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Background: In India, infected patients with hepatitis B virus (HBV) undergoing total knee replacement (TKA) are increasing. It is recognized that patients with HBV infection are more susceptible to complications after surgery. To evaluate the effect of HBV infection on complications and functional outcome after TKA was the aim of this study. Methods: This is the retrospective observation analysis of patients who underwent primary total knee replacement in our hospital from 2017 to 2019. A total of 92 patients were included in the study, of which 46 patients were asymptomatic HBV-positive, and these 46 patients were compared with a matched cohort of another 46 patients who were non-HBV. Results: A total of 92 patients were analyzed (asymptomatic HBV n = 46, non-HBV n = 46). The incidence rate of total complications in patients undergoing TKA with asymptomatic HBV was 19.57% compared to 4.3% in non-HBV (p < 0.001). Applied with regression models, patients with HBV had an 8.6% increased risk of surgical complication which included one peri-prosthetic joint infection, three wound dehiscence compared with the non-HBV group which had 2.17% surgical complications (one wound dehiscence). Medical complications were higher in asymptomatic HBV group with 10.87% (which includes one pulmonary embolism, two DVT, and two strokes). In comparison with the non-HBV group which had 2.17% medical complications (one DVT), asymptomatic HBV group had 5.35-fold (95% CI 1.09–26.33; p < 0.01) increase in overall complications. Post-TKA surgical complications are 4.29-fold (95% CI 0.46–39.91; p < 0.01) higher compared to non-HBV group. Conclusion: Our study showed asymptomatic hepatitis B patients are at an increased risk of complications (peri-prosthetic joint infections and wound dehiscence) compared to normal patients. In hepatitis B and non-hepatitis B patients, functional outcomes in terms of OKS are comparable. [ABSTRACT FROM AUTHOR]

Background: In severe arthritis cases, goal of total knee arthroplasty (TKA) management is to attain pain-free joint and restore the overall limb alignment. There are limited short-term studies published from Indian hospitals that investigated the importance of neutral mechanical component alignment in TKA patients. Methods: Retrospective and prospective study was conducted at the Department of orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune from June 2020 to September 2022. Enrolled patients were assessed preoperatively and postoperatively using clinical examination, radiological assessment and functional outcomes through the Oxford knee score, Knee society score and VAS score. Results: 204 patients enrolled, and 267 knees were evaluated for the study. Osteoarthritis was the commonest diagnosis (254 knees, 95.13%). Pre-operatively, 92.13% knees were varus, 4.87% valgus and 3% neutral while post-operatively, 51.69% were varus, 16.1% were valgus, and 32.32% were with neutral axis. Majority of patients with a pre-operative neutral axis converted to varus axis (62.5%), while most valgus axis cases preoperatively converted to a neutral axis (53.84%). For pre-operative varus subgroup, the majority patients with < 10° pre-operative axis converted to neutral (41.28%). Majority patients with 10°–20° pre-operative axis remained varus (60.53%) and with > 20° pre-operative axis remained varus (78.26%). Functional outcome parameters were significantly improved at follow-up (P < 0.05). Conclusion: Short-term postoperative functional scores were significantly improved in postoperative cases, with the postoperative alignment of 0° ± 3° relative to the mechanical axis was achieved. Thus, postoperative neutral mechanical alignment of 0° ± 3° can be the standard of care for patients undergoing TKA. [ABSTRACT FROM AUTHOR]

