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Chondromyxoid fibroma (CMF) is a slow-growing benign tumour seen in the metaphysis of a long bone. World health organization (WHO) Classification of Bone and Soft Tissue Tumours (2002) defines CMF as ''benign tumour characterized by lobules of spindle or stellate-shaped cells with abundant myxoid or chondroid intercellular material.1 Jaffe and Lichtenstein were the first to describe this tumour in 1943.2 They differentiated CMF as a benign lesion from chondrosarcoma which is a much more common malignant tumour. Chondromyxoid fibroma is a potentially aggressive tumour with a cartilage-like matrix. It accounts for approximately 1 % of all bone tumors.3 CMF is found in older children and young adults. This type of tumour normally affects people between the age of 10 to 30 years.3,4,5 It is associated with high local recurrence and with less than 2 % of malignant transformation5. While the cells of the CMF tumour do not undergo metastasis, but they can invade nearby tissues. It is painful and causes other symptoms like swelling, stiffness, tenderness, and abnormal growth under the skin. The most common site of this lesion is the tibia and other affected sites are the flat and facial bones, and sparsely in bones of the feet and hand.6,7,8,9 Its occurrence in calcaneum is rarely seen.9 So here we report a case of a female patient, presented with cystic swelling and pain in the left foot, which was diagnosed as CMF in excision biopsy.

Tendons and ligaments are important structures in the musculoskeletal system. Ligaments connect various bones and provide stability in complex movements of joints in the knee. Tendon is made of dense connective tissue and transmits the force of contraction from muscle to bone. They are injured due to direct trauma in sports or roadside accidents. Tendon healing after repair is often poor due to the formation of fibro vascular scar tissues with low mechanical property. Regenerative techniques such as PRP (platelet-rich plasma), stem cells, scaffolds, gene therapy, cell sheets, and scaffolds help augment repair and regenerate tissue in this context. Therefore, it is of interest to document known data (repair process, tissue regeneration, mechanical strength, and clinical outcome) on applied regenerative medicine in tendon healing.

This case series reports the various treatment modalities to treat the multiple recessions. Gingival recession is a widespread clinical manifestation affecting single or multiple root surfaces at all teeth types. Periodontal reconstructive surgery consists of various mucogingival procedures. The primary goal of these procedures is to benefit periodontal health through the reconstruction of lost hard and soft tissues, or by preventing its additional loss, and also enhancing the esthetic appearance. Platelet-rich fibrin is a second generation platelet concentrate and is defined as an autologous leukocyte and platelet-rich fibrin biomaterial. Care was taken not to extend the incisions till the tip of the interdental papilla. A full thickness mucoperiosteal flap was reflected, extending beyond the mucogingival junction. A wide range of surgical techniques has been proposed for the treatment of the gingival recessions, each with its advantages and disadvantages. To provide predictable and long-term results, it is of paramount importance that the surgical technique is individually selected, taking into account several crucial factors such as the size of the defect, the width of the keratinised gingiva apical to the defect and the thickness of the flap.

Objective: Osteoarthritis of wrist is an uncommon disorder but in rheumatoid arthritis (RA), wrist and metacarpophlangeal joint are involved in early stages. RA of wrist leads to severe pain and loss of function in a large number of patients. Conservative treatment is required in early stages, but in severe cases arthroplasty or total wrist arthrodesis is the treatment of choice. Problems in wrist arthroplasty include implant breakage, cystic erosion in the surrounding bone, and marked synovitis, which requires revision in most of cases. Total wrist arthrodesis is treatment of choice in severe wrist arthritis patient, who want to have good grip and wish to do heavy labour. Material and Methods: A retrospective review of 15 patients of RA with severe wrist arthritis, managed by wrist arthrodesis using 3.5 mm reconstruction plate and iliac crest bone graft was done. Patients were evaluated for pain relief, functional improvement and radiographic analysis. Patient function measures included: Visual analog score (VAS), the Mayo wrist score, and Disabilities of Arm, Shoulder, and Hand (DASH) score. Result: All 15 cases united well with marked improvement in wrist strength and diminished pain allowing improved function and heavy labor. Mayo wrist scores increased on an average of 37.5 Points (preoperative) 10 to 65 (postoperative). The average DASH score has decreased significantly up to 47 Points. Conclusion: Wrist Arthrodesis provides pain relief and functional hand in sever wrist arthritis in RA cases.

