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Aims and Objectives: The primary objective of this study is to evaluate and assess healing, functional outcomes and complications of conservatively versus operatively managed metacarpal fractures. Materials: Our study was conducted in a total of 50 patients with sixty-eight metacarpal fractures of the hand in patients aged 18 to 65 years conducted during the period of 2016 to 2018. Unstable metacarpal fractures, intra- articular fractures, avulsion fractures were included in this study. Fracture dislocations, open fractures with severe soft tissue injury, tendon injury, neurovascular injury and pathological fractures were excluded. Primary outcomes were assessed using the Quick DASH score and Michigan Hand QuestionnaireResults and Observations: Out of 50 patients, 72% were males and 28% females with the male to female ratio being almost 2.5:1. Almost 80% of patients fell in the category of 20-40 years. The 3rd and 5th metacarpal fractures were the most common, having an incidence of 20.6% and 32.4% respectively. The average time taken to union in study was approximately 6.5 weeks with age being more of a factor than treatment protocol as both conservatively managed and operatively managed fractures began to show union as early as 3 weeks. According to the study, 5 complications were found, with stiffness and superficial infection being the most common.Conclusion: Functional outcome is of paramount importance and restoration to maximum hand function and is the primary expectation of the patient. Conservative management and operative management, both have their merits and demerits and should be chosen as per surgeon experience, preference and patient expectation. Physical therapy and mobilization are key in managing these fractures and should not be neglected and should rather form an integral path to recovery.

Background: Musculoskeletal impairment is the most common cause of chronic pain and subsequent disability world over. Yet their very few Indian studies on this subject. The aim of study was to assess the extent of disability in out-patients suffering from chronic musculoskeletal pain, to determine whether the disability varied with the age and sex of the patient, to assess any correlation between the intensity of pain and the extent of disability, and to evaluate whether the extent of disability depended upon the site, periodicity and duration of pain.Methods: The 200 patients of chronic musculoskeletal pain were assessed for disability using the pain disability questionnaire (PDQ) and pain intensity using the numeric pain rating scale. The patients with mild, moderate and severe disability were compared using non parametric tests to assess the differences related to age, sex, pain intensity, site, duration and periodicity of pain.Results: The 56% patients had mild, 41% had moderate while 3% patients reported severe disability. Disability was higher in patients in the younger age group, higher intensity of pain, heel pain and variable pain. In the regression analysis, pain intensity emerged as the sole predictor of disability.Conclusions: We conclude that 56% patients had mild, 41% had moderate while 3% patients reported severe disability. Disability was higher in patients at the extremes of age, higher intensity of pain, and variable pain. Gender and pain duration did not have any significant association with disability.

Introduction The present study was done to assess the functional outcome and complications of interlocking intramedullary (IM) radius ulna nailing to treat radio-ulna fractures in adults. Methodology Thirty adult patients with diaphyseal or segmental fractures of radius and ulna were included and treated with IM nailing. Grace and Eversmann rating system was used to assess functional evaluation and grip strength was measured using grasp dynamometer. Results Mean age of the 30 eligible patients was 33.5 years, and males comprised 77% of the study population. Intra-operative complications like nail impaction and proximal screw locking problem for radius was present in one patient each. Increased swelling in three patients (10%) and posterior interosseous nerve palsy in one patient (3%) were observed post-operatively. In the post-operative period, all patients were able to move fingers, had 100° elbow range of motion and good grip strength. Pronation and supination till 80° was present in 80% and 57% of the patients respectively. Wrist flexion and dorsiflexion till 90° was present in 80% and 57% of the patients. Fracture union was confirmed radiologically in all cases at a mean of 3.6 weeks. Functional outcome was excellent in 73% and good in 13%. Grip strength was judged to be excellent in all cases. Conclusions Excellent and good functional outcomes were obtained in 86%, and no case developed mal-union or delayed union. Based on our results, IM nail for surgical treatment of radial and ulnar diaphyseal fractures can be used.

