axis, hip neck shaft angle and tibiofemoral angle showed non-significant (p value>0.05) differences while there were significant differences of femoral notch width index (p= 0.014) and posterior tibial slope angle (p

Introduction: Tibial plateau fractures are the common injuries that may be associated with poor outcomes and a high rate of complications. The problem rise significantly in high energy trauma and severe soft tissue injuries. Locked compression plating system has clear biomechanical advantages and avoids iatrogenic tissue damage when compared with conventional plating. The purpose of surgical management is to restore and preserve normal knee function. It can be accomplished by anatomical restoration of articular surfaces, maintaining mechanical axis, restoring ligamentous stability and preserving a functional pain free range of motion of knee. Materials and Methods: This is a prospective study of 36 patients with tibial plateau (Schatzker type I, II and III) fractures fixed with lateral locking compression plate over lateral surface of tibia and followed for a minimum period of 6 months and evaluated by using Rasmussen knee score system. Results: All patients were followed properly but two patients were lost to follow up so only remaining 34 patients were finally evaluated for functional outcome. Mean age of patient was 38.8 years with range of 19 to 70 years. All fractures united by average of 17.5 weeks (range 14-25 weeks) with delayed union observed in 6 cases. Three patients had wound dehisence, three varus deformity, one deep vein thrombosis, four arthritis and five cases of each knee joint pain & stiffness. According to Rasmussen's scoring system, 52.94% patients had excellent results, 32.35% patients had good, 8.22% fair and 5.88% poor result. Conclusions: Locking plates are good option for lateral tibial condyle fractures with minimum complications. Anatomical reduction can be easily maintained with locking plates, which also helps in early mobilization and hence obtaining good functional outcome in tibial condylar fractures. Keywords: Tibial plateau fractures, Schatzker (type I, II and III) classification, Locking compression plate, Rasmussen knee score

Introduction: The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) has been widely discussed in the orthopaedic literature. Theoretical and functional arguments and survivorship have all been used to support both its retention and its substitution. Moreover, with the advent of robotics and ever evoluting kinematic surgical procedures, the results for the cruciate-retaining arthroplasties are found to be more variable than for the cruciate substituting arthroplasties. The present study is sought to investigate if there was a difference in the clinical outcome as measured by the commonly-used scoring systems which includes (International Knee Society Score, Western Ontario McMasters Osteoarthritis (WOMAC) index and the SF- 36 health survey along with the radiological scores and outcomes of the two procedures in TKA. Methodology and Results: We performed a prospective, randomized trial of 30 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior- cruciate-ligament substituting total knee arthroplasty. Statistical analysis was performed using the Student’s t-test and ANOVA test for multiple trials. At follow-up at 3 months, no statistically significant differences were found in the clinical outcome measurements for either design. The results of theWOMAC 35 score which were subdivided into pain, stiffness and function showed high scores for cruciate substituting groups for pain as compared to the cruciate retaining groups whereas, other parameters were same in both the groups. For other systems including SF-36 and knee society score the results did not seem to vary to a great extent statistically. Conclusion: To conclude the present study found almost similar results for Cruciate ligament retaining and substituting procedures in long term follow up at 3 months, with slightly better outcomes for Cruciate ligament retaining groups at the earliest phases pre operatively and post operatively. Key