Musculoskeletal diseases affect millions of people worldwide and are one of the leading causes of long-term pain and physical disability. Traditional treatment methods for promoting healing and repair has always been consider gold standard, But the emergence of new therapeutic approaches aims to regenerate or repair musculoskeletal tissue. The recognition of a regenerative therapy in orthopaedics requires the demonstration of new Bone, Cartilage, ligament, tendons, healing of soft tissues injuries and Overuse conditions like plantar fasciitis or tennis elbow . Regenerative therapy boosts the body’s ability to use its repair systems to heal diseased or damaged cells after a severe injury, or other degenerative condition. A diversity of regenerative strategies have been evaluated, including distraction osteogenesis, bone grafts and bone substitute materials, bone matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue‐engineering approaches. This review aims to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable orthopaedic regeneration in clinical practice.

The main indication of total knee replacement (TKR) is pain and restricted range of motion of the knee. The key to a successful total knee replacement is correct alignment in flexion and extension. Here we report a case of TKR in severe osteoarthritis (O / A) knee with a large cyst on the medial side of the knee, resulting in the problem of ligament balancing and management with help of an Arthrex Internal brace. Proper diagnosis and treatment plan help to overcome the challenging cases of varus knee. The indication of total knee replacement is pain and restricted range of motion of the knee. Several authors have reported successful outcomes on patient satisfaction in the follow-up of almost ten to fifteen years. 1 Additionally, the results of surgery are satisfactiry with good implant survival. 2 But some patients indeed have poor results and some may require revision surgery in a short duration. The key to a successful total knee replacement is correct alignment and stability in flexion and extension.3 The ligament after balancing of the correctly aligned knee must consider the function of the resected ligaments in flexion and extension, because in TKR both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are usually sacrificed. In other words, total knee replacement is a soft tissue surgery in which bone is replaced. In the varus knee, medial side structures are tight and compensatory laxity on the lateral side. So knee stability should be managed by the remaining ligamentous structures that are both medial and lateral collateral and capsular ligaments. 4 The gap technique is the gold standard for ligament balancing in total knee replacement. 5 That is the execution of equal medial and lateral gaps as well as balanced flexion and extension gaps. This is usually obtained by medial side release in varus knee as the medial side is contracted and lateral side release in valgus knee accordingly. Here we report a case of TKR in severe osteoarthritis knee with a large cyst on the medial side of the knee, resulting in the problem of ligament balancing and management.

The recent spread of severe acute respiratory syndrome coronavirus (SARS-CoV2) and its associated coronavirus disease has gripped the entire international community and has caused widespread public health concerns due to the unavailability of treatment to this deadly disease. The COVID -19 has affected healthcare workers badly in the world with front line health care providers has a mortality rate of 1.4%. But in countries like Italy, it has gone up to 9%. To this date, there are no universal guidelines for musculoskeletal (MSK) care in the face of the coronavirus pandemic. Health care professionals, including orthopedic surgeons may encounter patients with suspected or confirmed COVID -19 infections and will have to act diligently not only to provide care but at the same time to prevent the spread of infection. During the lockdown period in INDIA we collected data of patients who came to an emergency in our hospital. Out of 81 patients, 40 patients were of pediatric trauma with a percentage of 49% making it highly significant. Thus, in this article, we tried to summarize current recommendations and our institutional guidelines for diagnosing and managing a pediatric orthopedic patient in the COVID-19 pandemic.

Objectives: COVID-19 pandemic has severely affected the health sector in the whole world. Routine OPDs including rehabilitation centers are partially functional to minimize the risk of cross-infection. In elderly patients, rotator cuff syndrome is a common cause of shoulder pain and daily physiotherapy is the main mode of management. To minimize the risk of cross-infection (COVID-19), we introduced E-rehabilitation services via various mobile apps to our patients. In developing countries like India, E-rehabilitation is still a new concept. Methods: This study evaluated 70 patients who had been enrolled for E-rehabilitation with a minimum of 4 weeks follow-up. Every patient was asked to use the rehabilitation App as per their requirement. Results were assessed with Disabilities of the Arm, Shoulder and Hand (DASH), visual analogue scale (VAS) and active ranges of movement (forward flexion and external rotation). Results: The average age of enrolled patients at the time of surgery was 55.0 years (range, 40–65 years). In 2 and 4 weeks, the range of forward flexion and external rotation has improved significantly. DASH and VAS Score has also been decreased significantly at an average of 2 and 4 weeks with [Formula: see text]. Conclusion: In this paper, we summarized the management of rotator cuff syndrome by using various mobile apps and also the various challenges faced in the elderly population with the newer concept of E-rehabilitation in this pandemic.

