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Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Bilateral presentation is frequently seen and males are more commonly affected. Total hip replacement (THR) is one of the most successful surgical procedures for AVN. THR is a time tested surgery giving good outcome in terms of relieving pain, restoring function & improving quality of life in patients of AVN. The purpose of the study was to analyse the outcome of bilateral THR & comparing the outcome of one stage THR with Two stage THR. In this study, 40 patients with AVN of bilateral femoral head who were presented in the Department of Orthopaedics, Hamidia Hospital, Bhopal from April 2016 to April 2020 who fulfilled the inclusion criteria were included in the study. THR of all the patients was done on elective basis by senior surgeons of the department. All patients were followed up clinically and radiologically for a period of 6 months after the surgery. Any complications if present were also noted. This study concludes that in patients of AVN of bilateral femoral head, THR gives excellent functional outcome with early walking & early return to work. As compared to Two stage bilateral THR, One stage bilateral THR has advantage of less blood loss, less need of parenteral analgesics & antibiotics & less hospital stay. However, there is no significant advantage in terms of functional outcome, walking capability & return to work.

Introduction: Anterior and posterior portals used for ankle arthroscopy but anterior portals are safer, provide good access and visualisation of joint. Aims: The anatomical structures nearby portals are vulnerable to injury during surgery. To study the anatomy of ankle joint using dissection method. Methods and material: 20 cadaveric limbs were dissected and the distance of different portals to the nearby neurovascular structures was measured. Results: The mean distance from anteromedial portal to the great saphenous vein and saphenous nerve was 5.28 mm, 9.12mm and that between the medial midline portal to the dorsalis pedis artery and deep peroneal nerve was 10.08 mm and 16.20mm. The mean distance from anterocentral portal to the dorsalis pedis artery was 2.38mm, to superficial peroneal nerve was 7.09mm and deep peroneal nerve was 4.12mm. The mean distance from anterolateral portal to lateral branch of superficial peroneal nerve was 3.18mm. There was injury in one specimen. Conclusions: This present study concluded that medial midline portal is comparatively safe for ankle arthroscopy. Anterocentral portal has potential risk of injury to dorsalis pedis artery.

Introduction: Teaching learning in the times of Covid 19 pandemic needs to be revamped in order to follow norms of social distancing. Therefore, online classes are a necessity now.Methodology: We registered our institution on Microsoft Teams under educational institutes. Entire college faculty was registered along with undergraduates and post graduate students. E- classes were planned after a professional demonstration.Results: The feedback of e classes given by students was encouraging. They were satisfied by the teacher’s way of delivering lecture. The students felt, on line classes are almost similar to offline classes. The main hinderance in e-classes was internet connection.Conclusion: The e classes helped to continue the teaching learning activities during restrictions because of Covid19 pandemic

In the horizon of knowledge, there is dearth of documentation depicting the incidence of Primary Bone Lymphoma (PBL) being delayed/misdiagnosed as chronic osteomyelitis, which entails that this case report is of more magnitude. It is a case report of young female, having complaints of pain and swelling in left arm initially which was misdiagnosed as chronic osteomyelitis. Later on, she was diagnosed as PBL. Here, we want to discuss the clinical presentation of PBL, and to make aware from such grave pathology and to consider it in the differential diagnosis of chronic osteomyelitis.

Introduction: Due to increased number of trauma cases, several injuries in the same limb are not an uncommon entity now. Literature describes the floating elbow as a forearm fracture and supracondylar fracture of humerus in same extremity. Aim: The purpose of the study was to evaluate our experience in dealing with such uncommon injury. Materials and Methods: This is a prospective interventional study of floating elbow in younger age group. All the cases were managed by K-wire fixation and followed up to the average of 20 months. All the patients were followed by clinical and radiological mean. Functional score were obtained by Mayo Elbow Performance Score (MEPS) and Khalfayan score. Results: Results are based on 17 cases with average age of 9.58 years. The fracture healing was noticed at average of 9 weeks with average range of movement of 95 degree. Conclusion: Floating elbow is a serious injury. Injury type is out of the way and treatment recommendations are polemical. In our experience, this injury can be best treated by aggressive surgical intervention.