Introduction: Fracture of distal femur and proximal tibial are often difficult to treat and associated with many complications. We aimed to assess the clinical and radiological union time and functional outcome in fractures of distal femur and proximal tibia managed by metaphyseal locking plates and to study the complications associated with it. Methodology: This prospective study was conducted from June 2014 to October 2016 in the Department of Orthopedics, Dr. DY Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai, using a consecutive sample of 50 patients fulfilling our study eligibility. Detailed clinical history of the patients and operative details were noted. All patients were followed up at 3 and 6 months, and were assessed for pain, range of movement (ROM), functional outcomes, union times and complications. Results: Distal femur fracture were seen in 42% cases (most common type A2) while proximal tibia fractures were seen in 58% cases (most common type II). 28.6% patients showed fracture union by 5 months, 85.74% showed union by 6 months. Complaint of pain at 3 months was given by 22% cases and at 6 months by 6% cases. Delayed, mal and non-union were seen in 12%, 4% and 2% of cases respectively. As per the Oxford Knee Score, excellent outcome was seen in 86% cases while good and fair outcome was seen in 8% and 6% cases respectively. Conclusion: Metaphyseal locking plates is a superior implant for the fractures around knee with an excellent functional outcome.

Introduction: Posterior lumbar interbody fusion (PLIF) is been used increasingly for degenerative lumbar spine disease to achieve a 360 degree fusion. With the advent of newer techniques and instrumentations the results are good. Aim: To study the outcome of PLIF with cages and that with bone graft for degenerative Lumbar spinal canal stenosis. Material and Methods: We did a double blinded randomized controlled trial at single center. All patients who met with our inclusion criteria and operated from 2007 to 2010 were included in our study. The patients were followed up serially for 5 years for the final outcome. Modified Oswestry low back score and final CT scan based interpretations were applied. Results: Totally 101 patients were included in the study of which 53 underwent PLIF with titanium cage and rest 48 underwent PLIF with bone grafting. We found the results of union rates in both the groups were gratifying, but early and better results with fewer complications were in group with titanium cages. Conclusion: We fairly conclude that better and faster fusion rates with good ambulation can be achieved with titanium cages rather than bone grafting in degenerative lumbar spine disease.

Introduction: As the elderly population grows, the number of hip fractures continues to increase. This study aims to compare the clinical outcomes of DHS and PFN in the fixation of intertrochanteric fracture of femur. Methodology: After obtaining approval of the ethics committee, a prospective study was conducted in the Department of Orthopedics, DY Patil School of Medicine from January 2014 till December 2015. Informed consent was taken from from patients who fulfilled the inclusion/exclusion criteria and relevant clinical information was collected, including intra and post-operative details. The patients were called for followup to check for complications. Results: During the study period, 50 patients with intertrochanteric fracture were included in the study, of which 23 were treated ith PFN and 27 with DHS. 76% of the PFN patients needed no blood transfusion, while 41% of DHS patients needed 2 units of blood transfusions. Post operative fever and deep vein thrombosis was more common in DHS patients. 79% of PFN patients started mobilizing on the first postoperative day as compared to 68% of DHS patients who starting mobilizing on third postoperative day. Similarly post operative weight, full weight bearing and return to activity of daily living was seen to be better in PFN patients. Conclusions: Our study showed that PFN is a superior method of osteosynthesis as compared to DHS in the treatment of intertrochanteric fractures. Future research should focus on studying the economic and rehabilitative impact of PFN on patients with intertrochanteric fractures.