Introduction: Inter-trochanteric fractures are one of the commonest fractures encountered in orthopaedic practice. Treatment of inter-trochanteric fractures had turned from totally conservative in the pre ‘70s to totally surgical now. Many surgical methods like Jewet nail, Gamma nail and condylar plates had been tried and given up. The commonest method used now are Dynamic hip screw (D.H.S) system and Proximal Femoral inter-locking nail (P.F.N) system. Materials and Methods: This, prospective study was conducted in Sri Venkateswaraa Medical College, Pondicherry from May 2015 to May 2017. 30 (Thirty) consecutive patients of age over 55 years, with inter-trochanteric fractures were studied. Of these 30 patients alternate patients (15 patients) were treated with minimally invasive D.H.S and the other 15 patients were treated with P.F.N. They were reviewed every 2 weeks. Their functional results were analysed using modified Harris hip score.37 Results: Males predominated in our study. 70% were left sided. Mean time of surgery with incision for D.H.S group was little longer than P.F.N group. P.F.N group bone weight earlier than D.H.S group. Blood loss was more in D.H.S group. There was no difference in mean hospital stay in both groups. P.F.N group patients bore weight earlier in both unstable and stable fracture groups. P.F.N group healed earlier than D.H.S group. The D.H.S group bore weight much later. There was only one complication in both groups. Bony union occurred earlier in P.F.N group than D.H.S group. Conclusion: The P.F.N group required shorter incision and had less blood loss. They were able to bear weight earlier in both stable and unstable groups, whereas D.H.S group with unstable fractures took long time to bear weight. The P.F.N group fractures healed earlier than D.H.S group. At the end of six months, the modified Harris hip score showed no marked difference between two groups. Considering all this, we conclude PFN is a better device to treat inter

Introduction: Hip is one of the important joint for locomotion in human beings. So fractures in and around hip joint are of great concern to treating surgeon and patient. We have made an attempt to evaluate these complex fractures and compared the efficacy of proximal femoral nail and extamedullary devices in treatment of subtrochanteric fracture femur. Materials and Methods: After informed consent was given, all 56 consecutive patients with subtrochanteric fracture of femur were randomized into two treatment groups. One group of patients were treated with dynamic hip screw or Dynamic condylar screw (Group I) and other group received proximal femoral nail (Group II). All procedures were performed by staff surgeons with patient supine on a fracture table. Result: The mean operative time in Group I (93.57 min) was significantly higher than in Group II (80 min) with a P value of Conclusion: We conclude that subtrochanteric fractures are difficult to understand and manage. We consider that the PFN is a good minimally invasive implant for unstable proximal femoral fractures when closed reduction is possible. In general, PFN afforded early return to physical activity, faster rehabilitation & walking ability, lesser blood loss and comparable success rate. Keywords: Extramedullary fixation, Proximal femoral nail, Subtrochanteric fracture femur, Dynamic condylar screw.

Fractures of distal radius in metaphyseal region in paediatric age are one of most common orthopaedic injuries in the paediatric emergency department.1,2 The distal radius is considered as most common fracture site in the forearm fractures, accounting for 20–30%.3, 4 The presence of epiphysis, adjacent to the fracture, poses challenge in managing these fractures by conservative or operative means. There are concerns about the maintenance of reduction in conservative treatment, ability of the bone to completely remodel after malunion, especially fractures in children over the age of 10 years. In this study, the distal radius paediatric metaphyseal fractures, which were grossly displaced and/ or angulated were treated using Sauve Kapandji's reduction maneuver and were fixed with two parallel or cross smooth K wires. This mode of treatment gave satisfactory correction of fracture and maintainance of reduction till the union time. Grossly displaced fractures, children over 10 years, inadequately reduced fractures, the results found to be less than satisfactory. Sauve Kapandji's method of intra focal reduction gives excellent reduction, maintainance of reduction and also predictable and reproducible results in terms of function and cosmesis. Here we are retrospectively studying 20 consecutively treated patients of distal third metaphysial fractures of radius by using Sauve Kapandji’s method of intrafocal reduction and fixation with K wiring at Belagavi Institute of Medical Sciences between Jan 2017 to Dec 2017. Keywords: Distal radius, Metaphysial, Sauve-Kapandji’s method, Deformity.

Introduction: Trigger finger is caused by irritation of the flexor tendon as it slides through the fibro-osseous sheath. Its surgical options include open and percutaneous minimally invasive methods. Aim: This study is aimed at elucidating the efficacy of percutaneous release of trigger finger. Materials and Methods: This is a prospective study carried out in our institution Shri Guru Ram Rai Medical College Dehradun, India over a period of 2 years from June 2015 to august 2017. This study includes 68 trigger finger and thumb of 58 patients between 28 to 64 years. Here percutaneous trigger finger release of A1 pulley was done with the help of 18G hypodermic needle under local anaesthetic cover as a day care procedure. Subsequently the patient was followed up at least for 3 months. Results: Symptoms were resolved completely in all patients. None had any serious complication. Only a few patients had minor temporary wound related complicationsand temporary stiffness. Conclusions: Percutaneous release of trigger finger is effective, convenient, cost effective day care surgery without any significant complications in skilled hands. Keywords: Trigger finger, Percutaneous.

