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Background: The study was conducted to evaluate the outcome of orthogonal plating system in distal humerus intraarticular fracture. Material and Methods: 15 patients of age between 18 to 60 yrs with fracture distal end of humerus with intraarticular extension were evaluated, with the mean age group of 37 to find the functional outcome of Orthogonal plating using olecranon osteotomy approach. Results: The mean union time was 9.53 weeks. The arc of flexion was 99.66o. Average mayo elbow performance score (MEPS) was 83. There were 2 case of infection. One case of implant failure noted secondary to infection leading to implant removal. Discussion and Conclusion: The following results were assessed: operating time, arc of flexion and extension, time to fracture union, functional recovery, and complications. By using proper principles of stable fracture fixation and appropriate exposure in intraarticular fracture (with transolecrenon approach) a good reduction can be achieved which leads to good union, which helps in early mobilization and restoring elbow functions with early intensive physiotherapy.

Introduction: Tibial plateau fractures occur due to a combination of axial loading and varus/valgus applied forces leading to articular depression, malalignment and an increased risk of posttraumatic osteoarthritis (OA). Various treatment modalities have been used over the years, with mixed results. We present a study to report the functional results of tibial plateau fractures and to evaluate the association of proximal fibula fractures with respect to final outcome. Methods: Patients diagnosed with tibial plateau fractures from July 2012 to March 2016 were included in the study. Patients with open injuries or neurovascular compromise were excluded. Patients were divided into subgroups on the basis of presence or absence of proximal fibula fracture. 124 patients were managed by either conservative or operative means and followed for an average of 19 months and clinically monitored for functional outcome using Knee Injury and Osteoarthritis Score. Results: The study population consisted of 65 males and 59 females. Mean patient age was 46 years (range, 24-67 years). Mechanism of injury included road traffic accident (56), fall from height (14), and falls (54). Functional outcome as assessed by Knee Injury and Osteoarthritis Outcome Score was comparable to previous studies. Role of proximal fibula in supporting the lateral condyle was evident from better functional outcomes seen in patients with intact fibula and lateral condyle fracture. Conclusion: An intact fibula contributes to the mechanical stability of the lateral tibial plateau. Therefore, the knee joint will be affected by injury of the bone or soft tissue that may occur in fibula fractures. A consideration to presence of proximal fibula fractures should be given while classifying tibial plateau fractures.

Introduction: Proximal humeral fractures are extremely common injuries, and are one of the true osteoporotic fractures. For those that have moderate to severe displacement, the optimal treatment for the patient has not been fully elucidated. The purpose of this study was to evaluate the functional outcome of a modification of percutaneous K-wire fixation technique. Material and methods: A prospective study was performed on all patients diagnosed with intra-articular proximal humerus fracture presenting to us from June 2013 to June 2016. Only patients with closed, displaced two or three part fractures as per Neer’s classification were included in the study. Fractures were managed by close reduction and percutaneous pinning with K wires which were linked by a fixator rod using clamps. Patients were evaluated for functional outcome using the Constant score. Results: Twenty seven patients comprising of 18 females and 9 males were followed for an average period of 14 months. Mean age of the patients was 56 years. Fall while walking was the most common mode of injury followed. Mean Constant Score of patients was 77.2. All patients achieved full functional range of motion by the end of 4 months. No nerve injury was reported. Conclusion: Modified technique for percutaneous Kwire fixation using the fixator mini clamps and rods is an effective and economical method allowing biological preservation with good results.

Stereophotogrammetry was used to investigate the functional relations between the articular surface geometry, contact patterns, and kinematics of the glenohumeral joint. Nine normal shoulder specimens were elevated in the scapular plane by using simulated muscle forces in neutral rotation (NR) and starting rotation (SR). Motion was quantified by analyzing the translations of the geometric centers of the humeral head cartilage and bone surfaces relative to the glenoid surface. In both NR and SR, the ranges of translations of the center of the humeral head cartilage surface were greatest in the inferior-superior direction (NR 2.0 +/- 0.7 mm, SR 2.9 +/- 1.2 mm). Results of this study also show that joints with less congruence of the articular surfaces exhibit larger translations, and elevation in SR yields greater translations than in NR. Kinematic analyses with the humeral head bone surface data yielded larger values of translation than analyses that used the cartilage surface data, suggesting that similar overestimations may occur in radiographic motion studies. Results of this study demonstrate that small translations of the humeral head center occurred in both SR and NR. The proximity of the origin of the helical axes to the geometric center of the humeral head articular surface confirmed that glenohumeral elevation is mainly rotation about this geometric center with small translations.

The shoulder is characterized foremost by its mobility and large range of motion. The glenohumeral joint is notable for its relative lack of bony constraint, relying heavily on the congruent articulating surfaces and surrounding soft tissue envelope for static and dynamic stability. Effective function in the articulation is achieved by a complex interaction between the various articular and soft tissue restraints. The rotator cuff muscles center the humeral head in the congruent glenoid fossa through the midrange of motion, when the capsuloligamentous structures are lax. However, incongruent joints, especially in positions of loading asymmetry (in external rotation), have larger translations that occur at the extremes of motion. Excessive translations are then effectively restricted by the mechanical properties of the inferior glenohumeral ligament. When the capsule is tightened anteriorly it results in an anterior tether and causes an associated posterior shift in contact on the glenoid. The posterior migration of the humeral head center and glenohumeral contact are again more pronounced in shoulders with reduced congruence. Additional studies of normal motion in different planes, the effects of rotator cuff pathology and dysfunction on the kinematics of the joint, proprioception of the capsule, and biomechanical tests of the inferior glenohumeral ligament and other components of the joint capsule at strain rates associated with injury, need to be conducted to understand the specifics of normal shoulder function and the pathophysiologic processes that occur during shoulder degeneration.