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The bidirectional Glenn shunt improves systemic arterial oxygen saturation without increasing ventricular work or pulmonary vascular resistance (1).BDG is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair (2).It is an important intermediate palliation in patients with a structurally or functionally univentricular heart who are ultimately destined to have a Fontan-type operation (3). Avoidance of cardiopulmonary bypass (CPB) has the advantage of early extubation, less blood products, reduced requirement and duration of inotropic support (4).The end-to-side anastomosis of the superior vena cava (SVC) to the right or left pulmonary artery, which may be converted to a total cavopulmonary connection later, can effectively both increase arterial blood oxygen saturation of the patients and decrease volume overload of the ventricle (5)

Introduction The surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). Methods Through our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. Results We have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. Conclusion LCP with ANVFG and AICBG is a reliable option for "complex" diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.

Introduction: Acetabular component placement is a crucial determinant in outcomes following total hip arthroplasty. Malalignment predisposes to impingement, increased rate of dislocation, wear of the bearing, osteolysis, and revision after THA. The study aimed to determine how reliably the transverse acetabular ligament could be identified during primary THA and its validity as a guide for acetabular component placement within the safe zone in THA. Materials and Methods: In this prospective study, 52 patients undergoing total hip replacement during the period from August 2014 to January 2017 in Bowring and Lady Curzon Hospital and Victoria Hospital, Bangalore were included; in whom the acetabular component positioning was done using transverse acetabular ligament as a guide. 22 cases were done via modified lateral approach, while 30 cases were done via posterolateral approach. Acetabular reaming was done by placing the reamer parallel to TAL, starting with a reamer the diameter of the native femoral head. Following serial reaming, the final component is placed such that TAL should embrace it. The anteversion and inclination/abduction of the acetabular component was measured post-operatively by anteroposterior radiographs. Results: TAL was identified in all cases, irrespective of the surgical approach used. The mean planar anteversion was 19.84° (± 3.8°), and the radiological inclination was 43.65° (± 3.2°). Anteversion was within the safe zone in 96.15% (n=50) of the cases, while inclination was within the safe zone in 84.6% (n=44) of the cases. Conclusion: Transverse acetabular ligament can be reliably used as a guide in achieving patient-specific anteversion of the acetabular component within safe zone. A simple, reproducible technique, devoid of complex instrumentation. However, as inclination is influenced by factors in addition to TAL, TAL alone cannot be used for determining inclination of acetabular component positioning.

Background: Intervertebral disc herniation is a degenerative lumbar disease and a common pathology of skeletal system. Currently, most experts assume that facet tropism may affect lumbar degenerative diseases. Considering the previous inconsistent findings on the relationship of facet tropism, the present study was aimed to find the association between facet tropism and lumbar disc herniation.Methods: Patients with low back pain attending the OPD of orthopaedics department, with signs and symptoms of disc herniation were sent for magnetic resonance imaging (MRI). 72 patients with single level disc herniation were included in the study. Facet angles were measured using MRI of 1.5 T using the method described by Karacan et al. Facet tropism was defined as difference of 100 or more in facet joint angles between right and left sides.Results: 45 of the 72 cases (50%) who presented with lumbar disc herniation (LDH) had tropism while none (0%) at the control level did. This association was not statistically significant (p=0.983). Significant association was found between the side of disc herniation and the distribution of the more coronal or sagittal facing facet (p=0.024).Conclusions: Despite the presence of tropism only in the intervertebral segments affected with LDH in our study, the association between tropism and LDH was not statistically significant.

A 49-year-old woman was referred to the internal medicine outpatient clinic for work-up of nonpitting edema. Her history was remarkable for a substantial weight gain (75 lbs [33.75 kg]) in the 6 months before presentation; this weight was distributed mainly in her thighs and upper arms. Her medical history was remarkable for mild essential hypertension and rheumatoid arthritis, both of which were controlled effectively with medication. She denied increasing her caloric intake. Her alcohol intake was excessive, with consumption of more than 1.5 L of wine per day; however, there was nothing to suggest cirrhosis of the liver. At physical examination, there was evidence of swelling in her upper limbs, with bilateral proximal arm circumference of 54 cm. According to the patient, her arm circumference was 39 cm 6 months earlier. Swelling was present but less impressive in the forearms. Swelling was also present across her upper chest, at the base of her neck, and in her upper thighs. There was no evidence of pitting edema. The findings of routine screening blood work, including complete blood count and electrolyte analysis, were normal. Thyroid-stimulating hormone levels and 24-hour urine cortisol concentrations were also normal. Subsequently, this patient underwent computed tomography (CT) of the head, neck, chest, abdomen, and pelvis.