Introduction: Non-union of long bones is a challenging scenario to deal with as management of such fractures is difficult. Tibia is common site of non union.1 Various modes of treatment are available such as ultrasound, electrical stimulation, bone grafting and bone transport by illizarov and rail fixator. We have compared the role of Ilizarov and Rail fixator devices in our study of 15 patients each under both groups. Only Rail fixator had some more patient tolerance as compared to Ilizarov due to problems such as heavy apparatus. Materials and Methods: 15 patients of non union long bones in each group from 21 to 60 years with mean age of 37.6 year in group A and 40.5 years in group B. 90% of the patients were male. Most of the patients had non union of tibia and further the middle one third was more commoly involved in either group. Nine out of 15 patients in both the groups had infected type of non-union. Average shortening was 2.9 cm in group A and 2.86 cm in group B. Maximum number of patients had undergone about two previous surgeries. 12 patients underwent acute docking or compression in group A compared to 13 in group B. Three and two patients underwent compression – distraction for treatment of non union in group A & B respectively. Patients were followed up at 6, 12 and 24 week intervals. Result: In our study union was seen in 13 cases in group A and 14 cases in group B. The duration for union was average 8.8 months and 8.1 months in respective groups. Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 80% of the cases in Group A and 86% of cases as per ASAMI scoring system. Conclusion: Bone results were more or less similar in both the groups. Functional results were a bit better in rail fixator group. Rate of complication were also similar in our study. However patients tolerated rail road with ease and application of rail fixator and comfortable distraction procedure had marginal benefit over

Introduction: A very common problem that we come across is that of lower backache in middle aged and elderly, in which disc prolapse is far more prevalent in the population than realised. However, radicular steps like spine surgery is a frightening concept for most. In our world, where technology has undergone such advances, offering a concept like day care spine surgery that too under local anaesthesia for relief of radicular pain, will be a welcome breath. This treatment option not only works faster than epidural injection or oral pain relievers, but also is a more permanent mode of treatment in a tertiary care centre where patient load is a big issue. Objectives: The aim of this study was to determine the success and surgical outcome of percutaneous transforaminal lumbar endoscopic discectomy on patients with disc prolapse and benefit to the hospital due to rapid turnover of patients. Material and Methods: Total 20 patients were followed and reviewed in Civil Hospital, Ahmedabad from between July to December 2016. Visual Analog Scale (VAS) was used to assess relief from pain and radiculopathy and Macnab’s criteria to know the patient satisfaction. Results: At the end of 6 weeks, mean post-operative VAS was 3 as compared to pre-operative 8.8 Macnab’s criteria gave excellent and good results in 80% individuals. Mean hospital stay was 1.2days with no complications like dural tear or infection. One patient underwent open discectomy. Conclusion: Transforaminal lumbar endoscopic discectomy is a novel technique for most of the government tertiary care centres with many patients but lacking advanced technology. Inspite of having a steep learning curve and high one time cost of instruments, it could become gold standard as it relieves symptoms immediately reducing surgical and anaesthetic complications. It being a day care procedure results in rapid turnover of patients. Keywords: Transforaminal, Lumbar discectomy, Percutaneous endoscopic.

