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Background: With Most patients with Osteoarthritis needing bilateral TKR for optimal functional results, the debate on whether to do a single stage bilateral TKR or staged bilateral TKR has become common. The aim of this study was to review the safety of single stage bilateral TKR done in our institution. Materials and Methods: We did a retrospective review of 127 cases of single stage bilateral TKR that was done in our institution during a period of 38 months from 2015 to 2018.Electronic medical Records of patients who underwent single stage Bilateral TKR during this period were reviewed. Only patients who received cruciate retaining prosthesis and had subvastus approach were included. Results were analysed using Chi square testing in terms of ASA grade and age and incidence of complications. Results: ASA grade and age was seen to be correlating with incidence of complications during the intraoperative and immediate postoperative period. The incidence of complications was 42.9% in the ASA-III group with p value less than 0.00001. The Incidence of complications was 16 % in the above 70 years age group with P value less than 0.00982. In the ASA-III group, the incidence was 50% in the above 70 group when compared to the 60-70 group (40%) with P value of less than 0.00001. Conclusions: Judicious patient selection using ASA grade and age may minimise complications of single stage bilateral TKR. The use of Cruciate retaining prosthesis and subvastus approach may have contributed to the low incidence of complications.

Introduction:Iliopsoas abscess is an uncommon condition, often with insidious and nonspecific symptoms. Patients often present with a limp, fever, weight loss, and flank or abdominal pain. An iliopsoas abscess can be either primary or secondary depending on the presence or absence of an underlying disease. Primary abscess is very common in Asia and other developing countries. If untreated, iliopsoas abscess can spread to lower limbs, compress iliac vein, ureter and can end up in sepsis. There have been only a very small number of cases of psoas abscess with associated hip septic arthritis reported so far. Bilateral iliopsoas abscess is also a rare entity. Case Report:We report here a 58-year-old diabetic lady with fever and both hip pain subsequent to a fall at home one month back around one 1 month before. . She was initially seen elsewhere, and a diagnosis of L4-L5 disc bulge was made following which rest , analgesics and steroids were given. Later, repeat magnetic resonance imageMRI showed bilateral Iliacus abscess and bilateral hip synovitis. She was started on anti anti-tuberculosis medications and referred to us. We investigated for occult sources of infection and did bilateral iliopsoas abscess drainage followed by staged bilateral total hip replacement. She now continues to be symptom free. Conclusion: Our patient had primary bilateral iliopsoas abscess with bilateral hip Streptococcus faeeacalis septic arthritis. It has not been reported in the literature till now. Clinical Message:Early diagnosis through meticulous clinical examination and investigations is important in treatment of the abscess and reducing morbidity and mortality. Keywords:Primary iliopsoas abscess, septic arthritis, bilateral iliopsoas abscess.

Background: Displaced patella fractures need to be treated by internal fixation for achieving good outcome. Metallic hardware related pain and irritation are one among the many reasons for reoperations. Fracture displacement can happen due to early mobilisation depending on bone quality and fracture pattern. The aim of our study was to evaluate the postoperative outcome and complication rates of patella fractures fixed with fibre wires in a vertical and figure of eight pattern. Methods: We retrospectively followed up all patella fractures fixed using fibre wires utilising Krackow stitches through patellar tendon, longitudinal fixation through fracture fragments and figure of eight wiring on anterior patella. We evaluated their clinical outcome, range of movement, time to union and complication rates. We also evaluated these for arthritic scenario and different fracture patterns. Results: We had 22 patients (mean age 50.7) with a mean follow up of 22.7 months, mean Bostman score of 23.5, mean range of movement 1150 and mean time to union 13.5 weeks. Arthritic patients though united without any complications had an unsatisfactory score. None of the patients developed any hardware related complications, fracture displacement or needed an implant removal. Conclusion: Fibre wires can be used in vertical and figure of pattern for achieving fracture union with good clinical outcome without fracture displacement or symptomatic hardware problems.

Background: The successful treatment of unstable intertrochanteric fractures of the femur in elderly patients is a challenge. Due to complications associated with internal fixation, primary hemiarthroplasty is increasingly becoming an alternative treatment to achieve early mobilisation. A transtrochanteric approach could potentially decrease the complications associated with primary hemiarthroplasty. Aim of the study is to document the postoperative outcome and complications associated with this treatment.Methods: In this retrospective study, all elderly patients with unstable trochanteric fractures, treated by primary hemiarthroplasty through a transtrochanteric approach, in a tertiary care centre, from September 2017 to December 2019, were enrolled. Their data from hospital records were analysed and results compared to literature.Results: 48 patients underwent the procedure. Average age was 85 years. One year mortality was 31.25%. Average duration of surgery is 85 min. 58.3% were ambulant at one year. One case of dislocation secondary to surgical site infection was present.Conclusions: Primary hemiarthroplasty as a primary treatment in this group of patients enables early mobilization and prevents complications associated with prolonged immobilization. Transtrochanteric approach reduces the duration of surgery. Achieving early ambulation is the key to successful treatment.

