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Introduction: The Total Hip Replacement (THR) procedure is indicated to the treatment of choice in chronic refractory joint pain and some types of proximal femoral fractures. Component malalignment is a major cause of THR failure, making it crucial to position the components anatomically for long-term joint survival. Aim: To assess the radiological parameters of uncemented THR surgery. Materials and Methods: This retrospective cohort study was conducted in the Department of Orthopaedic Surgery, King’s George Medical University (KGMU), Lucknow, Uttar Pradesh, India, from June 2017 to May 2021. It included 72 patients who underwent unilateral uncemented THR for isolated hip diseases. Data was collected over the first two years and analysed. Demographic information and radiographic characteristics such as acetabular cup inclination and anteversion, femoral stem placement, vertical and horizontal centers of rotation, and limb length discrepancy were determined. Data was entered into Microsoft Excel 2018-19, and Statistical Package for the Social Sciences (SPSS) software version 28.0 was used for statistical analysis. Results: The average age of the patients was 50.75±9.1 years. Comparison of acetabular cup inclination (preoperative 41.4±3.9° and postoperative 42.2±5.1°) and anteversion (preoperative 13.1±2.96° and postoperative 14.5±3.75°) showed non significant differences following treatment with a normal hip. However, there was a significant difference in the horizontal and vertical Centers Of Rotation (COR) following treatment with a normal hip. Conclusion: Preoperative radiological characteristics of the damaged hip were significantly restored to normal anatomy and alignment following surgery.

Introduction: Fractures of the shaft of both bones of forearm are one of the most common fractures in the paediatric age group. There is often a difference of opinion regarding the management of these fractures. Though, there has been an increasing inclination towards surgical correction of these injuries, conservative management is still very popular because of the advantage of good bone remodelling potential in children. Loss of reduction is a known complication of conservative method of treatment. Assessment of the cast index can serve as a tool for the prediction of failure of the conservative management. Aim: To analyse the functional and radiological outcomes of both radius and ulna forearm bones shaft fractures. Materials and Methods: This longitudinal interventional study was conducted in the Department of Orthopaedic Surgery, at King George’s Medical University, Lucknow, Uttar Pradesh, India. The duration of the study was one year 11 months, from June 2017 to May 2019. A total of 196 (156 males and 40 females) patients were included in the study, who presented with closed diaphyseal fractures of the radius and ulna, and were managed conservatively. The patients with acceptable reductions were followed-up at three weeks, six weeks, three months and six months. The functional and radiological parameters were assessed, analysed and the cast index was estimated at each follow-up visit. Chi-square test was performed on the numerical/frequency displays of the dichotomous variables. Student’s t-test with a 95% confidence interval was performed to compare the means of the two groups. Results: The changes in angulation for Anteroposterior (AP), as well as, lateral view of both radius and ulna were significant at each follow-up (p

Introduction: Newer coexisting conditions should be identified in order to modify newer risk factors. Aim was to identify patients with non-classical or less common coexisting conditions in patients infected of COVID 19. Method: Single centred study from June 2020 to May 2021 at a tertiary centre in North India. A preformed questionnaire was used to record clinical and laboratory parameters and to identify cases which are in addition to CDC list and Indian data. Results: 0.67% (46) cases out of 6832 patients were identified to have non-classical coexisting illness. It was divided into 2 groups-infections A (60.1%) and non-infections B (39.9%). Group A included-tuberculosis- pulmonary (14.3%) & extra pulmonary (32.9%), bacterial (25.0%) viral infections [dengue, hepatitis B & C] (14.3%), HIV disease (10.7%) and malaria (3.6%). Group B included- organ transplant (27.8%), autoimmune [myasthenia gravis, polymyositis, psoriasis] (22.6%), haematologic [Haemophilia, ITP, Aplastic anaemia, APML, CML] (27.8%), uncommon malignancies [disseminated sacral chordoma and GTN] (11.1%) and snakebite (11.1%). Serum Procalcitonin was not helpful for diagnosis of bacterial infection in COVID-19 disease. Group A had significantly longer duration of illness, hepatitis and elevated CRP. The mortality in group A & B were 32.1% and 43.8% respectively. Death in non-severe COVID cases was in tetanus and snakebite. 30.7% death among tuberculosis patients. More than 70% of deaths were attributable to COVID 19 in both the groups. Conclusion: In Indian settings, comorbidities like tuberculosis and bacterial infections can precipitate severe COVID 19 unlike other parts of the world where tuberculosis is relatively uncommon.