Objectives: Comparison of operative management and functional outcome of femoral intertrochanteric fractures by dynamic hip screw v/s proximal femoral nail implants. Materials and Methods: During 2013 to 2016, 50 patients with intertrochanteric femur fracture were prospectively studied. Fractures included were AO type 31 A1 & A2. 25 patients each were taken in two groups DHS & PFN. These groups were compared for functional outcomes based on parameters: Harris hip score, operative time, radiation exposure, blood loss and postoperative rate of union. Results: The age group in both groups was comparable with mean of 72.9 years. Domestic fall was found to be the most common cause of intertrochanteric fracture femur. Among the patients, 12 had A1 type fracture while 38 of them had A2 type fracture. PFN had the mean blood loss of 111.8ml as compared to 325.6 ml in DHS group. Radiation exposure was greater in PFN than DHS surgery. PFN had the mean operating time of 116.4 min and DHS had 106.4 min. Among the DHS treated group one case had superficial infection while two cases went into non union. Of the PFN treated group Z effect was observed in one case. Although the PFN treated patients showed a better Harris Hip Score on the initial 3 month follow up, both the implants DHS & PFN had a similar functional outcome on long term follow up. Conclusion: Any patient with intertrochanteric femur fracture AO type 31A1 & A2 treated with good surgical skill and reduction of fracture was achieved has similar results with DHS or PFN. Keywords: Intertrochanteric fracture, Dynamic hip screw, Proximal femoral nail.

Introduction: Aim of the study is to measure serum 25 – hydroxy vitamin D levels in patients with knee osteoarthritis in comparison with age matched healthy controls and also to assess the association of 25-OH vitamin with osteoarthritis. Materials and Methods: The study population consists of 240 patients divided into two groups, Group 1 and Group 2. Group 1 with 120 subjects with clinical features of knee osteoarthritis served as controls and Group 2 consists of 120 patients of patients diagnosed with knee osteoarthritis. Serum 25-OH vitamin D was measured in all the participants by the ELFA method and concentrations

Introduction: Ponseti method has become the mainstay of congenital clubfoot treatment in children presenting at early age. The initial efficacy rate of Ponseti method reaches almost 100%. The Ponseti method is also effective in older children with varied degree of success and preventing open joint surgery in almost every case. The Pirani method of evaluating the deformity and treatment outcome is easy and fairly reproducible and corresponds to the functional outcome of the treated feet. Aim: The present study aims at elucidating the efficacy of Ponseti method of clubfoot correction in an inexperienced hand and evaluating the feasibility and worth of Pirani severity scoring system in deformity and treatment evaluation. Materials and Methods: This is a prospective study carried out ii our institution Shri Guru Ram Rain Medical College Dehradun, India over a period of 2 ½ years from June 2015 to December 2017 and includes 44 idiopathic Clubfeet corrective cast application at weekly interval as per Ponseti protocol and were assessed with Pirani scoring system. The cases were followed up regularly at least for 6 months. Results: Following Ponseti protocol, we were able to achieve success rate of 95.45%. We experienced only a few minor complications such as plaster sores and overcrowding of toes that too in initial phase of study. Conclusion: Ponseti method is truly the gold standard of clubfoot management. Using Ponseti method, one can expect to achieve almost 100% success rate. It is also fairly effective in older children though with varied outcome or can at least prevent open joint surgery in them. The Pirani scoring system is clinical based, easy to apply and is in sync with Ponseti method. Keywords: Clubfoot, Ponseti method, Pirani score.

Introduction: Surgical site Infections (SSI) of the musculoskeletal system leads to High morbidity, mortality and sometimes limb amputation. In 1999 US Centre for Disease Prevention and Control (CDC) gave guidelines for prevention and hoped for preventing emergence of antimicrobial resistance for surgeries. Orthopaedic surgeries and arthroplasty inferences from high turnover centers of developing countries with cost effectiveness are always awaited with development of new surgical skill and techniques, better instruments and better anti-infective approach. Objectives: To study the effectiveness of intrawound vancomycin Powder and Special Multidisciplinary approach to control SSI in musculoskeletol surgeries. Materials and Methods: We have analysed (n=210) patients operated for trauma, joint reconstruction and arthroplsty orthopedic surgeries during 12 months duration retrospectively. Mean age was 51 and all operated with multidiscipline approach. Patients were evaluated by ASEPSIS Score. Results: In our study SSI rate was 13.88% in open fractures surgery out of (n= 36) patients and 1.33% in closed procedures out of (n=150) patients and total rate of Surgical site infection was 3.33% in our study with 95% confidence Interval (95% CI). Conclusion: Intrawound vancomycin Powder with strict adherence and implementation of Multidiscipline approach is effective to control SSI which allows major step forward in Preventing SSI and reducing national morbidity. Keywords: Arthroplsty, Orthopaedic, Vancomycin, Multidiscipline approach Introduction