Background: A high dose of statin is used to obtain an intensive lipid-lowering in stroke patients, even in patients with normal lipid levels. There are limited data on effect of dosage of statins and functional outcome in stroke patients. Objectives: 1. To compare serum cholesterol levels with severity of stroke measured by infarct volume. 2. To compare functional outcome measured by mRS at day 90 with the dose of statin. Materials and Methods: This retrospective observational study was conducted in KMC Hospital Manipal, India between 2016 and 2018. Result: A total of 100 consecutive patients were included in the study, out of which 60 (60.0%) were males. Hyperlipidemia was present in 65 (65.0%) patients. On comparing the serum cholesterol levels with infarct volume using MRI, patients with low volume of =70 ml had higher mean serum total cholesterol concentration (223.83 mg/dl), whereas patients with high volume of >70 ml had low mean cholesterol level (218.70 mg/dl). The patients were divided into those who received low dose (=20 mg) versus high dose (=40 mg equivalent) of Atorvastatin. On comparing the mRS values at baseline and on day 90 with the dose of statins, patients who received a higher dosage had a statistically significant fall in mRS (p-0.045) at day 90. Conclusion: It was found that serum cholesterol levels were inversely related to the stroke severity. However, a higher the dose of statins resulted in better functional outcome and survival in post-stroke patients, possibly due to its neuroprotective effect. [ABSTRACT FROM AUTHOR]

Background: Floating knee injuries result from high velocity trauma, are usually associated with multiple injuries making it challenging to treat and lead to high morbidity and mortality. There are no clear guidelines for their management. The aim of this study to evaluate the functional outcomes of operatively treated floating knee injuries in adults and the factors affecting them. Methods: The study was conducted in the Department of Orthopedics in a tertiary care hospital, northern India. Patients who were admitted with Floating Knee Injuries during the study period were enrolled in our study. Data collection of the patients was detailed history, clinical examination, investigations, management and complications of floating knee injury patients. Results: A total of 35 floating knee injury patient was enrolled in our study, predominantly male patients (91.5%), majority of the patients were of young age group between 186-40 years (48.6%). Right side fracture was involved in 60% of cases; RTA was the most common mode of injury (94.5%). 77.2% were open fracture, 62.9% were Type I. The majority of the patients (88.6%) had associated injuries. Common complication of floating knee injuries were shock (51.4%), local wound infection (40%), delayed union (28.5%). Excellent to good outcomes were found in 43% of cases. Conclusions: Floating knee is a complex injury caused by high energy trauma (RTA) with many associated injuries. The factors which determined the functional outcomes were type of fracture, pattern and, site of fracture. [ABSTRACT FROM AUTHOR]

Introduction: Tibial diaphyseal fractures are the most prevalent type of tibia fracture. A well known surgical method for treating tibial shaft fractures was the traditional infrapatellar approach for tibia Intramedullary Nailing (IMN). However, due to increased valgus and procurvatum deformities, IMN insertion through the infrapatellar route poses problems. Recently, suprapatellar nailing in the semi-extended position has been promoted as a safe and effective surgical treatment. Aim: To compare the clinical and functional outcomes of tibial shaft fractures treated with IMN utilising the Suprapattelar (SP) and Infrapatellar Methods (IP). Materials and Methods: A prospective interventional study was conducted on 40 patients, in the Department of Orthopaedics, in Government Medical College, Patiala, Punjab, India from November 2019 to May 2021. The patients were divided into two groups on the basis of tibial shaft fractures treated with IMN utilising the S.P and those treated with I.P techniques during a two year period (20 in each group) with six months followup. Group A patients were treated with IMN in tibia through suprapatellar technique and group B Patients were treated with IMN in tibia via infrapatellar approach. The outcomes of IMN in tibial shaft fractures via SP and IP approach were compared in terms of fluoroscopy time, average surgical time, anterior knee pain using Visual Analogue Scale (VAS) score, average blood loss, fracture union time and functional outcome (in terms of the lower extremity functional Score). For statistical analysis student t-test and chi-square test was used, p-value <0.05 was considered as significant. Results: There were significant differences between SP and IP IMN in terms of fluoroscopy duration (94.25 vs 129.40 seconds, p-value-0.001), anterior knee pain (VAS score) (19.65 vs 29.85, p-value-0.001), average blood loss (49.30 vs 62.45 mL, p-value 0.001), and functional result (75.45 vs 70.05, p-value=0.001). The fracture union time between the two groups was non significant (90.50 vs 90.30 days, p-value=0.876). Conclusion: In terms of fluoroscopy time, anterior knee pain, average blood loss, and knee ratings, the SP technique was superior to the IP strategy. [ABSTRACT FROM AUTHOR]

