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INTRODUCTION: The purpose of the study was to assess the efficacy of the dorsal closing wedge osteotomy for the treatment of Freiburg’s infraction. MATERIALS AND METHODS: Twenty patients with Freiburg’s infraction were admitted at our hospital over a period of six years. Patients with a normal plantar contour of the metatarsal head were included. All patients underwent a dorsal closing wedge osteotomy of the metatarsal. RESULTS: The mean Leeds Movement Performance Index (LMPI) score was 84 (range 70-86). The mean metatarsal shortening was 2mm. the passive flexion restriction was 16° and extension restriction was 10°. Also, a strong negative correlation was found between Smillie classification and American Orthopaedic Foot and Ankle Score (AOFAS) final score (r’s = −0.85, P < .001). CONCLUSION: The dorsal closing wedge osteotomy is an efficient and reproducible method for the management of Freiburg’s infraction.

The evidence base is growing regarding proximal fibular osteotomy. Most studies show that the pain relief and improvement in terms of radiology is statistically significant. More understandable biomechanical theories explaining this improvement are appearing. Because it has a low complication rate and is relatively easy to execute, proximal fibular osteotomy should definitely be considered in any algorithm for the treatment of medial compartment osteoarthritis of the knee. [ Orthopedics . 2020;43(6):e627–e631.]

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.

Purpose Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature. Methods From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered. Results All patients were males with an age range of 11–32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot. Conclusion Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest. The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified.

Objectives: Diabetes mellitus (DM), is affecting an ever increasing number of people worldwide. Diabetes is associated with several musculoskeletal manifestations. These may involve, the upper as well as the lower limb. We conducted this study to find out the prevalence of musculoskeletal problems in type 2 diabetics in the Kashmiri population. Methodology : The study was conducted on 403 patients with diabetes and 300 controls. All patients underwent screening for any musculoskeletal abnormalities. The patients with musculoskeletal abnormalities were further assessed to find the exact diagnosis according to predefined criteria. Results : The hand was involved in 80 patients [19.8%] in the diabetic group and 15 (5%) patients of the control group. The elbow was affected in 56 patients [14%] in the diabetic group and 24 patients [5.9%] in the non-diabetic group. The shoulder involvement was diagnosed in 61 patients [15%] on the diabetic cohort and 15 patients in the non-diabetic cohort. All the upper limb figures showed a statistically significant difference i.e. P value

This work aimed to study the pattern and epidemiology of pediatric musculoskeletal trauma and consequent morbidity in Kashmir Valley and compare the results with other studies and to formulate preventive measures and devise management strategies. This was a retrospective study of 1467 pediatric orthopedic trauma patients who presented to our hospital over a 3-year period between September 2005 and August 2008. Information was recorded in a prescribed proforma including the following: age, sex, mode of trauma, type of fracture/injury, radiological study, final diagnosis, intervention performed, and complications. The information was collected from the Medical Records Department of the hospital. The children's ages ranged from 0 to 16 years; there were 996 males and 471 females, with males outnumbering females in every age group (the overall male-to-female ratio was 2.12:1). Most fractures occurred in children aged 7-12 years [n=816 (53.96%)] and decreased in younger and older children beyond this age group. The left side was involved in 762 cases, 612 injuries involved the right side, 24 were bilateral, and 69 patients presented with multiple injuries. In children aged 0-6 years, the most common site of injury was the elbow, whereas in children aged 7-16 years, it was the forearm. In descending order, most injuries were sustained because of fall while playing (34.76%), fall from height (33.74%), road traffic accidents (14.92%), and fall from standing height (7.97%). The majority of injuries were caused by unintentional trauma (94.48 vs. 5.52%). The places where injury occurred were the home [603 (41.10%)], play field and orchards near the home [450 (30.67%)], roads [219 (14.92%)], school [183 (12.47%)], and unknown [12 (0.81%)]. The pattern and epidemiology of pediatric trauma differs from those in adults. The majority of musculoskeletal injuries are because of unintentional trauma in this young age group and hence preventable. Enhanced supervision at home and school is recommended. A safer environment and better playing conditions may decrease the high frequency of trauma in pediatric patients. Dedicated trauma centers with such facilities as orthopedics, neurosurgery, and plastic surgery need to be established for the proper management of pediatric trauma.

Introduction: Impending gangrene of the thumb in infants is rare. Case Presentation: A two-month-old baby was brought to our hospital with swelling and redness in the thumb of the left hand for one day. The child was irritable and febrile, but a systemic examination of the child was unremarkable. The thumb was swollen, with considerable redness and a small concentric band at the base of the thumb. A pulse oximetry probe could not detect oxygen saturation in the thumb. An intraoperative examination revealed a hair as the cause of the constriction band. All hair was meticulously removed. Oxygen saturation improved to 98% immediately after surgery, and the postoperative period was uneventful. A complete healing of the ulcer was seen after three weeks. Conclusions: Impending gangrene secondary to the mother’s hair is extremely rare. Fortunately, the prompt use of measures and the timely removal of the hair causing constriction in our case prevented established gangrene that would have led further to amputation.

Background: Fractures of the femur are amongst the most common paediatric orthopaedic injuries. The aim of this study was to assess the efficacy of the stainless steel elastic nail in the management of these fractures in the 6-10 year age group.Methods: Fifty patients in the age group of 6-10 years with displaced diaphyseal femoral fractures were stabilized with these nails. Patients were followed up clinically and radiologically for a minimum period of 1 year.Results: There were 64% excellent and 34% satisfactory results. 2% patients had poor result.Conclusions: These nails are a relatively easy to use, minimally invasive, physeal-protective implant system with high rate of satisfactory and excellent outcomes in children aged 6-10 years.

Background: Haglund deformity is a common cause of posterior heel pain and consists of a constellation of soft tissue and osseous abnormalities. The treatment starts with conservative approach and ends with surgical treatment in case conservative treatment fails and the symptoms are bothersome. Different surgical procedures and approaches have been used for this deformity. But in the literature, the results have been inconsistent. In this study we evaluated the clinical and functional outcome of osteotomy of the calcaneal tuberosity with debridement of the retrocalcaneal bursa and the Achilles tendon using a lateral approach at our institute.Methods: A total of 29 feet in 25 patients that underwent surgical procedure from August 2013 to March 2017 at our institute were included in this study. The clinical and functional outcome was evaluated using AOFAS ankle-hind foot scale.Results: The mean AOFAS ankle-hind foot score had improved by 32 points from the pre-operative mean score, with a mean score of 86 at the final follow up of one year. Five out of 29 operated feet had superficial surgical site infection in the postoperative period that responded to antibiotic therapy and regular antiseptic dressings. One patient had local betadine allergy.Conclusions: We conclude lateral approach to debridement and calcaneal tuberosity resection is an effective method with good clinical and functional outcome in patients with refractory Haglund deformity.

Crowd control has evolved from the baton, bayonet and live ammunition to the use of tear gas, pepper spray and Tasers. In spite of the availability of a wide variety of non-lethal/less-lethal weapons, projectile-based crowd control methods are still used in some parts of the world.[1][1] The recent