Introduction and Objectives: Among all the known tendinopathies plantar fasciitis and tennis elbow account for most cases.Corticosteroid injections considered the treatment of choice for tendinopathies. Emerging therapeutic modalities is the use of platelet rich plasma for tendinopathies having the advantage of being autologous and concentrated that are rich in growth factor proteins. The study was done to find the efficacy of these two modalities. Materials and Methods: The study was done at Rajarajeshwari Medical College and Hospital, satisfying the inclusion criteria and exclusion criteria. In this study, 3 ml of the extracted PRP or 40 mg of prednisolone was injected into the affected area. Post-intervention pain and functional assessment at 2 weeks, 6 weeks, 3 months and 6 months with visual analogue score and ankle hind foot scale and foot and ankle disability index score. Results: The age in our study was 18 to 55 years, the mean in the steroid group was 37. 3 and in the PRP group was 37.43, right side was most commonly involved 52%. In both the groups there was significant difference in the VAS scores p In both the groups there was significant difference p Interpretation and Conclusion: PRP has better effect pain in patients with longer duration as compared to local steroids but the difference is not statistically significant. The making of PRP is cumbersome but the patients did prefer to steroids due to the adverse effects. Keywords: FADI- Foot and ankle disability index score, PRP- Platelet-rich plasma.

Introduction: The Lumbosacral angle (LSA), is the angle formed between a line across the plane of the superior margin of the sacrum and a horizontal line. Various literature and studies around the world shows wide normal variation in LS angle, ranging from 320 to 440. Abnormal variation in LS angle is commonly associated with low back pain. Hence research involving study of normal variation of LSA in different ethnic population plays a significant role. In Indian scenario very few studies are available, especially from rural population, to know up to what extent, variation in LS angle is normal. Hence, the present study attempts to study the normal variation in LSA in rural population of Telangana. Materials and Methods: A descriptive study of normal LSA variability, involving 100 asymptomatic subjects between the age group of 20-60 years was carried out in orthopedic department of Medical College hospital, Telangana. Ferguson’s technique was employed for calculation of LSA. Results: In this study variation of LSA ranges from 280 to 600. Overall average LSA was 340.Females have greater average LSA as compared to males. Conclusion: Results of the present study show variability when compared to other similar studies, which further strengthen the fact that normal variation in LSA differs among different region and races; hence results of the present study will be a useful tool to health care providers for treating different spinal disorders of rural Telangana population. Keywords: Lumbosacral angle (LSA), Ferguson technique, Lumbar lordosis, LSA Variation, Spinal maturity.

Introduction: Long bone fracture of forearm is common skeletal injury. The most common causes of such injuries include road traffic accident, fall or direct trauma, amongst the various types of forearm fractures, both-bone diaphyseal forearm fractures in adults are frequently met by the orthopaedic doctors. There are various methods available for fixation of both bone diaphysial fractures like both bone plate fixation, both bone intramedullary nailing and hybrid method with nailing in one of the bones and plating in other. Our aim of the study is which method of fixation is most clinically justifiable in both bone diaphysial fractures amongst all the available choices. Materials and Methods: This is a retrospective study of 200 cases of diaphyseal fractures of radius ulna selected randomly over a period two year from March 2016 to March 2018 conducted at civil hospital Ahmedabad. All patients were followed up for a period 6 months post operatively. Result and Conclusion: After studying result of all four method of fixation hybrid fixation showed good union rate, less chance of infection, less chance of malunion and non union,relatively good stability, less incidence of swelling and better recovery with a less chance of implant removal incidence and failure. Keywords: Radius ulna fracture, Plating nailing, Both bone diaphyseal fracture.