Introduction: Infected non-union of Tibia is one of the most commonly faced problem in both compound as well as closed fractures of Tibia, treated surgically. Few patients also present with gap at the fracture site which may be either due to bone loss during trauma or due to debridement of dead bone during previous surgeries. Treatment of infected non-union is always challenging with unpredictable outcomes. Limb Reconstruction System (LRS) is one of the systems available to treat this complex situation. Aim: To evaluate the role of LRS in treatment of infected nonunion of Tibia in terms of union time, total duration of fixator applied and Visual Analouge Score (VAS). Materials and Methods: Twenty one patients of infected gap, non-union of tibia were included in the study and were treated with debridement, resection of dead bone and application of LRS and segment transport. The results were evaluated in terms of union time, total duration of fixator applied and VAS. Bony and functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. SPSS statistics 24.0 was used for analysis. Mean, median and mode were used to describe continuous variable. Results: Out of 21 patients, 19 were males and two were females. The mean age of patients was 29.43±14.07 years. The mean limb length discrepancy was 23.3 mm (range, 15- 40 mm). The mean duration from injury to LRS application was 7.9 months (range, 6-12 months). Mean duration of follow-up was 29.5 months (range, 16-50 months). Average union time was 44 weeks and average fixator time was 11.2 months. Bony and function results were good and excellent in 90% cases. Conclusion: The use of monolateral rail external fixator LRS is an effective method for the treatment of infected non-union of tibia augmented with a fibular strut graft. This provides good results in terms of bony union, subsidence of infection and functional results.

Introduction: Distal tibia metaphyseal extra-articular fractures are common injuries and despite of advancement in management, optimal surgical technique is still controversial because of their close proximity with ankle joint and soft tissue scarcity. Aim: To evaluate and compare the functional outcome of anatomic plating with minimally invasive plate osteosynthesis technique (MIPO) and reamed Intramedullary (IM) nailing for distal tibia extra articular metaphyseal fracture. Materials and Methods: Forty five patients with type Orthopaedic Trauma Association (OTA) 43A fracture were included and treated with anatomic plate fixation (Group A, n=20) and IM nailing (Group B, n=25) and followed up for minimum of two years. Results compared using independent student’s t-test and Oleurd Molandar score for functional evaluation. Results: No significant difference was found for mean union time (Group A 26.6±7.14 weeks, Group B 25.6±4.07 weeks, t-value 0.11, p-value 0.594), angulation (Group A 1.45±2.66°, Group B 3.54±3.66°, t-value 0.76, p-value 0.107) and shortening (Group A 0.21±0.32 cm, Group B 0.28±0.34 cm, t-value 0.009, p-value 0.446). Surgical time however was significantly shorter in Group B (Group A 94.5±10.11 minute, Group B 79±5.59 minute, t-value 2.0, p-value< 0.05). Malunion occured in one patient (5%) in Group A and in 4 patients (16%) in Group B. Mean Oleurd Molandar score in group A was 81.5±12.9 (range, 95-40) and in Group B was 82.4±11.5 (range 95-60). Conclusion: There was no difference pertaining to union rate, angulation, shortening and functional Oleurd Molandar score in IM nailing and anatomical plating groups however, IM nailing had the advantage of shorter surgical time. We conclude that both anatomical plating and IM nailing are possible treatment for distal tibia extra articular metaphyseal fracture.

Introduction: Diabetic foot complications pose a significant public health hazard and have negative effect on life quality. These complications are associated with increased risk of amputations and premature death. So focus is increasing on early treatment of complicated diabetic foot. Aim: To assess the diagnostic accuracy and surgical utility of MRI in complicated diabetic foot. Materials and Methods: Thirty four complicated diabetic patients were evaluated prospectively. Initially x-ray was done and a provisional management plan was formulated. Later T1W, T2W and FSat sequences of the affected foot and ankle was carried out. The soft tissue, tendons and osseous apparatus were evaluated and subsequently compared with histopathological examination. Before and after MRI, change in management plan was marked. Previously operated cases with persistent ulcer of affected foot were excluded from the study. Results: Twenty two males and 12 females with mean age of 52±8.8 years were analysed. The sensitivity of MRI for tenosynovitis and osteomyelitis was 88% and 100% respectively. The specificity for the same was 100% and 90%. Of all 34 cases, MRI reshapes surgical planning in 23.5% cases (8 patients). The difference between MRI and histopathological findings was evaluated statistically using Fisher-Z test and the proportion of difference between these two groups was not significant as values for tenosynovitis was Z=0.50 (p-value >0.05) and for osteomyelitis Z= 0.54 (p-value>0.05). Conclusion: The result indicates that MRI is a sensitive and accurate imaging modality for evaluation of diabetic foot and for planning proper treatment and the MRI correlates significantly with the surgical finding.