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Posterolateral corner injuries have seen an increasing trend in view of the increased high velocity injuries. Though isolated injuries are rare, it is usually associated with other ligament injuries. A meticulous clinical examination with a high index of suspicion and radiological assessment is needed for the diagnosis, failure of which may lead to chronic pain, chronic knee instability, cartilage damage, and failed cruciate ligament reconstruction. Surgical or nonsurgical intervention are based on the extend of the injuries. [ABSTRACT FROM AUTHOR]

Background: Trauma management is an ever evolving part of orthopaedics and with the latest advancement in metallurgy, crafting processes and biomechanical studies, the implants used have been continuously changing. Distal femur fractures occur at a major joint and their management has always been complicated ranging from preoperative, intra-op to postoperative period. All the studies and research are aimed towards achieving the best functional outcome and functional outcome studies help in collecting and assimilation of the data for the same which further help in modification of techniques to further improve the same. This study focusses on the outcomes achieved by using the distal femur locking compression plate for the management of fractures distal end of femur. Materials and Methods: Prospective, unicentric, observational study from June 2018 - February 2020. All patients with distal femur facture were included. Pathological fractures, open fractures, fractures older than 3 weeks and patients with ipsilateral proximal tibia, patella and proximal femur were excluded. Surgical approach was surgeon's choice. Functional outcome was measured using Knee Society Knee Scoring system at 6weeks, 3 months, 6months and 12 months. Functional outcome measured at 12 months was used for evaluation. Results: 28 patients, 19(67.9%) males and 9(32.1%) females. 89.47% of males sustained the fracture due to road traffic accident and 66.66% of females sustained due to fall and all belonged to age group more than 60 years. The average range of motion achieved was 112.3 ± 8.2. Functional outcome at 12 months 71.4% patients had excellent, 25% had good and 3.6% patients had fair and no patient had poor outcome. Conclusion: Distal femur fracture is more common in the age group of 21-40 years. The average range of motion of knee achieved in Type A and Type B fractures are significantly better than Type C fractures. Excellent functional outcome was statistically significant in Type A and Type B fractures when compared to Type C fractures. [ABSTRACT FROM AUTHOR]

Introduction: Bipolar hemiarthroplasty is a very common surgery done for geriatric patients with femoral neck as well as some trochanteric fractures. Complications usually range from infection, loosening, and dislocation to periprosthetic fractures. We present here a case report of a very rare presentation of aseptic acetabular protrusio with intrapelvic migration of a bipolar prosthesis and how it was managed. Case Report: An 80-year-old male patient of Indian origin operated with bipolar hemiarthroplasty 4 years back presented with severe pain and restricted movements of the right hip. The patient was having progressive pain for the past 1 year with a history of sudden giving way while walking 1 month back. Radiographs and further imaging showed acetabular protrusio of the bipolar prosthesis with intrapelvic migration of the head. There was no evidence of infection seen on investigations and hip aspiration. Surgery was associated with high risk due to the associated comorbidities and the close proximity of neurovascular structures to the prosthesis. The patient was managed with extended trochanteric osteotomy, implant removal, and revision total hip arthroplasty with antiprotrusio cage and long revision stem in a single stage. At 18-months follow-up, the patient is walking well without support. Conclusion: An elderly patient with multiple comorbidities and with the bipolar prosthesis lodged in the pelvis could be managed well with an excellent functional outcome. However, proper pre-operative planning with all required implants and instruments with a backup plan remains the key in such complicated and rare presentations. [ABSTRACT FROM AUTHOR]

