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For patients with concomitant genu varum deformity and anterior cruciate ligament deficiency, there is constant adduction moment at knee joint during weight bearing leading to increased load over medial compartment. In this prospective cohort study we treated these patients by anatomical single bundle ACL reconstruction and medial open wedge high tibial osteotomy and evaluated their clinical and radiological outcomes. The mean follow up period was 25 months. The mean International Knee Documentation Committee score improved from pre-oprerative 45 to post-operative 77. Range of motion was near normal in all cases. Lachman test and Pivot-shift test showed significant improvement post-operatively. The femorotibial mechanical axis was significantly corrected from 7.0° varus to 1.2° valgus and tibial posterior slope was not significantly changed. Thus to conclude although the procedure requires long learning curve, it decreases load on medial compartment, preserving articular cartilage and reduces adduction moment thereby lessening tension on the graft, both of which are important for future of these knees.

Calcific myonecrosis is a rare entity characterised by a latent formation of dystrophic calcified mass occurring most commonly in the anterior compartment of the leg and is usually a posttraumatic condition. Diagnosis is based on the history of trauma and typical radiological features. Symptomatic patients require complete excision of the mass. We report such a case not only for its rarity but also for challenging diagnosis and treatment.

Purpose: A number of surgical techniques with variable results and complications have been described for the treatment of chronic post-traumatic radial head dislocations or the missed Monteggia lesions. This study aims to evaluate open reduction of radial head with ulnar corrective osteotomy with rigid fixation with plate, without annular ligament reconstruction or repair.Methods: 11 patients were treated between 2011 and 2016, 7 were male while 4 were female, average age being 7.8 years (range 6-11.5 years). Right side was involved in 8/11. The average interval between injury and surgery was 4 months (range 2 to 11 months). Patients were followed up for mean period of 13 months (7-21 months), assessed clinically for elbow function, stability, pain, deformity and radiologically for reduction, periarticular ossifications, signs of malformation of the radial head or osteoarthritic changes. Results: All patient regained painless function of the elbow, adequate range of elbow and forearm motion with maintenance of the radial head reduction. Conclusion: Ulnar osteotomy with angulation and lengthening, provides adequate aid in reduction of radial head, without requiring additional annular ligament procedures.

Aim: To evaluate effectiveness of arthroscopic drainage of acute septic arthritis knee in adult population. Materials and method: 19 patients with average age of 38.9 years (19-66 years) evaluated retrospectively and prospectively, for a minimum follow-up period of 6 months (6-28 months), on Tegner-Lysholm Knee Scoring Scale. Arthroscopic drainage was performed on these patients at an average delay of 6.84 (4-17) days after onset of symptoms, followed by immediate intravenous antibiotics and then oral therapy, as per culture-sensitivity, with active physiotherapy. Repeat arthroscopic lavage was performed where required. Results: 16 of 19 patients (84.2%) had good or excellent results, while 3 had fair results, of which 2 had recurrence of acute septic arthritis and 1 progressed to chronic osteomyelitis of tibia. Successful elimination of infection seen in 94.7%. Conclusion: Arthroscopic drainage is safe and effective alternative to the gold standard procedure of open arthrotomy and debridement for acute septic arthritis knee in adult population. Early debridement and lesser Gachter stage more often lead to good to excellent results.

Tibial plateau fractures had been treated with single long midline incision technique traditionally. But recently two-incision technique is becoming popular Tibial plateau fractures are generally classified according to the method developed by Schatzker. Schatzker types V and VI fractures are high-energy fractures often accompanied by other injuries and complications, such as postoperative inflammation, wound problems and infections. It was a prospective randomised study where 56 patients with Schatzker types V and VI were included in the study group. Alternatively all were allocated in the two groups ie, two small incision and one midline incision. Two incision was better than single midline incision in terms of posteromedial collapse, postoperative infection, skin necrosis. Operative fixation of complex fractures of the tibial plateau remains quite difficult and is associated with postoperative functional limitations in a large percentage of patients. Dual plating through an anterolateral and posteromedial approach is recommended in fractures complicated by a significantly displaced posteromedial fragment or depression of the medial articular surface.

