Hemiarthroplasty is the most commonly used treatment for femoral neck fracture in the elderly. We performed a study in patients with femoral neck fracture aged between 50-70 year and found a comparable difference in the functional outcome in the patients. The patients were followed for 2 year. The mean age was 60 years (50-70) and 34 were female and 14 were male. The degree of functional outcome was better in those treated with cemented prosthesis than with non-cemented prosthesis. No statistical significant difference was found between two groups with regards to mortality, re-operation or post operative medical complication. The use of cemented bipolar hemiarthroplasty resulted in less pain and morbidity than in noncemented bipolar hemiarthroplasty.

Background: Distal tibial fractures or Pilon fractures are still challenging to trauma surgeons because of their associated complications. Various modalities have been described for the management of these fracture but there is a lot of controversy regarding optimal management of these fractures We evaluated the efficacy of Joshi External Stabilization System (JESS) in management of these fractures, Materials & Methods: This study was carried out from March 2008 to August 2009 on patients with distal tibial Pilon fracture, at emergency trauma center (Level II), King George Medical University, Lucknow. Total 32 patients (32 fractures) satisfying our inclusion criteria were enrolled in our study. Patients classified as per AO classification having Type B2 in 5, Type B3 in 3, Type CI in 4, Type C2 in 12 and Type C3 in 8 patients. All patients were managed by close reduction or limited open reduction and external fixation by JESS. Bone grafting was done in one patient having metaphyseal bone defect. Functional outcomes of patient were assessed in terms of Teeny & Wiss Criteria, while radiological evaluation was done in terms Ovadia and Beals criteria, by taking x-rays to access quality of reduction and union of fracture. Results: All patients were followed up for a minimum of 18 months after surgery. All patients except one showed union at an average of 15.2 weeks. Average range of dorsiflexion of the ankle joint was 15.8 degrees while plantar flexion was 29.6 degrees. Conclusion: That close reduction and percutaneous fixation with JESS, have a distinct advantage over other modalities of surgical intervention in terms of soft tissue protection, single stage surgery and less operative time with fewer complications.

Introduction Management open fracture is a point of debate as to when should go for definitive management. Earliest covering of the exposed fragments has always received consensus. Multiple modalities for bone coverage nave been described. Fasciocutaneous flaps are simple but their role has to be specified for better patient management and definitive management. Material and Method 24 prospective and 37 retrospective cases of open fractures of long bones were included in the study conducted in department of orthopedics GSVM medical college, Kanpur. Rotational, Translational, Cross leg & Chest wall fasciocutaneous flaps were done as per need of fracture using standard technique. Primary reduction and retention modality was either Plaster of Paris cast or external fixator. After flap viability patients were analyzed for the time required to go for definitive fracture management. Results 24 cases were taken up for flap surgery and the results were compared with 37 old cases treated without flap coverage, mean age was 27.8 years. 8cross leg, 14 local and 2 chest wall flaps were done. In 83.33% cases secondary defect was covered by split skin grafting immediately. In 75% cases mean duration of surgery was 2 weeks we found overall success rate to be 84%. the mean duration of commencement of definitive treatment in flap surgery group with Gustilo Type III fractures was 6.6 ± 0.766 weeks, Gustilo Type II fractures was 8.1±1.47 weeks with 3(12.5%) cases developing osteomyelitis at one year follow up. In other group the mean duration of commencement of definitive treatment was 10.22 ±1.003 weeks in Gustilo Type III and 9 ± 3.098 weeks in Gustilo Type II fractures and 13(35%) cases developed osteomyelitis / infected non union at one year follow up. Conclusion Primary fasciocutaneous flap coverage in open fractures significantly decreases the time in commencement of definitive treatment. Infection and chances of osteomyelitis are also reduced. However the timing of flap surgery plays vital role.