Aim: To compare the clinical outcome and patient related outcomes to assess patient satisfaction following ambulatory arthroscopic anterior cruciate ligament reconstruction. Methods: Data collected preoperatively and postoperatively at intervals of 3, 6 and 9 months. Patients with meniscal repair, other ligament injury and articular cartilage injuries were excluded. Results: Patient satisfaction increased with time. Statistically significant improvement in subjective scores of patient reported outcomes from preoperatively and at 3, 6 and 9 months post operatively. Conclusion: Patients reported subjective scores found to be more helpful in determining patient satisfaction and final outcome. [ABSTRACT FROM AUTHOR]

Introduction: In this study, percutaneous suturing for the treatment of acute Achilles tendon (AT) rupture was compared to open reconstruction for the treatment of chronic AT rupture. Materials and methods: We conducted a prospective comparison research at Department of Orthopaedics, Guntur Medical College, Guntur, Andhra Pradesh, India, between March 2021 to February 2022. Patients having a primary diagnosis of total Achilles tendon rupture were included in the analysis. Twenty-five patients were given advice on their treatment choices and encouraged to return in a year for follow-up. Results: Results of multivariate and univariate logistic regression methods are used. Comparable gram-positive and gram-negative bacterial growth was seen in this study of pleural space infections. pH, loculation, positive stain, culture, fever, and serum albumin were all statistically significant in their own right when analysed in isolation. After doing a multivariate analysis, we found that pH, loculation, and serum albumin were significant predictors of tube thoracostomy success or failure. Conclusion: Comparing open repair for chronic AT rupture to percutaneous suturing following acute AT rupture, one may find similar clinical and functional results, but a thicker tendon. [ABSTRACT FROM AUTHOR]

Background: Stroke is the fourth leading cause of death in India. Data on long-term outcomes of patients with stroke in India are relatively sparse. Objective: To document survival and long-term functional outcomes of patients with acute stroke and to assess the measures taken for secondary prevention of stroke. Methods and Material: A five-year retrospective cohort study involving 118 patients with acute stroke was conducted. Details about five years' survival, functional outcomes (modified Rankin Scale [mRS], Barthel index [BI], and Hamilton Depression Rating Scale [HDRS]), and secondary prevention measures were investigated. Results: Among the patients, 38.1% were diagnosed with ischemic stroke and 61.8% were diagnosed with hemorrhagic stroke. Hypertension was observed to be the predominant risk factor in a majority of the admitted patients. About 30.5% of patients died in the hospital within zero to four weeks after the index event, while 27.1% died during the follow-up period of five years. Approximately 21.1% of patients experienced a recurrent stroke over the next five years which turned out fatal. The quality of life was seriously affected in 32.4% of survivors. It was seen that 40.5% of survivors were fully independent and 45.9% were able to return to their occupation after five years poststroke. Prevalence of severe and very severe depression was observed in 3.4% and 1.7% of survivors, respectively. The majority of the survivors (93.9%) were aware of the risk of recurrent stroke. Physical activities as measures for the prevention of stroke were undertaken by 60.6% of survivors. Conclusion: Effective strategies for secondary prevention and also for long-term survival after stroke should be initiated as early as possible after the onset of the initial stroke. Stroke survivors should be closely monitored for their functional recovery and behavioral and emotional improvement poststroke. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic clubfoot is a common complex deformity of newborns that can be managed either by manipulation, serial casting or by surgery with individualised success of treatment rated differently. Aim: To determine functional outcome, health status of clubfoot patients and the percentage of recurrence that needs additional surgery at the end of three years of treatment by using both Ponseti and posteromedial soft tissue release method. Materials and Methods: A prospective interventional study was conducted in which two groups of idiopathic clubfoot patients were treated as per the two modalities of treatment (ponseti versus posteromedial release) at the Orthopedic Department of Veer Surendra Sai Institute of Medical Science and Research, Odisha, India between March 2017 to February 2021, with regular follow-up to a period of three years. Forty patients with 63 feet were taken in the study. Out of which 20 patients with 32 feet were managed by ponseti method in one group where as another group containing 20 patients with 31 feet were treated by posteromedial soft tissue release. During follow-up foot function was assessed by Laaveg-Ponseti score, general well being of the children was assessed by paediatric outcomes data collection instrument and any complications were recorded in terms of recurrence. Results: Mean age of presentation in Ponseti group is 4.73 month, whereas mean age of presentation in surgical group is 7.85 month. Though recurrence was the major complication in both the groups, significant difference was seen in severity of recurrence (p-value=0.049). More numbers of major recurrence were seen in posteromedial surgical group (5,16.13%) which subsequently required major surgical procedures for correction. Pretreatment pirani score of ponseti and surgical group (4.9±1.0, 5.1±0.90) was statistically improved (0.34±0.38, 0.20±0.33). Foot function was evaluated using Functional Rating System (FRS) total score showing higher in ponseti group 95.25±5.68 with good to excellent outcome. Health status of the patients was assessed by Paediatric Outcomes Data Collection Instrument (PODCI) score, showed no significant difference in result in both the groups (p-value=0.3562) in view of global function subscale. Conclusion: This study have documented a favourable outcome towards ponseti group in terms of higher rate of excellent to good outcome, better parental satisfaction and better passive mobility of clubfeet with less number of revision surgery required for recurrence. [ABSTRACT FROM AUTHOR]