Background: Fractures of tibia shaft are most common of long bone fractures. Proximal tibia fractures account for approximately 5% to 11% of all tibial injuries and affect knee function and stability in most of the cases. Higher rates of malunion and increased incidence of associated complications have made these fractures particularly problematic. In recent years due to advancement in technique, proximal tibia plating and multidirectional locked intramedullary nailing, both have become widely used treatment modalities for proximal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures. Materials and methods: This randomized prospective clinical study was conducted on 62 skeletally mature patients with closed extra-articular fracture of the proximal tibia treated with proximal tibial locking compression plating (PTLCP) or intramedullary nailing (IMN) by expert surgeons at a tertiary trauma center. Results: Postoperative hospital stay (p = 0.043), postoperative infection rate (p = 0.036) were significantly high in the PTLCP group than in the IMN group, while rate of malunion (p=0.041) and nonunion(0.037) were significantly high in IMN group than in PTLCP group. However there was no clear advantage of either technique in terms of functional recovery of knee. Conclusion: Present comparison of IMN and PTLCP for the treatment of proximal one third tibia fracture showed no clear advantage of either technique. Present study concluded that both forms of treatment (IMN and PTLCP) provide adequate fracture stability. Level of evidence: Level 2, randomized controlled trial.

Winging of scapula is comprehensively known for the serratus anterior palsy and its dynamic presentation. However, on the contrary, pseudo winging may occur due to nonneuromuscular cause like osteochondroma. It is a rare case of pseudo winging of scapula due to osteochondroma in a pubescent girl. This article is for knowledge to share the experience of static scapula alata due to osteochondroma. It was managed by excision and confirmed by histopathological study. Patient relieved completely from her complaints.

Background: Around 15% of population in the world is living with disability. The present study was carried out during the special project for assistance, rehabilitation and strengthening of handicapped (SPARSH) camp to know the current pattern of locomotor disability and to observe the outcome of the camp surgeries for the correction of deformity.Methods: This prospective observational cross-sectional study was conducted at the department of orthopaedics and traumatology Gandhi Medical College at SPARSH camp organised by the Government of M. P. at J. K. hospital Bhopal. All the patients with locomotor disability attending the SPARSH camp irrespective of age, sex and cause, were included in the studyResults: In total 287 patients attended the camp in which majority of the patients were suffering from cerebral palsy. 107 patients were selected for operative intervention in which tendo-achilles lengthening was performed most commonly.Conclusions: The corrective surgical camp provides an avenue of healthcare opportunity for the underprivileged sector of society. A camp based approach helps in identification, gradation & rehabilitation of orthopaedic deformities.

Background: Displaced intraarticular distal humerus fracture has been conventionally treated operatively with various triceps disrupting approaches. These approaches are associated with several complications, such as triceps weakness, nonunion or delayed union of osteotomy, implant prominence, and delayed mobilization of the elbow. We present the functional outcome of intraarticular distal humerus fracture fixation using a triceps-sparing paratricipital approach which allows early elbow mobilization and preserving triceps strength. Materials and Methods: Twenty five patients with intraarticular distal humerus fracture were operated using triceps-sparing paratricipital approach with orthogonal plate construct. There were 16 male and 9 female patients and average age was 42.16 years (range 23-65 years). The mechanism of injury was fall from height ( n = 8), road traffic accident ( n = 13) and ground level fall ( n = 4). Clinical, radiological, and functional assessment with Mayo Elbow Performance Index (MEPI) were obtained at follow up period. Results: All fractures united primarily. At the mean follow up of 13.58 months (range 6-22 months), mean elbow flexion was 121.08° (range 94°–142°) and mean motion arc was 114.92°(range 65°-140°). The mean MEPI score was 94.40 points (range 70–100) with 17 excellent, five good, and three fair results. The mean flexion deformity or extension loss was 6.16° (range 5°–15°). Conclusion: Open reduction and internal fixation of intraarticular distal humerus fractures with triceps-sparing paratricipital approach provide adequate exposure with no adverse effect on triceps muscle strength and allows early initiation of elbow motion. We analyzed, age and injury to surgical interval with relation to functional range of elbow using Z-test which is insignificant.

