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Introduction: Fractures of the mid-shaft clavicle are commonly encountered in clinical practice. These can be managed either by conservative method or operative by internal fixation. This study aims to compare the outcomes of conservative and operative management. Methods: Forty patients with displaced and comminuted mid-shaft clavicle fractures were included in the study, among which twenty-five patients were treated conservatively and 15 patients underwent surgery and were followed up for a period of 1 year. Time taken for union, functional outcome, complications, and patient satisfaction were compared. Results: In the non-operative group, 28% of the fractures took less than twelve weeks to unite, whereas in the operative group 60% of them took less than 12 weeks to unite. At the end of 1 year, there was no statistical difference in mean UCLA (University of California and Los Angeles) score and the mean DASH score of the non-operative group and operative group. There were more complications in the operative group. Re-operative rate in the operative group was 40%. Patient satisfaction was 80% in the non-operative group, whereas 48% of patients were satisfied in the operative group. Conclusion: Displaced and comminuted mid-shaft clavicle fractures treated conservatively have more advantages when compared to surgically treated fractures.

Purpose: In comparison to magnetic resonance imaging (MRI) imaging, this study compares the diagnostic efficacy of meniscal injury with clinical examination tests such the McMurray's test, Thessaly test, and joint line tenderness. Methodology: Two hundred and fifteen patients having a history of knee injuries with symptoms such as pain, instability, and locking were studied from June 2020 to June 2022 at our institution, for a 2-year period. Results: The sensitivity and specificity of McMurray's test for medial meniscus were 84% and 84.21%, respectively. The sensitivity and specificity for medial joint line tenderness were 88.15% and 55.55%, respectively. Thessaly's test for the medial meniscus was 92.10% sensitive and 88.8% specific. The sensitivity and specificity of MRI for medial meniscal injury were 94.87% and 93.75%, respectively. McMurray's test for lateral meniscus had a sensitivity of 84.44% and a specificity of 76.92%. Lateral joint line tenderness for lateral meniscus had a sensitivity of 86.95% and a specificity of 66.66%. The sensitivity and specificity of Thessaly's test for lateral meniscus were 93.33% and 84.61%, respectively. MRI revealed a sensitivity of 93.75% and a specificity of 90% for lateral meniscus injuries. Conclusion: Even though MRI is a precise and noninvasive method for detecting meniscal injuries, a thorough clinical examination by a skilled physician has the same diagnostic power as MRI to rule out meniscal injuries. In contrast to previous tests, the Thessaly test can be used as a useful tool to detect meniscal injuries, as we discovered in our study. [ABSTRACT FROM AUTHOR]

Introduction: Anterior Cruciate Ligament (ACL) is requisite for knee stability. Reconstruction in ACL tear is gold standard mode of treatment. Anatomical placement of graft is determined by precise drilling of femoral and tibial tunnels. Aim: To study the precision of placement of bony tunnel in single bundle arthroscopic anterior cruciate ligament reconstruction and to correlate functional outcome. Materials and methods: A hospital based longitudinal prospective study was conducted at a tertiary care hospital. We included 37 patients who underwent ACL reconstruction. Radiographic analysis of knee was done to assess the position of tunnels. The position of tunnels was compared with ideal placement of tunnels and functional outcomes were documented. Lysholm score at 3 and 6 months was used for comparison. Statistical analysis was done by SPSS Ver. 17.0. Results: At the end of 6 months, 56.75% cases had good to excellent functional outcome. There was inverse correlation of deviation in femoral tunnel and tibial tunnel with Lysholm score at three months. There was inverse correlation of deviation in femoral tunnel with Lysholm score at 6 months. Conclusion: Following an ACL reconstruction, tunnels placement is very important to gain a successful outcome. Placement of femoral tunnel is especially important in this regard. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to study radiology of glenohumeral joint with objectives to study the surgically relevant parameters. Materials and methods: We conducted a cross Sectional Study in a tertiary care hospital setting. Computed Radiography (CR) was used to measure Glenoid Diameter (Supero-inferior), Inclination (Humeral head), Humeral offset, Head-shaft angle of humerus, Height of humeral head above greater tubercle and Subacromial space and data was analysed by descriptive statistics. Results: Total study population was 80 with 41 males(51.2%) and 39 females(48.8%). We have assessed the surgically relevant parameters and the mean glenoid diameter on right side was found to be 36.6±6.9mm and and 38.2±3.5mm on left side, Inclination(Humeral head) on right side was 132± 7.8 degrees and 129.7± 8.0 degrees on the left, the mean Humeral offset was 66.5± 7.0mm on right and 67.5± 1.2 mm on left, mean Head-shaft angle was 49.7± 6.8 degrees on right and 49.5± 5.8 degrees on the left side, the mean Height of humeral head was 5.3± 2.2mm on right and 4.1±1.9mm on left side and the mean Subacromial space on right side was found to be 7.8± 2.1mm and 8.8± 2.3mm on the left side. Conclusions: Statistically significant difference of increased lateral humeral offset in male shoulder compared to female shoulders on the right side. Statistically significant result was seen in relation to sub-acromial space with increased sub-acromial space in study population > 30 yrs of age when compared to study population <30 yrs. [ABSTRACT FROM AUTHOR]