Introduction: Patients with Developmental dysplasia of hip many a times present later in the age due to missed or delayed diagnosis. The treatment of DDH is mainly dependent upon the age of the child at the time of presentation and varies according to it. In the late presenting cases it is mostly surgical with open reduction alone or in combination with pelvic and femoral osteotomies. Materials and Methods: This study between October 2012 and October 2014 includes 21 patients with unilateral dysplastic hips, surgically treated with a single stage procedure of open reduction and Acetabuloplasty of Pemberton, along with Varus derotation osteotomy and femoral shortening when necessary. Preoperatively they were classified according to Tonnis grade. Clinical assessment was done using Modified McKay’s criteria; Radiological evaluation was done using Severin’s radiographic criteria. Results: The mean follow up period was 15.14 months and the mean age at surgery was 66.86 months. McKay’s grades were excellent in 8 hips, good in 11 hips, fair in 1 hip and poor in 1 hip. Severin’s score was excellent in 4 hips, good in 15 hips, fair in 1 hip and poor in 1 hip. Conclusions: Every case of DDH is unique. The type of surgery chosen depends on the clear understanding of each hip after using the available resources. The combination of open reduction with pelvic and/ or femoral osteotomy when needed gives good immediate stability and promotes remodelling. This surgery is a technically demanding procedure but when performed properly by an experienced surgeon, it does give satisfactory results. Keywords: Developmental dysplasia of hip, Late presentation, Open reduction, Pelvic and/ or femoral osteotomy.

Introduction: The menisci are crucial structures of the knee in maintaining function. Meniscal repair has gained importance as meniscectomy causes early arthritis. Arthroscopic repair of meniscus has become the mainstay of management replacing open surgery, because of decreased duration of surgical procedure and better accessibility to the tear location. Methods: This study prospectively evaluated functional outcome in 34 patients who underwent arthroscopic meniscal repair. Tears involving outer (red-red), middle and inner (white-white) zone were included for repair. Complex and degenerative tears were excluded from repair. Follow-up consisted of clinical assessment by using Barrett’s criteria and comparison of pre-operative and post-operative Lysholm knee score. In the absence of joint-line tenderness or effusion, and if the McMurray test was negative, it was considered that the repaired meniscus has healed. Results: After a minimum of 1.5 year follow-up, 32/34 of the cases that underwent meniscal repair were asymptomatic for meniscal tears. The mean Lysholm score increased to 95.2 as compared with the preoperative mean value of 61. Arthroscopic meniscal repair was not associated with any neurovascular or other major complications. Conclusion: Stabilizing the meniscal tear by arthroscopy in all three zones appears to be an effective procedure. Keywords: Meniscal repair, White-white zone, Arthroscopy.

Patients undergoing Total knee arthroplasty (TKR) are transfused at the rates of 11-21%. As per ISHKS joint registry, data of 34,478 TKRs was assessed: Average age was 64.4 years These Geriatric patients are exposed to complications as a result of major orthopedic surgery and postoperative anemia, which exposes the patient to the complications associated with transfusion as well as increasing their duration of hospital stay. Geriatric patients are prone to existing comorbidities and are susceptible to risk factors, predisposing to Venous Thromboembolism (VTE). In our single center based short series study, we look to compare the efficacy of hemoprophylaxis provided by intravenous & intra-articular tranexamic acid. Our aim is to find an effective protocol to reduce postoperative anemia whilst minimising risk of VTE’s. Keywords: TKA, Tranexamic acid, Chemoprophylaxis.