The Intracerebral Hemorrhage (ICH) Score is commonly used in patients of ICH as a grading tool which assesses clinical outcome after ICH. It has undergone validation for 30 days mortality in various studies but data on its validation for long term outcome is limited. The aim of this study was to assess whether ICH Score accurately categorizes ICH patients with regard to mortality and functional outcome at 3 months. This was a prospective observational study which included patients reporting to emergency department of a superspeciality care hospital with acute intracerebral hemorrhage over one year period. Components of ICH Score and baseline parameters were recorded. The functional outcome was assessed using modified Rankin scale mRS) at 3 months post ICH. Of the 70 patients included in the study, 42(60%) patients survived at 3 months and out of them 26(37.1%) patients had a good outcome on mRS scale at 3 months. The ICH score correctly stratified patients with respect to mortality and functional outcome at 3 months as assessed by dichotomous cut points along the mRS. To conclude, the ICH Score is a valid score used in intracerebral hemorrhage for assessing mortality and functional outcome at 3 months. [ABSTRACT FROM AUTHOR]

Background: End stage arthritis in young patients requires surgical intervention. THA remains the treatment of choice for restoring function and activity in end stage hip arthritis. The medium term outcome of uncemented THA in Indian population is less studied. Hence this study was taken up with aim to study clinical and radiological outcome of uncemented THA in patients with age less than 40 years. Methods: This study was conducted during January 2013 to December 2013. Overall 66 patients with 74 arthritic hips were operated by single surgeon (1st Author) with Uncemented THA. All patients were either unilateral or bilateral arthritis of hip less than 40 years of age. Patients were evaluated preoperatively and postoperatively. After discharge patients were followed up at regular intervals. Activity level and Harris Hip score was calculated. Radiological evaluation was done with anteroposterior and lateral X-rays. Results: Total 50 patients (56 hips) followed up at five year follow-up. Clinical and radiological evaluation was done during follow-up. Most common etiology was avascular necrosis of hip (56.6%). None of the patients had any major complications. Mean Harris Hip score improved from 36 to 92. The activity level was assessed at five year follow-up with maximum patients in moderate manual labor category. Bony ingrowth with no evidence of loosening was seen consistently both on femoral and acetabular side in all patients on X-ray. No statistically significant association was found between initial alignment of the femoral component and clinical outcome Conclusion: Uncemented THA can be used in young patients with excellent to good functional and radiological outcome at midterm follow-up, high satisfaction rate and lower rate of complications. [ABSTRACT FROM AUTHOR]