This study was carried out to study the functional outcome of patients who underwent anterolateral plating for distal tibia fractures using the American Orthopaedic Society foot and ankle scoring, secondarily to study the relationship of various factors and the occurrence of complications post-operatively, and to relate the surgical duration with postoperative complications. Materials and Methods: This prospective study includes 31 cases of distal tibia fractures in patients in the age group between 15-65 years. The patients included in the study underwent anterolateral plating for pilon fractures. The study was conducted in the department of Orthopaedics at a leading hospital in Kerala between August 2013 and December 2016. Ethical and scientific committee clearance was obtained. Results: The average age of the patients in our serieswas 48.6 years ranging from 24-64 years, with a male preponderance (64.5 %). The radiographic classification included: 15 TypeA Fractures (6 A1, 5 A2, 4 A3), 10 Type B Fractures (4 B1, 1 B2, 5 B3), and 6 Type C Fractures (3 C1, 3 C2, 0 C3). There were 2 Grade 1 open (A3 and B2) fractures and 1 Grade 2 Open fracture (C2) according to the Gustilo-Anderson classification. 61.3% of the patients underwent their surgery within 3 days from the day of injury. The average duration of surgery was 93 minutes. Conclusion: All patients (n = 18) whose surgery was completed within 93 minutes had an excellent outcome. Patients whose surgery time exceeded 93 minutes had a greater chance of having a poor functional outcome (p <0.05). There was a statistical significance between the functional outcome and the patients who underwent surgery within 3 days from the day of injury. The incidence of complications was higher in the higher OTA classes but there exists no statistical significance in its occurrence. There was a statistical significance between the Functional Outcome and the OTA class. The greater the degree of comminution and intraarticular involvement, the worse the functional outcome. This is evidenced by the fact that the OTA class A being extraarticular fracture has a statistically significant better functional outcome than OTA type B fractures which in turn has a statistically significant better functional outcome than OTA type C fractures. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intra operative periarticular injection with that of post operative epidural analgesia for pain control following unilateral total knee arthroplasty under spinal anesthesia with regard to benefits in postoperative pain at rest and during activity and postoperative range of motion. Methods: Eighty patients undergoing TKA by a single surgeon were randomly assigned into two groups with the help of computer generated random numbers. One group received the local periarticular infiltration protocol containing 40 ml of 0.75% of Ropivacaine, 2 ml of ketoralac (30 mg/ml), 0.8 mg Morphine, 0.3 ml of Epinephrine (1:1000) and 16.9 ml of Normal saline. The other group underwent epidural analgesia with infusion pump. Both groups received the same operative procedures and rehabilitation protocol. The results were compared and the variables analyzedwere postoperative pain at rest and activity (Visual analogue scale for pain), postoperative complications, range of motion and rescue analgesia. Results: Periarticular injection was associated with significantly lower early postoperative pain at rest, better range of motion, less need for rescue analgesia and fewer complications. Conclusion: The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery with fewer complications. Hence it may be used as a safe alternative to Epidural injections. [ABSTRACT FROM AUTHOR]

Purpose: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL) deficiency remains controversial. The purpose was to evaluate cost and functional results after one-stage bilateral ACL reconstruction using hamstring tendon autograft. Methods: This prospective study evaluated the mid-termfunctional outcome of 7 patients (14 knees) who had undergone one-stage bilateral ACL reconstruction. Results: The median length of hospital stay was 4 (3-5) days. The duration of rehabilitation process in patients with bilateral ACL reconstruction was 6-8weeks. The mean Lysholm scorewas 93 (90-95), IKDC score 78.7 (74.7-82.75), and Tegner activity score level 5. The median time to return to full-timework and to full sports was 9 weeks and 8 months respectively. 6 patients (85.7%) in the study group returned to their pre-injury level of activity. Conclusions: Mid-term clinical results suggested that one-stage bilateral ACL reconstruction using hamstring tendon autograft is clinically effective. For patients presenting with bilateral ACL-deficient knees, one-stage bilateral ACL reconstruction is reproducible, cost effective and does not compromise functional results. [ABSTRACT FROM AUTHOR]

Introduction: Radial head is considered the second main stabiliser of the elbow in valgus, after the medial collateral ligament. In the event of a coronoid fracture, or a deficient medial collateral ligament, or a disrupted lateral collateral ligament, radial head is the main stabilizer of the elbow. It is due to the key role that radial head plays in the stability of the elbow that surgeons have increasingly tried to conserve the radial head. Isolated radial head fractures constitute about 5.4% of all fractures and 33% of all elbow fractures². The management of radial head fractures depends on the degree of comminution, displacement, free intra articular fragments, the percentage of articular surface involved and the angulations between the radial neck and shaft of radius. Radial head replacement with metallic implants can be used to treat irreparable radial head fractures. Method: From a period of 2012-2014, 5 patients who underwent radial head replacement for irreparable radial head fractures were taken up for the study and evaluated. Of the 5 patients, 4 patients presented with comminuted radial head fracture associated with elbow dislocation. Of which one patient had bilateral radial head fractures on one side associated with an elbow dislocation which was subjected to replacement and included in the study. All patients were followed up clinically and radiographically. Mean follow up of the group is 20.8 months (shortest 12 months, longest 30 months). The outcome was based on Mayo Elbow Performance Scoring. Result: On the basis of Mayo Elbow Performance Scores, 2 patients had excellent results; 3 patients had good results. None of the patients had elbow instability following radial head replacement. The prostheses were found to be well fixed and none had any signs of infection. Conclusion: The treatment of irreparable radial head fractures with primary radial head replacement using metal prosthesis and surrounding soft tissue reconstruction provided satisfactory results. Proper technique, correct implant, early mobilization are important for the final outcome and restoration of function. [ABSTRACT FROM AUTHOR]

An obituary for George H. Tavard, a priest of the Augustinians of the Assumption, is presented.