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Objectives: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through Burks and Schaffer's approach when combined with a rehabilitation programme, which emphasizes early range of motion. Design: Retrospective study Setting: Level 1 trauma centre, All India Institute of Medical Sciences (AIIMS), New Delhi Patients: From December 2006 to June 2009, 18 cases of PCL tibial avulsion injuries presented to our institution and underwent surgical intervention. Patients were followed up for 10 to 16 months (mean 12 months). Intervention: Fixation of tibial PCL avulsion fractures was with one or two 4-mm partially threaded cannulated screw and washer placed through a Burks and Schaffer's approach. Range of motion was begun on postoperative day 2. Main outcome measurements: Range of motion, clinical stability, radiographic appearance, each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) and gastrocnemius muscle strength were evaluated at final follow-up. Results: Union was achieved in all the cases, and all of them were having clinically stable knee at the time of last follow-up. The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) [ABSTRACT FROM AUTHOR]

Background: The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup. Materials and Methods: Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed. Results: Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance. Conclusion: Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon. [ABSTRACT FROM AUTHOR]