Objectives: To assess the course, outcome and complications in a mono-centric cohort of 53 patients with systemic onset juvenile idiopathic arthritis (s-JIA).Methods: In an observational study, 53 consecutive patients diagnosed with s-JIA on or before October 2009 were enrolled and followed up between October 2009 and September 2012. At each 6-12 weekly visit, clinical examination, laboratory investigations and details of on-going treatment were recorded. Disease course was classified as monocyclic, intermittent and persistent. At last visit, outcome was studied with respect to remission (Wallace criteria) and Steinbrocker functional classification. Juvenile Arthritis Damage Index (JADI) was measured on a subset.Results: In 53 patients analysed, the mean follow-up period was 5.5 ± 1.85 y, with a cumulative follow-up period of 291.5 patient-years. The mean age at diagnosis was 6.3 ± 3.4 y. Thirty-three patients suffered from disease and/or drug related complications. Infections were observed in 16 (30%) and macrophage activation syndrome in 5 (9.4%). Nine (17%) had a monocyclic course, 31 (58.5%) had an intermittent course and 13 (24.5%), a persistent course. At last visit, 9/9 patients of the monocyclic group, 17/31 in the intermittent group and 3/13 in the persistent group were in remission. At the end of the study, 96.2% of the index patients were Steinbrocker functional class I and II with the monocyclic group having the best functional outcome. JADI was performed on 20/53 patients. Nine had significant articular damage. The range of Juvenile arthritis damage index-articular (JADI-A) was 0-25/72 (median-6) and of Juvenile arthritis damage index-extra articular (JADI-EA) was 0-4/17 (median-1).Conclusions: The outcome of patients with s-JIA in a resource limited setting where early diagnosis, multidisciplinary care and availability of biologics are hurdles, is further altered by complications related to longstanding disease and over use of steroids. [ABSTRACT FROM AUTHOR]

Background The Comprehensive International Classification of Functioning, Disability and Health Core Set for Head and Neck Cancer (ICF-HNC) is an application of the ICF and guides multidisciplinary cancer follow-up and rehabilitation in patients with head and neck cancer. The objective of this study was to understand the role of physicians within the multidisciplinary team and to explore the content validity of the ICF-HNC from the perspective of physicians. Methods In a 3-round Delphi survey, physicians experienced in the treatment of head and neck cancer were asked what patients' problems, resources, and aspects of environment they treat. The responses of the first round were linked to the ICF. In the second round the participants received a list of identified ICF categories and were asked if these ICF categories represent patients' problems, resources, and aspects of the environment they treat. Round 3 required a reconsideration of the given answers in accord with the group response. The agreement of the linking process between 2 health care professionals was calculated using kappa statistics. Results In all, 55 physicians from 25 countries gave 781 statements; 83 ICF categories were linked to the statements after the first round; 55 ICF categories reached consensus of ≥75% after the third round. Of these, 46 categories (84%) are already included in the ICF-HNC. Within the entire ICF-HNC, physicians treat most categories from body structures (88%) and functions (76%) and some categories from activities and participation (15%) and environmental factors (21%). The kappa coefficient for linking ICF categories was 0.988 (95% bootstrapped confidence interval: 0.95-0.99). Conclusions The content validity of the ICF-HNC was supported by the perspective of physicians. This study supports the need for a multidisciplinary team. The aspects of functioning which are not treated by physicians should be addressed by timely involvement of other health professions. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Objective: The objective was to assess functional outcome of rehabilitation in chronic severe traumatic brain injury (TBI) in-patients. Setting: The study was performed at university tertiary research hospital. Study Design: A prospective cross-sectional study Materials and Methods: Forty patients (34 men) with mean age of 30.1 years (range 6--60, SD 10.8), severe TBI (Glasgow coma scale 3--8, duration of coma > 6 hours, post-traumatic amnesia> 1 day postinjury) were admitted in rehabilitation unit minimum 3 months (mean 7.7±4.6 months, range 3--22 months) following injury falling in Glasgow outcome scale (GOS) of 3. Functional recovery was assessed using the Barthel Index (BI) score and disability rating scores (DRS). Data Analysis: Paired Student's t-test was used for the assessment of functional recovery using mean BI scores at admission and discharge. The Wilcoxon nonparametric test was used for the assessment of functional recovery by comparing admission and discharge DRS scores. Results: Mean duration of stay was 30.8 days (range 18--91, SD15.6). Significant functional recovery observed in patients comparing BI and DRS scores at admission and discharge (mean BI admission 50.5±25.4, range 0--85 vs. mean discharge BI score 61.1±25.3, range 0--95, P<0.001, mean DRS admission score 7.57±4.1, range 2.5--21.0 vs. mean discharge DRS score 6.36±4.3, range 1.0-21.0, P<0.001). Conclusion: Patients with severe TBI continue to show functional recovery even in chronic phase with rehabilitation. They are left with significant residual physical and cognitive deficits and would require long-term care and assistance from care givers for the daily activities, as suggested by the mean DRS score at discharge. [ABSTRACT FROM AUTHOR]