Fracture of capitellum is a rare fracture of distal humerus mostly seen in young adult. At present time there are different method of treatment and fixation of capitellum are available and described in literature. In this article we present diagnosis and management of different types of capitellar fracture in rural medical college with available instruments and implants. Between 2007 to Sept 2015 eight patient of capitellum were treated in our hospital. There were five male age16 to 30 years and three female patient age 22years and 45 years. In two cases the fracture was missed by private hospital and managed there conservatively by above elbow POP cast for 6 and 8 weeks marked stiffness of elbow present in both cases. Six cases came directly to our hospital. In these eight cases six cases were type one (Hahn steinthal fracture), one was Mc kee type four type and one case was associated with fracture of lateral condyle. All cases were treated under general anaesthesia and tourniquet by open reduction through modified Kochers approach and internally fixed by 4mm partially threaded cancellous screws inserted from posterior part of lateral condyle avoiding the penetration of anterior articular surface. All the fractures united uneventfully except one with loss of 15 degree in flexion and extension. Radiologically no signs of AVN and arthritis were present in seven cases but mild arthritis was present in one case. Screws were removed after 12 to 18 months of surgery. We got good result by using modified Kochers approach and fixation by partially threaded cancellous screws. We use Mayo elbow performance score to evaluate the result of surgery which was excellent in seven cases and good in one case. Keywords: Capitellum fracture, Hahn- steinthal fracture, Internal fixation, Mc. Kee type IV fracture.

Introduction: Achilles tendon is the strongest tendon in the body, paradoxically is also the commonest one to undergo rupture. Corticosteroids are one of the most commonly used drugs in tendon disorders; also it is blamed for early and late ruptures. We wanted to assess whether there is any difference in functional outcome in steroid-induced TA rupture group versus spontaneous (no steroid injection) TA rupture. Materials and Methods: A total of 12 patients were included in the study as per inclusion-exclusion criteria and preoperatively grouped based on previous history of intralesional steroid injection. Both the group underwent same tendon augmentation surgeries and similar physiotherapy protocols. Functional outcome was assessed using AOFAS and Leppilahti Scores. Results: Better functional outcome was seen in the group with no previous exposure of intralesional steroid injection which was statistically significant (p Conclusion: Uses of intralesional steroid correlates negatively with outcome. Keywords: Achilles tendon disorders, Tendo Achilles ruptures, Peroneus Brevis, Intralesional steroid injection, Tendon augmentation surgeries.

Background: Present study was done to compare the effectiveness i.e. range of motion and incidence of failure rates, recurrence and pain of arthroscopic repair versus open surgical techniques for the management of recurrent anterior shoulder instability. Materials and Methods: Institution based open-label, comparative clinical study was done at Medical College and Hospital, Kolkata between March 2016 to August 2017 (1.5 years). Based on the result of a similar previous study, a sample size of 15 in each group was calculated. Therefore, 15 cases of anterior shoulder instability treated by arthroscopic method and 15 cases treated by open surgery have been selected for study. Inclusion criteria were patient with soft tissue Bankart’s lesion, bony Bankart’s lesion, humeral avulsion of glenohumeral ligament (HAGL), anterior labral posterior sleeve avulsion (ALPSA), glenoidlabrum and articular disruption and capsular stretch and injury. Study tools were used like Modified Rowe score, ASES (American Shoulder and Elbow Society) score and Goniometer. Operative techniques were used like arthroscopic capsulolabral repair and latarjet procedure. Results: About 14 (93.3%) patients were negative in bony apprehension test in arthroscopic technique. Approximately 15 (93.8%) patients were positive in bony apprehension test in Open technique. Association between bony apprehension test in two groups was not statistically significant (p difference was found between according to CT scan report in two groups (p=0.30910). Mean Rowe pain was significantly higher according in arthroscopic technique compare to open technique at 6W and 9W follow-up period. Mean Rowe stability was significantly higher according in arthroscopic technique compare to open technique at 6W and 9W follow-up period. Conclusion: Both arthroscopic and open surgical methods are utilized for management of anterior glenohumeral instability. The use of arthroscopy has increased significantly in today’s practice an