Introduction :Bio absorbable screws are increasingly being used instead of titanium screws as fixation device in ACL reconstructions. The possible advantages with bio absorbable screws are better postoperative MRI evaluations and easier revision surgery. Purpose :The aim of this study was to compare the Clinical outcome after ACL-reconstruction with BPTB-grafts fixed with titanium interference screws or bio absorbable screws with minimum of 2 years follow up. Methods :Between 2009 and 2011, 30 patients all male between 20-36 years with ACL deficient knees were randomized for arthroscopic ACL reconstruction using BPTB-graft fixed either with metal interference screws [Titanium) group l(n=16) (M) or bio absorbable Poly-L-lactic acid screws group 2(n=14) (B). Patients were observed during subsequent follow up at 4 weeks, 8 weeks, 12 weeks, 18 weeks, 24 weeks, 9 month, 1 year and 1.5 years and at 3 years with clinical examination and functional outcome of both groups. Results: The clinical and functional results were similar in both groups. There were no significant differences oetween the groups in any parameter measured. Conclusion: The potential advantages of using PLLA screws compared to metal screws are not sufficient to warrant the routine use of PLLA-screws in ACL reconstructions.

Background - Open surgical treatment of complex fracture of lower 1/4th tibia is associated with substantial complication in many patients [1]. Indirect reduction and stabilization of fracture by means of using a ring external fixator, can be a useful method of achieving satisfactory joint restoration and employs the principle of ligamentotaxis to realign disrupted joint and articular surface[19]. Material and Method - We treated 16 patient between March 2010 to October 2011 of complex fracture of lower 1/4th tibia with ilizarov external fixation. 10 male & 6 female patients were included in this study, ranging from 18 to 58 years with 11 open fracture (5 type 1,4 type 2, 2 type 3) and 5 closed distal tibial fracture included in this study. We used RUEDI & ALLGOWER classification based on size and displacement of articular fragment. Out of 16 cases 6 cases belong to type 1, 7 cases belong to type 2,3 cases belong to type 3. Resutls - Results were assessed according to ovadis and beals criteria (1986). Out of the 16 patients there are 11 patients with excellent, 2 with good, and 1 with fair results. 8 patients reported no pain, 4 mild pain and 3 moderate pain. Result were statistically significant with few complications. Conclusion - Ilizarov ring fixator is an excellent minimally invasive method for management of distal tibial fracture. It not only obviates the need of open reduction and internal fixation, calcaneal traction and pop casts but also gives better functional results.

Background: Treatment of fracture calcaneum still remains controversial. The purpose of this study was to analyse outcome of operative and non-operative management of intra-articular calcaneal fractures. Method: We prospectively studied 56 patients with 67 intra-articular calcaneum fractures with follow up ranging from 24 months to 36 months, and an average follow up of 30 months who were managed with conservative as well as by operative means. All patients were evaluated preoperatively using computed tomography and fracture pattern was studied in detail. The foot was evaluated with the use of a protocol followed by Parmar et al. Results: A total of 67 fractures in a series of 56 patients with 20 fractures in 18 patients of operated group (open reduction, internal fixation and bone grafting) and 47 fractures in 38 patients of conservative group. Ankle movement in conservative group was normal in 81.2% patients of undisplaced and 64.7% of displaced group while it is 100% in undisplaced and 85.7% in displaced operative group. In operative group 100% of patients were able to walk without limp and returned to same work while it was lower in conservative. Calf wasting was also higher in conservative group. Conclusion: With adherence to proper surgical techniques and biomechanical principles open reduction + Internal fixation and bone grafting with calcaneal locking shows very good preliminary results.

Background: Osteoporosis has been defined as the disease characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. The major clinical consequence of osteoporosis is a greatly increased risk of fracture. Materials and Methods: In this study 40 patients attending outpatient department of orthopaedic surgery of a medical college hospital of northern India were included. Bone mineral density of patients was obtained by dual energy x-ray absorptiometry (hologic), and osteoporotic patients (T score ≤2.5) were included. Female to male ratio was 4:1 and average age group was 69.9 years. Average follow-up period was 12.9 months. Patient were categorised in three groups on the basis of treatment given. First group (n = 18) received zoledronic acid 5 mg i.v. yearly, second group (n = 10) was given risedronate 35 mg once weekly, and third group (n =12) took synthetic parathyroid hormone analogue teriparatide (PTH 1 -34) 20 microgram subcutaneusly daily, and all groups continued 1200 mg calcium, 400IU vit-D, and weight bearing exercise daily. Results: Patients on therapy of zoledronic acid 5 mg i.v. yearly increased their bone mineral density by 4.9%, those on the treatment of teriparatide 20 microgram subcutaneusly daily increased their bone mineral density by 8.9%, and those who took risedronate 35 mg once weekly increased their bone mineral density by 3.1 %. Conclusion: Our study shows that it is most beneficial to treat those at highest risk and to utilize cost effective interventions as and when possible.