Objective Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure. Material and methods We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria. Result Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient. Conclusion Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortatlity worldwide. Malnourishment in COPD patients is very common and is a prognostic factor in its treatment. The present study has been conducted to assess nutritional status in COPD patients and its correlation with severity of disease.Methods: This institutional based analytical cross sectional study was conducted in the Department of Pulmonary Medicine at tertiary care hospital in Himachal Pradesh (India) from 1 Dec 2017 to 31st May 2018. A total of 52 COPD participants attending the pulmonary Medicine OPD and fulfilling the inclusion criteria were enrolled.Results: All participants reported being smoker since long with the mean years of smoking since 31 years and about 13.6 cigarettes being smoked per day. 22 (42%) of the participants were undernourished as per BMI criteria But when compared with MUAC criteria, a large number 38 (73%) came out to be undernourished. haemoglobin and cholesterol levels were less in patients with severe diseases than mild and moderate category (76.9%).Conclusions: The malnourishment and severity of the disease has direct correlation. More the severity of COPD, more is the malnourishment. Biochemical parameters, although not deranged significantly in any group, but more on the lower side in patients with severe COPD. There is a need for regular nutritional assessment of every COPD patient and recommendation of supplementary food for them.

Gingival recession is a common manifestation in most populations. Gingival recession is clinically manifested by an apical displacement of the gingival tissues, leading to root surface exposure. Gingival recession may be a concern for patients for a number of reasons such as root hypersensitivity, erosion, root caries, and esthetics (Wennstrom 1996). Recently, new techniques have been suggested for the surgical treatment of multiple adjacent recession type defects. These are mainly derived from the coronally advanced flap, a supraperiosteal envelope technique in combination with a subepithelial connective tissue graft, or its evolution as a tunnel technique. The current case reports introduce a novel, minimally invasive approach applicable for both isolated recession defects as well as multiple contiguous defects in the maxillary anterior region. Access to the surgical site is obtained by means of an approach referred to as vestibular incision subperiosteal tunnel access.

Aims: The aim of this study was to estimate the pH of saliva, concentration of calcium and inorganic phosphate, and calculus formation before and after usage of Recaldent ® (GC Tooth Mousse Plus TM ), Functionalized Tricalcium Phosphate (3M ESPE ClinPro TM Tooth Creme) and standard dentifrice (Colgate dental cream). Settings and Design: Randomized double-blind study. Materials and Methods: A total of 50 subjects were recruited, the subjects were assessed at their first visit, on the 21 st day and on the 42 nd day. At the first visit, scaling was carried out and oral hygiene instructions were given. After 21 days, the subjects were given coded dentifrices where the operator and the subjects both were unaware of the type of dentifrice. Clinical parameters assessed were Plaque index, Gingival index, and Calculus index. Salivary samples were obtained to measure calcium, phosphate levels, and pH at 21 st day and 42 nd day. Statistical Analysis: ANOVA test, t-test, Mann-Whitney test, Kruskal-Wallis test. Results: The mean salivary calcium level and mean salivary phosphate level were higher in Group III (functionalized tricalcium phosphate (3M ESPE ClinPro TM Tooth Creme) as compared to Group II (Recaldent ® GC Tooth Mousse Plus TM ) and Group I (Colgate dental cream) on the 42 nd day after using dentifrices, which was statistically significant. This showed that the usage of remineralizing dentifrices led to an increase in the salivary calcium, phosphate, and pH but it did not reach the level of super saturation of the ions caused by elevated pH which could lead to calculus formation. Conclusions: Thought here was a statistically significant increase in salivary calcium and phosphate level in all three groups from baseline to 42 nd day, there was no calculus formation.