Introduction: Lumbar microdiscectomy has been associated with high rates of success and low postoperative morbidity. We aimed to evaluate the clinical outcome of patients undergoing lumbar microdisectomy for disc herniations. Methodology: The study was performed in the Department of Orthopedics, Lokmanya Hospital Chinchwad and Lokmanya Hospital Nigdi, Pune from August 2002 till May 2004 on all patients scheduled for microlumbar discectomy for lumbar disc herniation. Intra-operatively, type and level of prolapse and operative time was noted. We also noted the length of hospital stay and any complications experienced by the patient. For assessing the patients, instruments like Visual Analog Scale (VAS) for pain at the end of first week and return to normal activity of daily living (ADL) and satisfaction with the result of surgery at the end of six months were used. Results: All surgeries were single level microdiscectomy. Operative time on the average was 85 minutes and 83% of the patients had a stay of less than 5 days in the hospital. Disc sequestration and disc exclusion were the most commonly seen types of prolapse. Pre-operatively five patients had a back pain VAS of more than 4 and four patients had a leg pain VAS of more than 4. On assessing the outcome in patients in terms of returning to activities of daily living and satisfaction with surgery only four and five patients had a score more than two respectively. Conclusions: Proper preoperative planning and correct surgical technique can prevent complications in these cases. Future multicentric studies with larger sample size and longer follow up periods are needed to support our findings.

Introduction: The clinical presentations of lumbosacral radiculopathy vary according the level of nerve root or roots involved. Lumbar Discectomy is very commonly performed for this. We aimed to study the clinico-epidemiological profile of the patients who presented to our hospital with low back pain, were diagnosed with lumbar disc herniation and were operated with micro-lumbar discectomy. Methodology: The study was designed and performed in the Department of Orthopedics, Lokmanya Hospital Chinchwad and Lokmanya Hospital Nigdi, Pune from August 2002 till May 2004. After approval of the institutional ethics committee, we included patients who were admitted and operated for lumbar disc herniation with microlumbar disc surgery. We collected personal, demographical, clinical history and clinical examination findings of the patients. The data was compiled and analysed descriptively using Epi Info software. The frequency tables were prepared and percentages were calculated. Results: We included 24 patients, 15 patients were males, average age was 45.85 years. L4-L5 was the most commonly involved level of disc involved in our patient population. Radiation of pain towards the right was more commonly seen then left. Majority of the patients had duration of symptoms between 2 to 6 months (42%). 7 patients had sensory distribution of neurological symptoms, 4 had motor and reflex distribution of symptoms each. Conclusions: Understanding the clinical and epidemiological profile of patients with disc herniation can help us in identifying candidates for microdiscectomy and better outcomes as a result.

Background: Fracture shaft of femur is one of the most common fractures encountered in orthopaedic practice. Fracture shaft of femur is major cause of morbidity and mortality in patients who sustain high energy trauma. This study looks at the epidemiology of patients presenting with femur fracture at a tertiary level hospital in Navi Mumbai. Methods: This prospective study was performed at a tertiary level hospital in Navi Mumbai from January 1, 2014 till July 31, 2015. All patients aged 18 years or above, who presented with comminuted femur fracture and were treated with interlocking nailing was included in the study. Various clinical and radiological parameters were collected during the course of treatment. Results: 50 patients were included in the study; 84% males. 88% aged 50 years or less. Road traffic accident was the most common mode of injury and 54% of patients had fracture in the middle one-third femur. 76% of the patients presented within 24 hours of injury. 52% of the patient’s demonstrated clinical union of the fracture in 12 to 14 weeks and majority showed radiological union in 16 to 18 weeks. Partial weight bearing was started in 36% patients in 10 weeks and full weight bearing in 42% patients in 16 weeks. Majority of the patients stayed in hospital for 10 to 14 days and the functional outcome as measured by Klemm and Borner criteria was excellent in 66% patients. Complications were seen only in 6 patients. Conclusions: In our experience, interlocking nailing had very low complication rate and excellent functional outcome in two thirds patients of comminuted femur fracture.

