Background: Subtrochanteric fracture and reverse oblique intertrochanteric fractures are difficult and challenging fractures to treat. There has been near elimination of non operative treatment once advocated due to superior results obtained through surgical intervention. Various types of implants are available for fixation of subtrochanteric and intertrochanteric fractures and that include both intramedullary devices and extramedullary devices. Both types have their own advantages and disadvantages and therefore choice of implant remains controversial. Material & Methods: A retrospective case study was done with 30 patients of comminuted subtrochanteric fracture & reverse oblique intertrochanteric fracture of femur to evaluate result of dynamic condylar screw fixation. Majority of patient suffered fracture by road traffic accidents (70%), other common mode being fall from height (21%). The average age of patients was 35.4 years (range 25-75). Majority of patients were male (24 patients compared to 6 female patients). Results: Majority of fracture united in 16-18 wks, average time being 17.2 wks. Two patients suffered implant failure and non-union which were treated by repeat surgery with cancellous bone grafting. Two patients developed limb length discrepancy observed on subsequent follow–up. Average Harris hip score of 90 (80-95) was achieved. Excellent result was obtained in 19 cases and fair result was achieved in 11 cases. Conclusion: The results of our study suggest that the dynamic condylar screw can be used for fixation of reverse oblique intertrochanteric and subtrochanteric fractures with excellent outcome.

Background: High frequency ultrasonography is an accurate non-invasive imaging technique for evaluating patients with painful shoulder.

Objective: To compare the clinical diagnosis established by a physical examination with high frequency ultrasonography findings in patients with painful shoulder.

Methods: 75 consecutive patients with a non traumatic shoulder pain were prospectively included in the study. All had a physical examination performed by a clinician. Ultrasonography examination was carried out within one week of the physical examination by a radiologist experienced in this technique who had no knowledge of the clinical findings. Ultrasonography was considered the optimal diagnostic technique.

Results: Clinical assessment showed low accuracy in the diagnosis of shoulder lesions.

Conclusion: Ultrasonography should be used wherever possible to improve diagnosis and treatment of painful shoulder. This study emphasises the importance of good clinical examination skills in diagnosing common shoulder abnormalities. The addition of imaging, particularly ultrasound further increases the likelihood of an accurate diagnosis

Between December 2004 and June 2008 twenty-eight patients with closed displaced acetabular fractures were treated with open reduction and internal fixation.

The surgical procedure consisted of open reduction and internal fixation by anterior, posterior or combined approaches during the same period of anesthesia.

The cases were reviewed to determine the adequacy of the various approaches, ease of reduction and to determine the choice of approach for various fracture patterns.

The patients were followed for a mean period of 20 months after surgery (Range 12 months to 36 months). Anatomical reduction and rigid internal fixation could be achieved in 71% of the cases. The clinical result was excellent for 11 hips (39 per cent), good for 10 hips (36 percent), fair for 3 hips (11 per cent), and poor for four hips (14 per cent).

Osteonecrosis of the femoral head was noted in one hip (3 per cent), and progressive wear of the femoral head was seen in two hips (6 per cent).

Our findings indicate that anatomical reduction can be achieved in these complex injuries in a large percentage of cases with satisfactory long term results.

Background: There is no consensus as to which is the best treatment for intra-articular fractures of the calcaneus. Many people treat it conservatively whereas many go for operative procedures . Even for surgical treatment many do it by percutaneous technique many go for open reduction and internal fixation with plate or cancellous screws.

Purpose: To present a case series of 30 patients with intra-articular joint depressed fractures of calcaneum treated by open reduction and internal fixation with plate through a lateral approach.

Material and Methods: A retrospective study was done in a level 1 trauma centre in which 30 patients (27 males and 3 females) of joint depressed type of calcaneum fractures were treated by open reduction and fixation by plate. All had acute trauma. Based on 2-dimensional CT scans, the fractures were categorized using Sander's classification. Radiographs and Maryland foot scores were used for evaluation of the results. Average follow-up was 24 months.

Results: 26 patients had full sub-talar range of movement and 4 patients had restricted range of movement. Eleven out of 12 patients returned to manual labour jobs, the others were not employed at the time of injury. Twenty three patients had an excellent Maryland foot score and 7 patients had a good score.

Interpretation: Intra-articular calcaneum fractures are associated with high chances of sub-talar arthritis with loss of sub-talar movement if not treated properly. Reduction of posterior facet is more important in joint depressed type of fracture. Lateral plating for these complicated fractures resulted in good to excellent sub-talar joint function with restoration of heel height, width and normal heel valgus.

There are several methods of the management of upper diaphyseal fracture of tibia, but the results of Sirus nail with cross screw fixation are encouraging. There were 14 male and 1 female. Most of the patients were between 20 to 40 years. Out of 15 patients 11 were closed and 4 cases were compound fractures. Most of the cases (86.67%) required 9 mm and 13.33% required 8 mm thick nail. All fractures healed in an average time of 20 weeks. The follow up period ranged from 17 to 19 months. In our series no implant failure was observed. All patients returned to their pre fracture level of activity. Sirus nail with cross screw fixation appears as a reliable method of treatment for upper diaphyseal fracture of tibia.