Primary hyperparathyroidism due to parathyroid adenoma is sporadic in nature and seldom symptomatic. Patients usually present with pathological fractures. The objective of this study was to diagnose primary hyperparathyroidism in patients presenting with pathological neck of femur fractures, detection of the adenoma or ectopic tissue, removal of the tissue, and treatment of the fracture. All patients presenting with pathological fracture neck of femur, with clinical features suggestive of hyperparathyroidism were investigated for blood calcium, alkaline phosphatase, parathyroid hormone. If found to be raised patients underwent nuclear scan for detection of primary hyperparathyroidism. Primary hyperparathyroidism (usually parathyroid adenoma) when found was excised. After 2 weeks fixation of fracture was done. Follow-up at 6 weeks, 12 weeks, 6 months, 1 year were done. Time to radiological union, functional assessment and other systemic complaints were noted. Nine patients were included in the study as they presented with pathological fracture due to hyperparathyroidism. All except 1 were due to parathyroid adenoma. Excision of the tumour with early fracture fixation lead to quick rehabilitation of the patient. All fractures united. Hyperparathyroidism is asymptomatic in many patients, and may present only with a fracture. Orthopaedicians should keep this possibility in mind while diagnosing these cases, failure to which may result in disastrous complications.

As in many cases long bones get available in fragments, so gender determination from short as well as robust bones like patella paid importance now-a-days. So far the literature reviewed such records are little in Indians especially from West Bengal. The present study is aimed to demonstrate the gender differentiability of different patellar anthropometric parameters viz, length, breadth, surface areas of articular surfaces, patellar Index, etc, amongst population of northern part of West Bengal in India. A total 46 intact patellae of which 23 belonged to males and 23 belonged to females, were taken out from human corps of 20 to 50 years of age group, brought for postmortem in the forensic department, NB Medical College, Sushrutanagar. Patellar vertical length, width, different measurements of the individual articular facet, angulations at the vertical ridge, patellar index and total surface area of the posterior surface and articular part, etc, were measured. In males patellar height, diameter, index, dry weight, articular surface area would be more than 3.75cm, 4.1cm, 108.23, 18g and 11.67cm2 respectively and values less than those will be for females. But in contrary angulation at the vertical ridge between medial and lateral articular facets will be more than 119.28 degrees in females, and less than for males. The results of this study revealed that we can determine sex of North Bengal population just by using the patellar measurements, when other long bones, skull and pelvis get not available, or fragmented. But there remains a scope for multicentric study throughout the India to validate the fact.

Cervical spinal cord injury is a major cause of fatality among trauma victims. Unlike developed countries, national spinal cord injury database is not maintained in India. Paucity of data hampers the understanding of epidemiology of the event in India. So, this study was conducted to ascertain the epidemiological pattern of death due to cervical spinal cord injury and to identify the risk factors; also to find the association of vertebral injuries with various epidemiological parameters.Among autopsies conducted in Burdwan Medical College and Hospital from 2000 to 2010, cases with autopsy report mentioning "death due to cervical spinal cord injury" either primary or secondary were included in the study. It was a retrospective observational study based on autopsy report.536 cases met the inclusion criteria. Among them 89.4% were male and 10.6% were female; 63.8% victims were young adults (20-39 years). Mean (plus or minus S.D.) age was 33.5 years (plus or minus 12.8). All, apart from 5.4%, suffered from single segment injury with commonest site being C3-C4 (37.3%). Highest number of trauma occurred between 6 am to 9 am, 56.6% of the victims died before hospitalisation. Commonest mode of injury was road traffic accident (52.2%) followed by fall from height (25.0%); 53.7% cases had vertebral fracture with dislocation, 34.3% had only vertebral fracture. Only dislocation was significantly high up to 19 years age (p0.001) and among females (p=0.029). All elderly suffered from fracture.This study revealed an unusually high male:female ratio with much representation of the younger age groups in the injuries in comparison to other parts of world. In absence of national database, this result can be used as a surrogate data.

Injuries to the tendo-achilles in our country are mostly open injuries due to fall or slippage into the Indian type of lavatory pan. After thorough debridement open repair of the tendoachilles is done by non-augmented or augmented method. We studied about the augmented versus non-augmented open surgicalrepair of fresh tendo-achilles injuries. This was a prospective randomised study. It is evaluated from the study that the mean operative time was about 29 minutes longer (p0.001) and there was about 7 cm longer (p0.001) incision needed in augmented repair group which is statistically significant. The study shows that, the functional outcome of non-augmented repair group is better at 6 months follow-up but at 9 months follow-up functional outcomes are comparable in both non-augmented and augmented repair groups. The time for full functional recovery is more in augmented repair group. So, it is safer to use non-augmented repair technique in the treatment of fresh cases of tendo-achilles injuries due to less operative time, smaller incision, less complications and early functional recovery.