Introduction: Fractures of the clavicle are common, accounting for 2.6-4% of adult fractures and 35% of injuries to the shoulder girdle. Fractures of the shaft account for 69-82% of all fractures. Prevalence of non-union or mal-union in displaced midshaft clavicular fractures after conservative treatment is higher than previously presumed. Plate fixation can help obtain firm anatomical reduction in severe displaced or comminuted fracture. We have taken up this study to evaluate the functional outcome after plate osteosynthesis ofclavicular fractures. Materials and Methods: This is a prospective study done in Department of Orthopedics at tertiary care teaching hospital in central India over period of 1 year. The patients who presented with fracture clavicle and fulfilled the inclusion criteria were studied. Functional outcome was evaluated using modified Constant and Murley scoring system. Results: 24 patients of displaced midshaft clavicle fracture matching inclusion criteria were included in this study. Follow up evaluation of the patients was done at the desired interval with a minimal follow up of 6 months. 52.17% were in the age group of 20-29 years. 73.91% of patients studied were males. Type-2 middle third fracture type-2 B1 was encountered in 78.26 % of patients. The mean modified Constant Shoulder Score was 65.39 with range 48-72. In this study 17 patients (73.91 %) had very good functional outcome. Conclusion: Use of locking plates for displaced midshaft clavicle fractures results in early union with very good functional outcome and is associated with very low complication rates.

Introduction: Surgical site wound closure plays vital role in pos t-operative success. The use of either sutures or s taples for skin approximation is a frequently debated issu e. We compared the outcome of using staples versus sutures in elective orthopedic surgical procedures. Material and Methods: Study was conducted in tertiary care teaching hospi tal in central India over a period of 2 years which included all p atients aged between 18 to 80 years undergoing elec tive open surgeries. Computer generated random number randomized them in two groups. Skin closure was done by either monofi lament nylon or metallic staples. The wounds were assessed for infection, wound dehiscence, pain during remov al on the basis of VAS pain scale. Follow up was done in the 6th week in terms of patient satisfaction using visual analo gue scale (VAS) and validated cosmesis scoring system Hollander Wound Evaluation Score (HWES). Results : Total 503 wounds were included in this study (262 in suture and 241 in st aple groups), 14 (5.3%) wounds were culture positiv e in the suture group within 8th postoperative day as compared to 36(14.9 %) in staples group with χ2 9.65 and (p=0.002) which is significant. 320 wounds with >10cms incision were analyzed (166 in suture and 154 in staple group) out of which 12 (7.22%) were infected in suture group and 24 (15.5%) in staple g roup with χ2 was 7.6 and (p=0.006) that statistically signific ant. Conclusion: We found a statistically significant higher incide nce of superficial wound infection following skin c losure by metallic staples as compared to monofilament nylon.

INTRODUCTION: Femoral shaft fractures are common fractures in paediatric age group. There are various methods to treat them. Elastic stable intramedullary nailing is one of them and an established and reliable method for treating these fractures. Ideal treatment of femoral shaft fractures in the age group of 5 to 14 years is still a matter of debate as no consensus has been achieved till now. We have done a study to know whether elastic stable intramedullary nails can be used reliably in this age group. So, purpose of the present study is to evaluate the outcome of titanium and stainless steel elastic nail in paediatric femoral fractures in 5-14 years of age group. METHODS: A group of forty two children with femoral fractures that were treated with elastic nails (which includes both titanium and stainless steel nails- both nail types were of similar design) and outcome was evaluated. Twenty children (16 boys, four girls) in the age group of 5-14 years (average 9.3 years) with femoral shaft fractures (16 closed, two Grade- I and two Grade- II compound) were stabilized with Titanium Elastic Nail (TEN), while twenty-two (16 boys, six girls) in the age group of 5-14 years (average 9.1 years) with femoral shaft fractures (18 closed, two Grade- I and two Grade- II compound) were stabilized with Stainless Steel Elastic Nail (SSEN) between June 2009 and October 2011. A familiar retrograde insertion technique was used. Major complications were defined as malunion with sagittal angulation of >15° and coronal angulation of >10°, nail irritation requiring revision surgery, infection, delayed union, and rod breakage. Minor complications were defined as nail irritation or superficial infection not requiring surgery. RESULTS: Radiological union was achieved in all cases in a mean time of 7.7 weeks (6-12 weeks) in TEN groups while that took 7.9 weeks in SSEN group. Full weight bearing was possible in a mean time of 7.7 weeks (6-12 weeks) in TEN groups and a mean of 7.9 weeks in SSEN group. All cases were assessed by Flynn classification method and outcome scoring system. We noted excellent results in 26 cases (63%), satisfactory results in 14 cases (33%), while poor result in 2 cases (4%) in this study. There were six minor complications such as one superficial cellulitis and one case of implant-related pain and four cases of skin irritation at the nail tip (18%). Two cases deep infection (both cases are associated with grade II open fractures) requiring prolonged treatment with antibiotic were seen in each group. 2 case of shortening >1cm (9%) but 100 (9%) was seen with stain less steel elastic nail. CONCLUSIONS: Our results indicate that that elastic nail can be effectively used to treat fractures of diaphysis of femur in children. It can also be used very effectively in open fractures (up to Gustilo &Anderson grade II), in comminuted fractures (up to Winquist & Hansen type II) and in a multisystem injured patient.