Treatment of subtrochanteric fractures is challenging due to anatomical and biomechanical factors. Many methods have been suggested to achieve and maintain fracture reduction during operative fixation for subtrochanteric fractures. Open reduction and intramedullary fixation, clamp assisted reduction without cerclage wires and fracture reduction cables are suggested methods. We conducted a retrospective study to look for the results of subtrochanteric fractures managed by intramedullary fixation with or without cerclage wires. We reviewed all cases of subtrochanteric fractures operated with intramedullary fixation with long proximal femoral nail with or without cerclage wire fixation. All available data from patient's records available in medical records department were retrieved and evaluated. Statistical analysis were performed using SPSS software (v16). There were 86 cases of subtrochanteric fractures operated with intramedullary fixation at our Hospitals over a period of 5 years. Quality of fracture reduction of fractures are assessed good reduction was seen more often in cerclage group 64%. Cerclage wiring was done in 14 cases. Nonunion was seen in 8 cases overall, 3 in cerclage group and 5 in non Cerclage group. Implant failure was seen in 3 cases in no cerclage group and 2 cases of cerclage group. We conclude that anatomical reduction is the key factor for successful outcomes. Closed reduction with good to acceptable reduction had better results. Cerclage wiring should be considered in selected cases where reduction is poor after open reduction. [ABSTRACT FROM AUTHOR]

Introduction: Distal radius fractures accounts for around 15% of all fractures diagnosed and treated in the emergency rooms. These fractures usually result secondary to high velocity injury such as a motor vehicle accident or fall on an out stretched hand. In the elderly, it is a common fragility fracture. Volar Locking Compression Plates (LCP) is effective devices for fixation of the distal radius fractures. There is a lacuna with regard to literature on the 2.7 mm volar LCP and the current study retrospectively assesses the postoperative radiological outcomes. Aim: To measure the radiological outcomes in patients with displaced distal radius fractures managed with 2.7 mm volar LCP fixation using Sarmiento's Modification of Lindstorm Criteria. Materials and Methods: A retrospective study was conducted in the Department of Orthopaedic Surgery at Kasturba Medical College Allied Hospitals, Mangalore from May 2014 to July 2016. All displaced distal radius fractures of skeletally mature patients who underwent volar locking plate fixation between May 2014 to July 2016 and follow up with X-rays at six weeks and three months were included as part of the study. The study comprised of 20 patients and fractures were classified using the AO and Melone's classification systems. The radiological outcome was scored based on Sarmiento's Modification of Lindstorm Criteria. Results: Post operative check X-rays were analysed at immediate post operative, six weeks and three months. The mean immediate post operative radial shortening, decrease in radial deviation and loss of palmar tilt were 4.08±2.23, 5.91±4.01and 4.11±3.29 respectively. The corresponding values at last follow up were 4.71±2.31, 7.9±5.13 and 4.91±3.32 respectively. No statistically significant difference (p=0.930;874;716) in radial shortening, decrease in palmar angulation and loss of radial deviation was seen till the final follow up. Sarmiento's Modification of Lindstorm Criteria showed a good radiological outcome in 60% followed by fair in 25% and excellent in 15%. Conclusion: Use of 2.7 mm volar LCP showed good to excellent post operative radiological outcomes in majority of the cases. The fracture reduction achieved in the immediate post operative period is maintained throughout the follow up duration. [ABSTRACT FROM AUTHOR]

