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Background: Tibial plateau fractures are commonly seen fractures of lower limb. They are challenging to manage since they are mostly associated with soft tissue injuries. Deep vein thrombosis (DVT) is a significant cause of morbidity and pulmonary embolism can even cause mortality in all hospitalized patients, especially after trauma and lower extremity fracture, which further carries risk of significant morbidity and mortality. We aim to evaluate the epidemiological characteristics of postoperative DVT in tibial plateau fractures.Method: A prospective observational randomized study was performed. A total of 79 patient were included in this study who had proximal tibia fractures. Pre-op ultrasonography was done and post operative ultrasonography was done following proximal tibia plating surgery on day 2. Successive evaluation with USG was done at week 2, week 3 and week 4 for DVT. If DVT is diagnosed it will be managed medically.Result: A total of 79 patients were included in the study, 28 were females and 51 males. 4 out of 79 patients were diagnosed with DVT following surgery of tibial plateau fracture. Predominantly DVT was seen in male patient of elderly age group who had high energy trauma operated by open reduction with duration of surgery of more than 1 hour. 3 out of 4 patients had distal DVT and 1 had proximal DVT.Conclusions: Six risk factors were found to be strongly associated with DVT i.e., old age, male gender, high energy trauma, increased preoperative interval, open reduction and prolonged duration of surgery. These epidemiologic data will be helpful in individual assessment, risk categorisation and development of targeted prevention programs.

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.

Unobtrusive observations of bicyclists were conducted at two-way, three-way, and four-way stop-controlled intersections. Consistent with previous reports, most cyclists did not stop at the stop sign. However, most cyclists did exhibit safety-related behaviors by making accommodations for traffic conditions. It was found that the cyclists conducted precautionary visual search when approaching stop signs, and that they were more likely to slow substantially or stop if cross traffic was not controlled by stop signs or if there were potential conflicts from other road users. Implications for safety interventions are discussed.

It is not surprising that many multi-vehicle collisions occur at intersections, as intersecting streets present potential conflict situations where vehicle paths can cross one another. What does surprise both naïve observers and many professionals involved in accident investigations (e.g., accident reconstructionists, human factors scientists, lawyers) is the explanation that most red light running accidents happen only when the vehicle violating the red light enters the intersection approximately 4 to 6 seconds or more after the light has turned red. This paper provides a framework to study the conditions under which red light running collisions occur. This framework is applied to real-world intersection geometries and red light running collisions captured on video. A comparison of observational and crash data indicates that only a small fraction of red light running results in collisions. The mathematical framework can be used to develop likely timing scenarios in accident investigation, and can be expanded to study motor vehicle collisions with bicyclists or pedestrians.

When faced with a potential hazard, a pedestrian may need to change course, stop, maintain speed or accelerate. Logically, this must involve both a delay phase (to perceive a hazard and formulate a response) and an action phase (e.g., to arrest forward momentum in a stopping response). Qualitatively, the decision and response processes are similar to those an individual faces while driving an automobile or riding a bicycle, but very little research has been found on this subject for pedestrians. In the current study, jogging or walking subjects were asked to stop quickly in response to an auditory signal, and data were extracted from video recordings of the trials. The reaction time phase observed in the study was similar to prepared reaction times in other settings. The halting phase visibly began with a change in body angle, with rapid deceleration following the subsequent heel strike. Both the time and the distance to stop required from a jog or walk can be important for analysis of vehicle-pedestrian collisions and other mishaps.

Most outdoor and many indoor walking environments present abrupt elevation changes of 1.25 cm (0.5 in) or more. Such bumps can disrupt walking as well as travel on small wheels (e.g., skates or skateboards), yet serious accidents from tripping are reasonably infrequent given how much walking is done. Data are presented from walkway profile surveys and factors affecting human ambulatory behavior. Relevance to industry Falls on the same level produce a substantial portion of workplace injuries. Improved understanding of the role of perception and expectation in such falls can lead to improved strategies for preventing injuries.

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.