Background: The plantar fascia is a common condition, for which there is no consensus on the best treatment option. The aim of this study is to compare the pain and fascia thickness outcomes of patients treated with botulinum toxin A injection versus corticosteroids injection.Methods: 50 patients of plantar fasciitis randomly received injections of either botulinum toxin A (100 units in 2.5 ml normal saline) or methylprednisolone (2 ml of 40 mg/ml) under ultrasonographic guidance. Patients were assessed for pain using the visual analogue scale (VAS) and fascia thickness at baseline, 1 and 3 week, 3, 6 and 12 months post injection. Patients in the two treatment groups were compared for pain scores and thickness at each follow up.Results: There were no significant differences in the patients in both the groups at baseline. Patients in both the groups had significant improvement in VAS pain scores over a 12 months follow- up. At the end of the study (12 month follow up), the VAS pain score was significantly lower in the group of patients who received botulinum toxin A (1.68±0.62 vs. 4.72±1.02, p value=0.001). There was a significantly less plantar fascia thickness in the group of patients who received botulinum toxin as compared to those who received corticosteroids at the 3 week, 3 month, 6 month and 1 year follow up.Conclusions: Better clinical outcomes were observed with botulinum toxin type A as compared to corticosteroids. Similar studies need to be replicated with larger sample sizes before this can be offered as a standard treatment for plantar fasciitis patients.

Background: Shoulder pain is a common musculoskeletal complaint that may be due either to intrinsic disorders of the shoulder or referred pain. In this study, we aimed to find out the sensitivity and specificity of the clinical and radiological methods in diagnosing the chronic shoulder problems and to compare clinical and radiological diagnosis with arthroscopic diagnosis.Methods: After obtaining approval of the institutional ethics committee, we enrolled patients who presented with chronic shoulder pain in the outpatient clinic of Department of Orthopedics, DY Patil Medical College and Hospital, Navi Mumbai from August 2003 till August 2005. We obtained historical data of each patient in detail and made clinical, radiological and arthroscopic diagnosis. The findings from each diagnostic modality were compared and analysed.Results: During the study period, 34 patients were enrolled in the study. Injury was traumatic in 32% of the patients and 50% of all patients were heavy workers by occupation. Half of all the patients had pain in shoulder for more than 6 months. Clinical diagnosis of biceps tendinitis was made in 44% of patients, but radiological and arthroscopic diagnosis of biceps tendinitis was made in 18% and 12% respectively. Impingement was diagnosed in 29% patients clinically, in 15% patients radiologically and in 21% patients arthroscopically. Rotator cuff injury was diagnosed in 26% patients clinically, in 41% patients radiologically and in 67% patients arthroscopically. Conclusions: Findings from this single centre study suggest that arthroscopy can diagnose and treat conditions causing chronic shoulder pain, which is cost effective as well.

Background: Fractures of the clavicle have been traditionally treated non- operatively but has been associated with various postoperative complications. In this study, we analyzed the outcomes of the operative management and compare its results with conservative treatment considering it as standard treatment option.Methods: The present study was carried out at the Department of Orthopedics, DY Patil Medical College and Hospital, Navi Mumbai. Open fractures, fractures associated with complication like head injury with associated other bone injuries were included in this study. We excluded patients less than 18 years of age, patients with middle third fracture of clavicle and patients with medial end clavicle fracture. The fractures were classified according to Robinson’s classification. Patients were followed up every week for 4 weeks then at 8 weeks, 12 weeks, 6 months and 1 year. The functional outcomes were assessed by Constant and Murley score.Results: We included 48 patients in the study, 34 of which were males, average age of the patients was 37.53±7.64 years. 23 injuries were on the left. There was statistically significant better union times with operative management (p=0.034). Various complications were observed like infection, implant failure, man union, non-union, deformity and skin infections, statistically seen more in patients who underwent conservative management. Overall, patients experienced excellent and good results with operative management in 6 and 12 patients respectively.Conclusions:Operative treatment gave statistically significant functional outcome and early healing compared to conservatively treated in displaced, communited lateral end clavicle fractures.