Objectives: To study the effects of interferential therapy in pain relief and range of motion in Frozen shoulder. Methods: 27 Patients of Frozen shoulder were subjected to Alternate day interferential therapy, supervised range of movement exercises for a period of one month and were assessed for pain and Constant Murley score respectively at the end of 15 days and at 30 days. Results: On presentation the range of motion averaged at 106.42± 29.62, 100.95± 29.52. 34.28± 13.53, 36.42 ±8.82 degrees of forward flexion, abduction, external ,and internal rotation respectively. On day 30^th the range of motion averaged 145.71± 23.99, 136.67± 28.91 , 71.91±5.58 , 56.19 ±5.89 degrees of forward flexion, abduction, external ,and internal rotation respectively A statistically significant improvement in Constant Murley score from 44.52 ± 13.8 to 66.33 ± 3.05 (p < 0.001) & reduction in VAS from 7.61 ± 0.97 to 3.52± 0.87 (p < 0.001) was seen. Conclusion: Interferential current therapy when given to patients of Frozen shoulder had a significant improvement in both pain and range of Motion leading to early regaining of day-to-day activities.

The potential for structural modification by natural mineral supplement was evaluated in a pilot prospective, study of six months duration in twenty patients with moderate Osteoarthritis of knee. WOMAC values (subsets and total) showed significant improvement from baseline over the course of six months treatment (p < 0.001). The pain free distance covered during a Six minute walk (6MWD) also significantly improved by 140 feet ((p< .001 ). Requirement of rescue medication decreased to once a week in 45%. The mean (SD) change for the percentage of painful days were 45.0 (38.7). 25% patients demonstrated improved cartilage thickness by at least 0.01 mm as against 15% who lost thickness at least by 0.01 mm. 55% patients showed improved Cell counts (below 500 microlitre) in Synovial fluid. Hematological and Biochemical safety variables showed that mineral supplement is absolutely safe. The study suggests that natural mineral supplementation helped in synovial metabolism and in reducing cartilage pathology hence had structural efficacy.

Osteoarthritis Knee in one fo the most disabling condition globally. Hyaluronicacid is an important component of synovial fluid which provides lubrication and protection to the joint. The synovial fluid from an arthritic joint has lower elasticity and viscosity than synovial fluid from normal joint. Visco-supplementation therapy which consists of intra articular injections of Hyaluronicacid restores elastic & viscous properties of synovial fluid and thus helps in the repair of the intra articular homogenesity that is disrupted in the joint disease. This study presents the results of 96 knees with osteoarthritis treated by five intra articular treated by five intraarticular injections of Hyaluronicacid acid at weekly intervals and assessed using VAS scale, 80.2% of patients with moderate to severe osteoarthritis have shown good results.

Simulatneous bilateral traumatic patellar tendon rupture are extremely rare. We describe bilateral simultaneous rupture of extensor mechanism knee, with rupture of patellar tendon on one side & rupture of tendious portion of quadriceps on other sides. This combination is exceedingly rare & very few are described in the literature.

Introduction: Isolated tuberculosis of pubis symphysis is rare entity and infrequently reported in litreature. Its incidence was tremendously decreased after evolution of effective anti-tubercular chemotherapy. We are reporting a case of 45 year old female with isolated tuberculosis of pubic symphysis bone presented to us in our OFD with chief complaint of pain over suprapubic area. Case Report: A 45 year old female presented with complaints of pain over supra pubic area along with a history of off and on fever since four months. Patient also had a history weight loss. There was no history of any trauma or surgical procedure. On examination tenderness was present over supra pubic area along with bilateral flexion deformity of hip, inguinal lymph nodes were not enlarged.

A nine year old male child presented with a history of trauma on right shoulder. Clinical examination and radiographic evaluation revealed Anterior dislocation of shoulder joint with Salter Harris type-II epiphyseal injury. The patient was managed successfully by close reduction under GA and percutaneous fixation of epiphyseal separation by K-wire.

Metaphyseal fractures of the proximal humerus along with anterior dislocation in preschool children are extremely rare injuries. We are reporting a case of a metaphyseal fracture of the proximal humerus along with anterior dislocation in a 3-year-old boy. The patient was managed by close reduction and internal fixation by K-wires.