Background: Osteoporosis is characterized by a reduction in bone density, associated with skeletal fragility and an increased risk of fracture after minimal trauma. Bone loss starts between the ages of 35 and 50 yr in men and continues into old age in both sexes. Measurements of bone density can accurately predict the risk for fractures and timely treatment can prevent them. Until recently, the diagnosis of osteoporosis in men was based on the development of fractures after minimal trauma. The introduction of dual-energy X-ray absorptiometry for the measurement of bone density has stimulated interest in the diagnosis of osteoporosis before fractures occur. Quantitative ultrasonography has proved its importance in being an economical, portable, and simple procedure with larger field outreach.

Methods: This was a retrospective study including all male patients presenting with back pain, history of fracture after minor trauma, alcoholics, patient on steroids and chronic smokers. The study does not include the patients having fractures due to road traffic accidents or pathological fractures associated with primary or secondary bone tumors. The BMD estimation of these patients was done by quantitative ultrasonography of the os calcis and the analysis done on the basis of T–scores.

Results: Among 610 male patients included in the study 45% were osteoporotic and 29% were osteopenic, 10% were severely osteoporotic. Most common presenting symptom was low back ache followed by generalized bone pain. Most of the osteoporotic patients were in the 40-60 yrs age group.

Conclusion: Quantitative ultrasonography of calcaneum is an effective tool for diagnosis of osteoporosis and osteopenia and is inexpensive, non-ionizing, simple and a reliable method.

Proximal humerus fractures represent 5% of all fractures and 45% of all humerus fractures with an increasing incidence due to their association with osteoporosis in increasingly aged population. This study was conducted in the Department Of Orthopaedics, S.N. Medical College, Agra. Total 30 cases were included in this study including both male and female, in which 9 cases (6 cases by PHILOS and 3 cases by K-wire) have been previously treated in the department and studied retrospectively and rest 21 (70.00%) cases studied prospectively from September 2010 to September 2012.The findings of the present work are based on evaluation of fracture upper end Humerus treated by multiple K-wire fixation in 10(33.33%) patients and by PHILOS in 20(66.66%) patients by delto-pectoral approach. Most of the fractures occurred in 30-50 years of age groups that is 46.66%.The length of follow up in our study varied from 16 to 18 months. The fracture united well in time in 18(90%) of PHILOS and 8(80%) of multiple K-wire fixation and there is no case of non-union. Results of this study compared with modified Constant score which was more in cases of PHILOS than cases of multiple K-wire fixation. Full ranges of movement in severely comminuted fractures are unlikely outcome. From this study, we concluded that for good success rate, the indications of operative treatment must be adhered to, followed by early and effective physiotherapy.

A femoral neck fracture with dislocation of femoral head in the presence of intact actabulum is a rare and unusual injury pattern around the hip. Such injuries usually pose a dilemma to treating Orthopaedic surgeon because of unfamiliarity with these injuries. Therefore we present a case of a young female patient who sustained a similar injury to her right hip following a road traffic accident. After a thorough clinico-radiological examination including Computerized Tomography of the injured hip the patient was diagnosed to have a subcapital femoral neck fracture with dislocation of femoral head. The Computerized tomography of the hip also showed a fracture of the dislocated femoral head; however the actabulum of the injured hip was intact. Patient was managed by Hemiarthroplasty using cemented modular bipolar prosthesis.

Giant cell tumour is a neoplasm of undifferentiated mesenchymal stromal cells with presence of abundant, multi-nucleated giant cells. Actually it is a benign aggressive tumour which involves the epiphyseo metaphyseal end of long bones.

Giant cell tumour rarely involves small bones of hand and foot. Among the tarsal bones it involves talus and calcaneum commonly.

In the case report, a 20 year female patient complains of pain and swelling over the left ankle for one and half year. Radiological examination (plain radiographs and computerized tomography scan) and guided fine needle aspiration cytology confirmed a diagnosis of giant cell tumour. The tumour was of grade II according to Campanacci grading and there was deformed cortex. Intralesional curettage and an autogenous cancellous bone graft (iliac crest) with bone cementing was performed. After 6 month follow-up, the patient was able to walk with full weight bearing on the affected limb without pain. There were no signs of recurrence after 12 months of follow up.

Closed subtalar dislocations are very rare injuries. They pose difficulty in management as well as prolonged morbidity if neglected/missed. We report a case of 22 year old female with subtalar dislocation. Successful closed reduction under regional anaesthesia and stabilization with multiple Kwires was done. Ankle immobilization with below knee cast was done for 6 weeks and non-weight bearing walk was allowed. K-wires and cast was removed after 6 weeks and ankle physiotherapy was started. Patient gained full range of motion at ankle in further 6 weeks. Patient was pain free at final follow-up at 4 months. Sometimes, even in these cases avascular necrosis of the talus or arthritis of the surrounding joints can compromise the final functional outcome.

Scapular winging is an uncommon incapacitating condition that leads to restricted functional activity of the upper extremity. It commonly results from long thoracic nerve dysfunction/palsy leading to paralysis of serratus anterior muscle. Diagnosis is effortlessly made upon inspection of the scapula, with serratus anterior paralysis resulting in winging of the scapula. Here we present a patient with scapular winging secondary to long thoracic nerve palsy. We will also briefly review the anatomical basis of scapular winging caused by serratus anterior, trapezius and rhomboid paralysis.