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Trigger finger is a stenosing tenosynovitis producing triggering/ clicking on finger movements along with pain and swelling. This condition although most often involves the thumb, however, any finger of the hand can be involved. Fibrocartilaginous metaplasia of the tendon near the A1 pulley causes nodule formation, resulting in triggering of the finger on finger movements. Treatment of this condition starts with NSAIDS, activity modification to the open surgical release of the A1 pulley. We present our outpatient-based, hypodermic needle release of A1 pulley of triggering finger for chronic trigger finger with functional recovery. In our 30 digits with triggering complaints for more than 6 months, 20 patients were females. Thumb was involved in 19 cases and Age ranged from 25 to 68 years. Using a hypodermic 18 G needle, the average duration of the procedure including local anaesthesia application was 6 minutes. We observed successful results in 97% of cases, one trigger finger needed open release after the persistence of symptoms. No complication was observed in any case during the follow-up period. Hypodermic Needle based release of A1 pulley for trigger finger is a safe, cost-effective, reliable, reproducible procedure with acceptable functional outcome, and we recommend this procedure for chronic trigger finger management.

Background: Fractures of distal radius are very common injuries, accounting for about 15% workload of an Orthopedic trauma unit. While cast treatment is universal for stable fractures, unstable fractures with comminution and intrarticular involvement are a different injury and are treated mainly by ligamentotaxis with proper restoration of anatomy. In this study, we evaluated the effectiveness of external fixator with or without augmentation for management of unstable distal radius fractures. Methods: The study was performed on 49 patients with unstable distal radius fractures admitted in the emergency department. Patients who met inclusion criteria, were operated with bridging external fixation using 2 pins in radius and 2 pins in second metacarpal augmented with percutaneous K wires in some patients. Functional evaluation at 12 months was done using Solgaard Scoring. Results: The study comprised of 49 patients in age group of 20-60 years, including 28 males and 21 females with a mean age of 42 years. Laterality included right side (n=23) and left (n=26). Mechanism of injury was road traffic accident (n=19), fall from height (n=17) and fall from standing height (n=13). The mean admission to surgery interval was 1.2 days, the mean operative time was 35 minutes and the mean time to union was 7.2 weeks. Complications included pin tract infections (n=7), transient neuropathies (n=5), early sympathetic dystrophy (n=2), malunion (n=2) and loss of motion more than 200 (n=9). Final evaluation done using Solgaard scoring system revealed excellent results in 22 patients, Good in 18 patients, Fair in 8 patients and Poor in one patient. Conclusion: For unstable distal radius fractures excluding shear injuries, external fixation with or without augmentation is the preferred method of treatment as it is simple, less expensive, with acceptable complications and yields excellent results in a majority of patients.

Knee osteoarthritis is a degenerative disease characterized by cartilage destruction which manifests as pain, stiffness and loss of joint motion. With increasing longevity, aging of population and increased incidence of obesity, osteoarthritis remains a potentially major health problem as well as global economic burden. Intraarticular steroids are frequently & effectively used to treat acute and chronic inflammatory conditions of joints, especially during osteoarthritis flare with evidence of inflammation like increasing pain and joint effusion. This reduces acute episodes of pain and increases joint mobility and rehabilitation. This was a prospective hospital based study of 240 Patient with osteoarthritis knee. Average age was about 54±3 years, knee effusion detectable in 80% of patients and radiographic features of osteoarthritis in 91% cases at time of injection. Results showed significant improvement in pain and joint tenderness at 6 weeks after injection. There is consensus now that intraarticular steroids are extremely helpful in acute episodes of arthritic pain and efficacy is almost similar and equal to other modalities of intrarticular injection therapies. Intraarticular steroid injections are reasonably safe, reliable and time tested treatment of arthritic conditions and thus can be used as first line of treatment in flares of osteoarthritis with features of synovial inflammation to reduces crisis of pain and promote rehabilitaional activities and bring back smiles to patients.