Introduction: Adhesive capsulitis is one of the shoulder’s most common benign disorders. Its etiology varies from post-traumatic, association with diabetes and hypothyroidism to idiopathic. According to many research studies it is a self-limiting condition, according to its natural history it takes around 9 months to 2 years to resolve. Patient has to suffer the morbidity until then. To hasten the resolving process many treatment methods have been proposed ranging from non-invasive types like physiotherapy and manipulation under GA to minimally invasive types like local infiltration of steroid, platelet rich plasma, hyaluronic acid and arthroscopic capsular release. In this study a comparison has been made between the efficacy of combination of arthroscopic capsular release with sub acromial decompression, rotator interval release plus MUGA and only MUGA. The results obtained in the study are also discussed and compared with the existing literature. Materials and Methods: An prospective interventional study of 40 patients aged between 30 to 60 years suffering from primary adhesive capsulitis refractory to treatment with physiotherapy [Dr. Brian Dierckman protocol] and analgesics for a period of 6 months, hence treated with combination of arthroscopic adhesiolysis with sub acromial decompression, rotator interval release plus MUGA and only MUGA was done. Patients have been randomly allocated into 2 groups (20 patients in each group) by simple random sampling using chits. The outcome of the patients in each group has been observed and followed up to a period of 6 months. Result: Statistically there is a significant difference between the outcomes of only MUGA and combination of arthroscopic adhesiolysis with sub acromial decompression, rotator interval release and MUGA. Arthroscopic adhesiolysis with sub acromial decompression, rotator interval release and MUGA shows superior results in both the Oxford shoulder score and visual analogue scale from 1 month follow up

Earlier, in the beginning of 20th Century, orthopedic spinal disorders would be the candidates for conservative management. These patients often lost the best chances for neurological and functional recovery and suffered long term morbidity. Various methods of operative intervention are used. Out of all methods, anterior decompression and reconstruction with or without stabilization is the most attractive modality from orthopedic and rehabilitation point of view. The purpose of this study is to show the role of anterior decompression and reconstruction of the spine using cage graft with or without instrumentation. 22 patients are included in this study with mean follow up of 24 months. Outcome measures for the study were: Denis Pain Scale, Denis Work Scale, and Bridwell Grading System of fusion. Spinal injuries are more common in males while tuberculous and degenerative spinal disease are common in females. Most of the spinal injuries are concentrated over D-L region while tuberculosis in dorsal spine. Cervical & Lumbar spines are prone to degenerative changes. Outcomes with Denis pain scale suggested that maximum pain was seen in patients with traumatic and degenerative spine, with Denis Work Scale suggested that out of 22, 10 were totally disabled, 7 were cases of traumatic paraplegia whereas 3 were of tuberculous spine and of Bridwell grading system of fusion showed that out of 22 patients 9(40%) had definite fusion status which was primarily assessed by plain radiograph. Hence, in spinal injuries, earlier decompression with rigid reconstruction of spine especially anterior spine fusion achieve good results in terms of neurological recovery pain free rehabilitation and functional recovery. Keywords: Anterior decompression, Cage graft, Reconstruction of spine.

Introduction: The clavicle is most frequently and easily fractured bone, due to direct blow or fall on the outstretched hand. With changing trends in treatment of midshaft clavicle fractures, plating was one of the standard procedure remains for fixation. Recent attracting alternative new technique of fixation is the titanium elastic nailing system (TENS). Due to lacking of prospective studies, the present study was undertaken to assess effectiveness of minimally invasive method TENS for the treatment of midshaft clavicle fracture. Materials and Methods: The study population included 30 patients exclusively with fracture of midshaft clavicle on plain radiographs from January 2014 to June 2015 at a tertiary care centre. Most of cases were operated within 24-48 hours after trauma. Intra operatively, image intensifier was used for monitoring the manipulations and maneuvering of the nails for closed reductions of the fractures. Patients were followed for 6 months postoperatively and then titanium nails were removed. Result: Average age of the study population was 35.8 ± 10 yrs. Most cases were operated within 24-48 hours after trauma. In 24 cases, closed reductions and nailing were done, while in 6 cases, open reductions and nailing were done. Constant score was used to assess the clinical outcome of our patients after union of the fracture. Clinical union was achieved in 3-5 weeks, while radiographic union was achieved in 6-8 weeks. There was no post-operative infection in this study. Conclusion: Operative interventions with TENS showed better results in regards to early functional recovery. The specific advantages of TENS over plating are that it is minimally invasive, needs lesser operative time, and early mobilization. Keywords: Clavicle fracture, Titanium Elastic Nailing (TENS), Closed reduction, Open reduction.