Background: Clavicular hook plates are effective fixation devices for lateral end clavicle fractures and acromioclavicular joint dislocations and have been extensively used in the last decade. Although this plate achieves a high percentage of union, there are concerns about sub-acromial osteolysis and impingement of supraspinatus tendon. Objective: To show that impingement of supraspinatus tendon can be prevented by measuring the depth between acromion and supraspinatus tendon posteriorly and using hook plates of appropriate depth. Materials and Methods: We performed a prospective study on 25 patients with lateral end clavicle fractures and acromio clavicular joint disruptions by measuring the depth between posterior border of acromion and the superior border of supraspinatus at the point of application of hook plate. Fixation is then done by appropriate sized hook plate. Results: None of the patients had impingement of supraspinatus tendon. Five patients developed subacromial osteolysis which did not have any impact on shoulder function. Conclusion: There is a variation in anatomy of the acromion in different ethnic groups. Hence uniform sized hook plate will be inappropriate. A smaller hook depth is needed in south Asian population to prevent impingement.

Zygomycosis is an aggressive fungal infection occurred in immunocompromised patients commonly involving sinuses and lungs. zygomycosis has been reported in road traffic accidents and in farmland injuries. The mortality rate of zygomycosis is 40% to 80% due to angioinvasion. We report a case of immunocompetent young girl developing zygomycosis after road traffic accident in a urban area. The extensive infection patient survived after above knee amputation and antifungal therapy.

Aim To study the efficacy of topical intraarticular vs intravenous tranexamic acid (TXA) in reducing blood loss following primary total knee replacement (TKR). Materials and methods A phase 3, single center, double blind and randomized controlled study was conducted in the Department of Orthopedics, Sri Ramachandra University, Chennai, Tamil Nadu. A prospective study of 100 patients lasted from July 2013 to July 2015. Results Postoperative transfusion rates were zero in both the groups (intraarticular and intravenous). The mean 48-hour drain collected is 285.6 ml in group A (intraarticular), while it is 325.8 ml in group B (intravenous); the mean drop in hemoglobin is 1.7 gm/dl in group A (intraarticular) while it is 2.4 gm/dl in group B (intravenous). Conclusion This study shows that topical intraarticular administration of TXA has better efficacy than intravenous TXA in controlling postoperative blood loss following primary uncomplicated TKR with no significant complications. How to cite this article Vijay A, Nageswaran J, Loganathan S, Bedford SC. Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement. J Postgrad Med Edu Res 2016;50(2):64-68.

Background: Comminution of the lateral trochanteric wall, postero-medial communition, reverse oblique fractures, fractures involving communition of greater trochanter are unstable fractures which had poor results with the regular methods of fixation. Our aim in this study is to evaluate radiological and functional outcome at the end of one year following proximal femur locking plate fixation for certain group of unstable intertrochanteric fractures. Methods: 20 patients (14 male and 6 female patients) with per trochanteric fractures underwent proximal femur locking plate fixation in Sri Ramachandra Medical College hospital. Intertrochanteric fractures were classified according to Boyd and Griffin. Mean age of the patients was 55.2 years (26-82 years). The Schatzker & Lambert Criteria used to evaluate the functional outcome at the end of one year. Minimum follow up period was six months and maximum follow up was one year. Results: The functional outcome was assessed by Schatzker and Lambert criteria and was excellent in 8 patients; good in 6, Fair in 4 and Poor in 2.The average time to bear weight fully and walk was 6.5 weeks. Conclusions: Union was achieved in unstable, comminuted trochanteric fractures without significant complications and neck shaft angle was maintained in majority of the cases following proximal femur locking plate fixation.One of the major drawbacks of using proximal femur locking plate is that weight bearing is to be controlled and done only after radiological evidence of callus formation.

The existing scoring system like American Orthopaedic Foot and Ankle Society (AOFAS)-ankle hindfoot scale, Leppilahti et al scoring system, Achilles tendon total rupture score, foot and ankle outcome score, the physical activity scale (PAS) questionnaire and Tegner activity score were not designed to evaluate all the parameters following surgical treatment of Achilles tendon rupture. Hence, we developed a comprehensive score called the comprehensive Sri Ramachandra Medical College (SRMC) scoring system. We compared the results of 60 patients who were surgically treated for acute Achilles tendon rupture using our comprehensive SRMC scoring system with the most commonly used AOFAS-ankle hindfoot scale. Results We found that there was 6.7% poor results using our scoring system, whereas no poor results using AOFAS scoring system mainly because our scoring system also assesses quality of life, patient satisfaction and tendon strength. Similarly, there was 10% fair results in our scoring system compared to 3.3% in AOFAS scale indicating that our scoring system is more sensitive. Comprehensive SRMC scoring system was found to be reliable statistically as per alpha method (α = 0.7787) and was statistically significant at p < 0.001. Conclusion Comprehensive SRMC scoring system was found to be superior to AOFAS scale specifically for analyzing Achilles tendon repair. Poor results are likely to be picked up by our scoring system which has been shown in our results. How to cite this article Nageswaran J, Ram GG, Bedford SC. Ankle Hindfoot Scale vs Comprehensive Srmc Scoring System in Acute Achilles Tendon Rupture. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):77-79.