Objectives: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through Burks and Schaffer's approach when combined with a rehabilitation programme, which emphasizes early range of motion. Design: Retrospective study Setting: Level 1 trauma centre, All India Institute of Medical Sciences (AIIMS), New Delhi Patients: From December 2006 to June 2009, 18 cases of PCL tibial avulsion injuries presented to our institution and underwent surgical intervention. Patients were followed up for 10 to 16 months (mean 12 months). Intervention: Fixation of tibial PCL avulsion fractures was with one or two 4-mm partially threaded cannulated screw and washer placed through a Burks and Schaffer's approach. Range of motion was begun on postoperative day 2. Main outcome measurements: Range of motion, clinical stability, radiographic appearance, each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) and gastrocnemius muscle strength were evaluated at final follow-up. Results: Union was achieved in all the cases, and all of them were having clinically stable knee at the time of last follow-up. The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is one of the common causes of stroke in young people. Mortality in CVST, in addition to progressive thrombosis, is related to elevated intracranial pressure causing transtentorial herniation. The role of decompressive surgery in CVST is not well established. Aims: We report our experience with decompressive surgery in CVST and review the literature. Settings and Design: This is a retrospective study carried out in the Stroke Unit of a multispeciality tertiary care hospital in south India. Materials and Methods: The medical records of patients admitted with the diagnosis of CVST between December 2003 and July 2009 were reviewed. The clinical presentation, etiology, medical management, indications for surgery and outcomes were assessed for patients undergoing decompressive surgery. The sensorium was assessed using the Glasgow Coma Scale (GCS), while the outcome was assessed using the modified Rankin scale (mRS). Descriptive statistics were used as appropriate. Results: One hundred and six patients were admitted with the diagnosis of CVST during the study period. Eleven patients (10%) underwent decompressive surgical procedure. Indications for surgery included a low GCS at admission with large infarct on the computed tomography scan, mass effect and midline shift, clinical and radiological signs of transtentorial herniation, deterioration in the sensorium in spite of anti-edema measures and postthrombolysis hematoma. Eight patients (73%) had a good outcome while three patients (27%) died. Of the patients who died, two had a low GCS and bilaterally nonreactive pupils before the surgery while one had thrombosis of the deep venous system. Conclusion: Decompressive surgery for patients with large cerebral venous infarcts is a life-saving procedure. Patients with CVST who develop clinical and radiological features of transtentorial herniation either at presentation or during the course of medical management may benefit from decompressive surgery. [ABSTRACT FROM AUTHOR]