Purpose: Pediatric hip fractures are very uncommon and the complications of these fractures are very serious. With this purpose in mind we evaluated retrospectively the treatment of pediatric femur neck fractures admitted during proceeding five years in our hospital. The Aim of study was to evaluate the outcome of our treatment and know preventable complications of pediatric neck fractures in comparison with literature. Method: We evaluated 19 pediatric femur neck fractures with age from 3-12 years including 12 males 7 females. Treatment was by closed reduction and internal fixation at average of 4.5 days after hospital admission. Spica cast was applied for all patients up to age 10. Clinical and radiological evaluation was done by RATLIFF CRITERIA Results: We enrolled 23 cases in study 4 lost to follow up and thus excluded from final study. We had 10 cases of Delbet type II, 7 cases type III and 2 cases of type IV. Patients were treated by closed reduction and internal fixation at average of 4.5 days after admission. Our results were 12 good, 3 fair and 4 poor. Complications encountered included avascular necrosis in 5 patients, 1 coxa vara, 2 cases of superficial infection and 1 septic sequel of sab acute septic arthritis. Conclusion: Fluoroscopic aided reduction and internal fixation is a very good method of treatment for pediatric neck femur fractures. Emphasis should be on measures to reduce avascular necrosis and infection and give maximum smile to the children and their parents. In our under eloped and far-flung area complications are unavoidable but preventable once infrastructure and facilities of emergency and postoperative care are improved. Education regarding prevention of pediatric fractures in general and neck femur in particular and active participation of parents will help in minimizing complication of these fracture thus limiting diability and morbidity of these fractures.

Spinal tuberculosis is the commonest form of skeletal tuberculosis and is most dangerous because of involvement of spinal cord. In adults, lower thoracic and upper lumbar vertebrae are common sites of spine involvement with cervical spine being rare. Concomitant bacterial infection is very rare, only few cases of bacterial infection in setting of Tuberculosis spine have been documented in literature [1]. We present a case of tuberculosis spine in a middle aged man with superadded bacterial infection, presenting as refractory tuberculosis [2].

A case of lytic lesion foot with no definite history of trauma presented with diagnostic challenge as being potentially malignant. On routine evaluation and subsequent imaging especially USG foot foreign body was suspected. With all relevent differential diagnosis in mind surgical exploration and biopsy was done which confirmed foreign body and foreign body granuloma induced lytic lesion of foot. Foreign body trauma and its sequele should be kept in defferential diagnosis in foot diseases when likely hood of penetrating foreign body is quite high like labourers and housewives.

Twenty patients of Lisfranc joint injuries managed by flouroscopic guided closed reduction and percutaneous K-Wire fixation were evaluated for functional results with average follow up of 24 months. Males were 80% of total cases and road traffic accident represented cause of injury in 55% cases rest being due to fall. Majority of injuries were type B as per Myersons classification. The average AOFAS-M score was 78 with 80% patients returning to their original occupation. Early flouroscopic guided closed redusction and K-Wire stabilization of Lisfranc injuries is effective easy and reliable method of Lisfranc joint injury treatment with no secondary surgical procedure needed for implant removal and no cosmetic problem of scar formation

Background: The aim of this study was to look at the epidemiology of elbow fractures in children in Kashmir region who were treated at a major trauma institute, the hospital for Bone and Joint Surgery Srinagar for two years. Method: In this retrospective study over a two year period we studied 550 children with elbow fractures who were treated at Bone and Joint Surgery Hospital Srinagar, Kashmir. Each case was studied with respect to age, sex, trauma side, fracture type, associated injuries and the mechanism leading to trauma. Results: annual incidence of elbow fractures was 275. Among all fractures analysed during this interval of time, elbow fractures accounted for 31.51% of all fractures, which was second only to forearm fractures (35.53%) and femur fractures constituted the third (26%). Rest of the fractures (8%) constitued fractures of leg bone, clavicle, proximal humerus and others. Average age was 6 years. Most of the children were of age group 4 to 6 years. Among all elbow fractures males constituted 72% of all fractures and female children were 28% with male to female ratio of 3: 1. Left side dominated among all fracture types and constituted 70% of all fractures. Supracondylor fractures constituted 65% of all fractures. Most common mechanism of trauma was due to fall in recreational accidents (90%). Compound fractures constituted 2% of all fractures and the associated lesions were present in 5% of cases. Most of the associated injuries were fractures of the distal forearm(44%) and mid forearm(20%). Rest associated fractures included fracture clavicle(15%), proximal humerus (14%), hand (5%) and scapula(2%). Key words: Elbow, Children, Fracture, Supracondylar, Kashmir, Injury, Retrospective

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

Idiopathic hypoparathyroidism is a rare disorder of unknown etiology. It usually presents by second decade of life but delayed manifestations are known to occur. It presents as neuromuscular excitability, numbness, carpopedal spasm, 1 cramps, laryngeal stridor and convulsions. In subtle cases of hypoparathroidism neuromuscular excitability can be made evident by eliciting Chovstek's and Trousseu's 2 sign. Typical ECG manifestations are QTC prolongation. Cataract, intracranial calcification are well known entities. 3 Various other manifestations are Parkinsonism, Choreo athetosis, Spasm etc. Typically patients have low serum calcium, high inorganic phosphorus with low to undetectable PTH. In all such patients renal failure, chronic GI disorders, persistent alkalosis, rickets and osteomalacia should be excluded. JMS 2012;15(2):182-83