Introduction: Distal tibia fractures are challenging injuries with multiple fixation options. Minimal invasive plating for distal tibia fracture is becoming more popular with documented good outcomes. Aim: To evaluate the functional and radiological results of fixation of distal tibia fractures with locking plates with Minimally Invasive Plate Osteosynthesis (MIPO) technique. Materials and Methods: Fifty fractures of distal tibia without Intra-articular extension were operated with locking compression plating with MIPO technique. They were followed up at regular intervals. Functional and radiological results were evaluated at the end on one year. Results: The fractures united in 48 (96%) patients with 2 (4%) cases of delayed union which took 30 weeks of time. Postoperatively, 2 patients developed superficial skin infection, 2 patients developed deep infection and 3 patients developed ankle stiffness due to loss of postoperative protocol and 4 patients had implant failure in form of screw breakage. Good amount of range of mobility of ankle joint was present in almost all patients. Conclusion: MIPO with locking plates for distal tibia fractures is associated with good functional outcomes and is an effective treatment for distal tibia fractures. Although, a larger sample of patients and longer follow up are required to fully evaluate this method of treatment, we strongly encourage its consideration in the treatment of such complex fractures. [ABSTRACT FROM AUTHOR]

Introduction: Neuroendocrine differentiation in colorectal carcinomas, detected using immunohistochemistry and ultrastructural techniques, has been studied as a prognostic marker for invention of targeted therapy. There are a few studies done on this aspect which have shown conflicting results ranging from poor prognosis to no prognostic significance. Aim: The aim of the study was to determine the clinical significance of neuroendocrine differentiation in colorectal carcinomas using immunohistochemical stains such as chromogranin A & synaptophysin in relation to its prognostic significance. Materials and Methods: A retrospective study was conducted wherein all the colorectal carcinomas, received in the Department of Pathology, over a period of 3 years, were reviewed. Neuroendocrine markers were done on 53 cases of moderately, poorly and undifferentiated adenocarcinomas. Based on the degree of immunoreactivity for these markers, tumours were divided into group 0, group 1, group 2, group 3 & group 4. Group 0 & 1 were categorized as neuroendocrine differentiation absent & group 2, 3 & 4 as present. Neuroendocrine differentiation was correlated with age, sex, grade, stage, diagnosis & survival. Follow up data of the cases was recorded. Results: Neuroendocrine differentiation was present in 18 cases (33.9%). The degree of immunoreactivity for neuroendocrine markers in present study were; group 0- 58%, 1- 7.5%, 2- 9%, 3- 13% & 4- 11%. The mean age of patients was 54 years with a slight male preponderance {M:F::1.6:1}. Most of the carcinomas with neuroendocrine differentiation belonged to Grade II (61%) & Stage II & III (83%). Neuroendocrine differentiation did not show any significant association with age, sex, location, histological type, grade, stage & survival. Conclusion: The above results indicate that the presence of neuroendocrine differentiation cannot be recommended as a prognostic marker in colorectal carcinomas. [ABSTRACT FROM AUTHOR]

Aim To evaluate functional and radiological results of internal fixation of displaced talar neck fractures. Materials and methods Twenty patients with displaced talar neck fractures who underwent surgery and fixation by cancellous screws were evaluated. Patients were evaluated by American Orthopedic Foot and Ankle Society score which is based on pain (40 points), function (50 points) and alignment (10 points) with excellent (90–100 points), good (75–89 points), fair (60–74 points) and poor scores (<60 points) and radiographically for assessment of union, osteonecrosis and osteoarthritic changes in the subtalar and ankle joint. Results Among the 20 cases, 13 cases had closed injuries and 7 had open fractures. The most common etiology of injury was road traffic accidents. The average follow up time was 28 months. Osteonecrosis was evident on follow up X-rays in 7 cases of which 2 progressed to talar dome collapse. Post traumatic arthritis was observed in 11 cases. Based on American Orthopedic Foot and Ankle Society scores, excellent result was obtained in 4 cases, good 7 cases, fair 5 cases and poor 4 cases. Conclusion Talar neck fractures are associated with high rates of morbidity and complications. Post traumatic arthritis is more common complication than osteonecrosis following surgery. [ABSTRACT FROM AUTHOR]