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Purpose Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures. Methods The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5–12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n = 17) or stainless steel (n = 17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria. Results Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group. Conclusion Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: To describe the cross sectional anatomy of Alcock’s canal. To illustrate the primary and secondary signs of pudendal neuropathy. To demonstrate image guided intervention in Alcock’s canal for pudendal...

As an elective procedure, total knee arthoplasty is under scrutiny to evaluate clinical and functional outcome. In this regard, we examined 32 knee arthoplasty to assess factors associated with better functional outcome. METHOD : It is a prospective study of 32 knee cases in between 2006-2012. In this 28 knee had osteoarthritis knee and 6 knee had rheumatoid arthritis. Infective, traumatic and metabolic bone disease knees were excluded from study. All patients were evaluated by American knee society score (KSS and functional score). RESULT : Total knee arthoplasty was found to be associated with substantial functional improvement. The greatest amount of improvement is seen within few months after surgery with more gradual improvement occurring up to years of surgery. CONCLUSION: Total knee arthoplasty is a very effective procedure for overall functional improvement and pain relief of the patient with arthritic knee.