Introduction: The intertrochanteric fractures of femur are commonly fixed using dynamic hip screw using a conventional open Dynamic Hip Screw (CDHS). This is associated with a long incision, blood loss, considerable soft tissue trauma and pain. All these problems can be avoided using minimally invasive Dynamic Hip Screw (MIDHS), which has a theoretical advantage of less blood loss, soft tissue trauma, and early rehabilitation. Thus, we conducted a prospective comparative study of the two techniques. Materials and Methods: This is a prospective comparative study conducted over a period of 2 years at Department of Orthopedics GMC Bhopal. Fifty patients in the age group of 50-80 years who presented with intertrochanteric femur fracture and fulfilled inclusion criteria were divided into two groups of 25 each for fixation by CDHS or MIDHS. Patients in both the groups were matched. The data analysis was performed using SPSS package. Results: The patients in minimally invasive group had shorter operative time (45 min vs. 75 min). The average postoperative blood loss in drain in conventional group was 150 ml whereas no drain was used in minimally invasive group. Postoperatively need for analgesic was significantly lower in minimally invasive group (P < 0.05). Duration of hospital stay was significantly less with minimally invasive technique. The duration of bony union was similar in both techniques. Conclusion: Our study concludes that the minimally invasive technique of fixation of Intertrochanteric femur fractures is superior in terms of less operating time and less duration of hospital stay.

Background: Since December 2011, a non-governmental organization (NGO) has been associated with our clubfoot clinic. Debates related to the effectiveness of NGOs in clinical milieu have raged on for a long time. The aim of this study was to analyze the effectiveness of an NGO in supporting the running of a clubfoot clinic in a tertiary care center. Methods: A descriptive, observational study was conducted from October to December 2014. The three main conceptualizations of effectiveness namely goals, resources and reputation were evaluated for this study, and to analyze them, we compared our treatment data with other published reports, and devised a ten-point questionnaire looking into the working of the NGO. This questionnaire was given to all parents (49) of children with clubfoot attending the clinic and also to an independent observer who was present at the time of patients’ interactions with the counselor. The significance of patients’ and observers’ response was tested by Wilcoxon matched-pairs signed-rank test. Results: 138 cases with 228 feet were registered in the clubfoot clinic till the end of our study. The average number of visits by the patients was 6.67 and 69.47% of cases required tenotomy during the course of treatment. Of the 49 patients, 33 (67.35%) graded the role of the NGO as excellent, while the rest showed a good response; 28 observers (57.14%) responded as excellent. The average score of parents towards role of the NGO was significantly higher than the observer’s score. Conclusions: The NGO associated with our clubfoot clinic successfully supported formal health care professionals.

Intraosseous ganglion is a benign bony cyst that mainly involves the epiphysis and metaphysis of long bones. Intraosseous ganglions are rare in talus, and in all the cases reported in literature, the patients had symptoms pertaining to the ankle joint. No case has been reported where the lesion in the talus has caused symptoms specific to the subtalar joint. A 20-year-old female presented to our hospital with pain in the right foot from last 6 months. Ankle joint movements were within normal limits, but the subtalar movement were significantly reduced. Plain radiographs of the foot and ankle were normal. Computed tomography (CT) scan of the foot and ankle showed a cystic lesion (0.5 × 0.5 cm) involving the base of the talar body which communicated with the subtalar joint. The patient was treated by curettage of the lesion through a curvilinear incision over the medial aspect of the subtalar joint. The clinical results after 3 months were excellent. The patient returned to her regular and light recreational activities with full, painless range of motion. There was no recurrence of symptoms at 6 months. Intraosseous ganglion is of talus is a rare entity. Symptomatic patient should be treated surgically.