Background: Tibial plateau fractures involving two or more columns were routinely assessed by two-dimensional radiography in the past. This often misled surgeons and attention was given only to the medial and lateral column without consideration of the posterior column, especially the postero-medial corner. Luo in 2010 introduced the new three-column classification system based on multiplanar computed tomography images. This study was conducted to assess the outcome after internal fixation of tibial plateau fractures involving two or more columns in our centre based on the column specific approach., Materials and Methods: This was a prospective study conducted at our institute, between 2011 and 2016. Total of 183 patients with tibial plateau fractures involving two or more columns were admitted during this study period of which 123 patients were satisfied our inclusion criteria. 8 patients were lost to follow up. Hence 115 patients with tibial plateau fractures involving two or more columns were classified based on the new three column classification system. Dual column fixation (Anterolateral +Anteromedial) was done in 76 patients, (Anterolateral+Posteromedial) fixation in 25 patients and triple column fixation (Anterolateral + Anteromedial + Posteromedial) in 14 patients. Post operatively patients were assessed by Modified Rasmussen functional and radiological scoring system., Results: Based on Modified Rasmussen functional scoring system, 73 patients (63.5%) had excellent results, 37 patients (32.2%) had good results and 5 patients (4.3%) had fair results. Based on Modified Rasmussen radiological scoring system, 71 patients (61.7%) had excellent results, 38 patients (33.1%) had good results, 6 patients (5.2%) had fair results. 3 patients had deep infections., Conclusion: Based on our study, we like to conclude that we had good outcomes utilizing this modern column specific approach to the treatment of these two or more column tibial plateau fracture injuries, which includes assessment of three columns., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study is to assess the incidence of retinopathy of prematurity (ROP) in preterm infants and to compare the visual outcomes in babies with and without ROP., Materials and Methods: A consecutive cohort of 812 preterm babies were recruited with gestational age ≤32 weeks and or birth weight ≤1500 g. The outcome was assessed at the end of 15 months by determining fixation behavior, cycloplegic refraction, and vision by Cardiff cards. Incidence of visual outcomes with 95% confidence limits and relative risks were estimated. Chi-squared test and t -test were used as tests of significance., Results: The incidence of ROP was 25%. The incidence of myopia, hypermetropia, astigmatism, and strabismus were 15.8% (14.3-17.3), 6% (5.1-7.1), 55.6% (53.6-57.7), and 1.8% (1.4%-2.5%), respectively, in the cohort. The most common refractive error in terms of spherical equivalence was myopia (19.8% in ROP and 14.4% in non-ROP group). The mean visual acuity measured by Cardiff Acuity cards was 0.282 and 0.27 logarithm of the minimum angle of resolution units (right eye) and 0.293 and 0.277 (left eye) in patients with and without ROP, respectively. Strabismus was present in 5% of ROP group and 0.8% of non-ROP group babies. Babies with ROP had six times (risk ratio-6.02; 95% confidence interval 2.8-12.8) higher chance of developing strabismus than those without ROP., Conclusions: Ophthalmological morbidities in premature infants such as refractive errors and strabismus are high in addition to complications like ROP. The incidence of these conditions is more in infants with ROP when compared to non-ROP group., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Middle East African Journal of Ophthalmology.)

Background: Rotator cuff tears have long been recognised as a cause of pain and disability. Over the past decades the treatment of rotator cuff tears has evolved from an open procedure to a mini-open procedure to an all-arthroscopic one. The indications and benefits of each of the procedures are still debated. The purpose of this study was to observe the results of "Mini-open repair rotator cuff tear"., Material and Methods: This was a prospective study conducted in the postgraduate department of Ortho-paedics Government Medical College, Srinagar, from March 2013 to January 2018 with cases followed up for a minimum of 3 years. This study included 50 patients of either sex with non-massive full thickness tears of rotator cuff., Results: The mean UCLA score improved from 10.96 preoperatively to 30.68 at final follow-up. Overall, 88% of the patients achieved excellent or good results and 92% were satisfied. No significant difference was noted in functional outcomes between traumatic and degenerative tears. Size of tear seems to be a determining factor in the functional outcome. Stiffness as a complication occurred in two patients., Conclusion: 1. Mini-open rotator cuff tear repair eliminated sym-pto-matic full thickness rotator cuff tears with significant improvement in functional scores. 2. There were no major complications of the surgical procedure adop-ted or the fixation method used. 3. Mini-open rotator cuff repair remains a useful technique despite advan-ces in arthroscopy.