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Objective: We had evaluated our experience in the treatment of Morrey Modified Masons type III and IV radial head fractures with radial head prosthesis. Materials and Methods: From April 2011 to September 2014, modular radial head prostheses were performed in thirty patients. There were twenty female and ten male with mean age of forty years. The follow-up was a mean of 25 months. Fractures of the radial head have been classified by Morrey Modified Masons classification. The indications for a radial head replacement were type III fractures in 24 cases, type IV fractures in 6 cases, and comminuted radial fracture associated with disruption of the medial collateral ligament in 3 cases. Patients were assessed postoperatively and on follow-up based on Mayo Elbow Performance Index (MEPI) Score. Results: By using the MEPI, out of thirty cases, twenty cases had excellent results, seven cases had good results, two cases had fair results, and one case had poor result. Twenty-eight cases had no complications, one case had infection, and one case had implant failure. Conclusion: Modular radial head prosthesis can be used successfully for treatment of the Morrey Modified Masons type III and IV radial head fractures.

Background: Avascular necrosis (AVN) of the femoral head is a progressive disease that generally affects patients in the third through fifth decades of life; if left untreated, it leads to complete deterioration of the hip joint. Treatments range from simple decompression of the femoral head, to bone grafting of the involved area, or by using a vascularized fibular graft with varying degree of success. In most instances, the disease progresses further causing secondary arthritis. We present a study of management of early stage AVN (stage I and II A/B of Ficat Arlet classification) with core decompression autologous cancellous bone grafting along with platelet rich plasma. Aims: To evaluate the results of the above modality in the management of AVN of the hip. Settings and Design: This prospective study of 30 cases was done during the period of 2011-2013. Materials and Methods: Patients with stage I and II A/B were treated with the above modality and were followed up for 1-year. The results were evaluated on the basis of progression or remission of the disease by radiographic studies, preoperative and postoperative Harris hip score (HHS), age and sex distribution. Statistical Analysis Used: Primer software for calculating the statistical data was used and paired t -test was applied to all the data. Results: Show males were more affected than females and average age group of presentation in stage I and II was 29 years (22-55). The most common cause was idiopathic followed by steroid use. Average preoperative HHS was 56.80 and postoperative HHS was 79.73. 60% (18) showed remission of the disease (radiographically) compared to preoperative stage at 1-year follow-up, in 30% (9) disease did not progress further and 10% (3) progressed and required arthroplasty. Conclusion: Management of stage I and II A/B AVN of femur showed good satisfactory results in terms of disease remission and prevention of the further progress of the disease by the above method at 1-year follow-up and further follow-up is awaited.

Background: Fractures of distal radius continue to be the most common skeletal injury treated by orthopedic surgeons. The treatment of distal end radius fracture has changed over period. The aim of treatment of distal radius fracture is to obtain a good anatomical reduction and fixation and finally a good functional outcome. Objective: To study comparative evaluation in the measurement of the radial height, radial inclination and ulnar variance in fracture distal end radius treated conservatively by closed reduction and cast and closed reduction, Kirschner wire and cast. Materials and Methods: In the present prospective study, we are reporting our experience in 30 cases where comparative evaluation in the measurement of the radial height, radial inclination, and ulnar variance was done in fractures distal end radius treated conservatively by closed reduction and cast and closed reduction, K- wire, and cast technique. Results: As measured by Mayo functional score, we had 14 satisfactory and 1 poor result in the Group 1 (closed reduction and cast) while 8 excellent results and 7 good results in the Group 2 (closed reduction, Kirschner wire and cast). As measured with the modified demerit point system of Saito, in the Group 1 (closed reduction and cast), 11 had average results and 4 had fair results; and in our Group 2 (closed reduction, Kirschner wire and cast), 9 had excellent results and 6 had good results.

Background: Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. Aim: The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. Material and Method: A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. Result: Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker's classification have lesser outcome type of fractures Conclusion: We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after stabilization with mini external fixator results in good functional outcome of the knee and reduces hospital stay. Complications associated with this method of treatment are minimal.

Introduction: Afflictions of shoulder by tuberculosis is rare and when it occurs its more commonly a dry lesion (caries sicca). Wet lesions in shoulder are rare and we report this case for the rarity of its occurrence. Case Report: A 55yrs old female patient presented with a painful swelling with restriction of movements of the right shoulder since six months. Patient had taken various treatments without any relief; there was no history of trauma, weight loss, recent infection in the past or any history of tuberculosis in family or contact with tubercular patient. Right shoulder revealed restricted movements with no local rise in temperature. Tenderness was present over anterior and posterior aspect of the right shoulder diffusely. External rotation and abduction movements were restricted while adduction and flexion were not restricted. Power of the muscles was unaffected with no neurological deficit. Antero-posterior and axial X-rays of the right shoulder showed no bony involvement however, ultrasonography showed lipoma. Serological investigations showed a markedly raised erythrocyte sedimentation rate (73mm / hr) and a positive C-reactive protein. Surgical excision of the mass revealed rice bodies. DNA PCR was positive for tuberculosis and patient was started on anti-tubercular treatment( Category I) for six months. Conclusion: Any patient coming with the complaints of long standing painful restriction of the movements of the shoulder associated with or without complaints swelling, shall be evaluated to rule out skeletal tuberculosis along with other differential diagnosis of periarthritis of shoulder and adhesive capsulitis. Most of the patients with skeletal tuberculosis may not necessarily present with the constitutional symptoms of fever, weight loss, etc and also because of the widespread prevalence of the organism in India. Keywords: Shoulder Tuberculosis, Caries Sicca, rice bodies.

Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years) underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with

Background: Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. Aim: To study the correlation between clinical, magnetic resonance imaging (MRI), and arthroscopic findings in knee injuries. Materials and Methods: About 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. Results: MRI had better sensitivity (0.95 vs. 0.85) and specificity (1.0 vs. 0.5) in comparison with clinical examination for medial meniscus. In lateral meniscus injury (sensitivity 0.65 vs. 0.61 and specificity 0.95 vs. 0.92) and in ACL injury (Sensitivity 0.77 vs. 0.8 and specificity 1.0 vs. 0.96) the sensitivity and specificity of MRI versus clinical examination showed minimal difference. Conclusion: Our conclusion is that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison with MRI scan. MRI may be used as an additional tool for diagnosis.

Background and Aim: Anterior cruciate ligament (ACL) deficient knee usually present with instability of the knee, in our study we are comparing the results of ACL reconstruction using bone-patellar-bone and quadrupled stranded hamstring tendon grafts. Materials and Methods: Thirty patients presenting with chief complaints of the knee instability were diagnosed clinically by Lachman test, anterior drawer test, pivot shift test and confirmed by diagnostic arthroscopy or MRI to have ACL tear. ACL tears that are more than 6 weeks old are included. Fifteen patients were treated with ACL reconstruction using autologous ipsilateral hamstringtendon and 15 patients were treated with bone patellar tendon bone graft through arthroscopy assisted technique. All patients were reviewed and analyzed at the end of 1 year post-operatively. Assessment includes pre-operative, intra-operative findings and post-operative subjective assessment scores and examination findings, pre- and post-operatively the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) evaluation system were used as scoring systems. Results: Comparisons of results within the same groups showed statistically significant improvement as assessed by IKDC, Tegners and Lysholm operative scores. There was also significant correlation between manual Lachman test and stress laxometry findings. There was no statistically significant difference between scores of two groups (hamstring and bone patella tendon). Conclusions: Arthroscopic ACL reconstruction by either quadrupled hamstring tendon graft or bone patellar tendon graft gives equally satisfactory results.

Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescent patients. Diagnosis requires a high index of suspicion as clinical findings are often subtle. Limited range of motion may be the only notable clinical sign. The diagnosis is made by thorough clinical examination, radiographic examination and magnetic resonance imaging (MRI). Early diagnosis and treatment can change the prognosis of the disease. If not diagnosed early, OCD can lead to the development of osteoarthritis at an early age. Conservative management is the mainstay of treatment for stable lesions. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management.

A 35 years old female came to orthopedic OPD with multiple joint pain since 1 year with history of fever and morning stiffness without any history of trauma and previous infection. On examination there was small joint tenderness involving metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with splenomegaly. Routine investigation revealed neutropenia and rheumatoid factor (RF) was positive. Patient was diagnosed to be suffering from Felty's syndrome. Treatment was initiated with methotrexate. Overall treatment was tolerated well, except for the development of mild fever, mild arthritis and transient thrombocytopenia. She is currently on methotrexate with reasonable control of her symptoms.

We report a rare case of compound fracture of the first metacarpal with volar dislocation of second, third, and fourth carpometacarpal (CMC) joints of the right hand. These injuries were diagnosed early and treated successfully with debridement and open reduction and internal fixation using multiple Kirschner wires (K-wire) within 6 hours of injury. The functional results were good at 16 weeks follow up.

Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA) by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

A 17-year-old female presented with complains of swelling in left scapular region since the age of 5 years, which had progressively increased in size. This condition was asymptomatic, but caused visible cosmetic concern to the patient and her parents as she was approaching a marriageable age. An En bloc excision of exostoses scapula was done; the patient had full functional recovery with no visible swelling. Histopathology, the diagnosis of osteochondroma was established. The patient was satisfied after the surgical resection of the tumor as, cosmetically, she looked near normal.

Background: Uncomplicated diaphyseal fractures of the humerus successfully healed in over 90% of cases when treated conservatively by reduction and immobilization. Open reduction with internal fixation, is preferred for open, segmental and pathological fractures. Objective: To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. Materials and Methods: We randomized prospectively 30 patients with fractures of the shaft of the humerus were treated by open reduction and internal fixation by dynamic compression plate (DCP) in 15 cases and closed reduction and internal fixation with interlocking intramedullary nail in 15 cases. Patients were followed up for a minimum of six months. Result: There were no significant differences in the function of the shoulder and elbow, as determined by the American Shoulder and Elbow Surgeons′ score, the visual analogue pain score, range of movement, or the time taken to return to normal activity. In our study, complications in DCP and IMN groups common were radial nerve injury and shoulder impingement. We had to perform secondary surgery on four patients in the IMN group, but on only one in the DCP group. Conclusion: Our findings suggest that open reduction and internal fixation with a DCP remains a better treatment option for fractures of the shaft humerus. Fixation by IMN may be indicated for specific situations, but is technically more demanding and has a higher rate of complications.

A case of multicentric giant cell tumor with synchronous occurrence in all three bones around the knee is reported here in view of its rarity. A 33-year-old average built male reported with complaints of severe pain, gradually increasing swelling around the right knee. A 3 × 2 cm swelling was present on the lateral aspect of the distal end of the right femur and a 3 × 3 cm swelling on the proximal part of the right tibia. Plain X-ray of right knee showed subarticular eccentrically located expansile lytic lesion in the lateral tibia condyle, lateral condyle of femur and patella. Fine needle aspiration cytology and subsequent histology ascertained the diagnosis of giant cell tumor of the bone. The patient was treated successfully with curettage, bone grafting and methyl methacrylate cementing (Sandwich technique).