Background: Conservative management of displaced mid-shaft clavicle fracture has been reported with suboptimal outcomes.

Purpose: To study the outcome of middle third clavicle fracture treated with reconstruction plating in terms of function using Constant shoulder score, shortening, union time, complications and patient satisfaction.

Methods: 30 patients with displaced middle third clavicle fracture were treated with open reduction and internal fixation with contoured locking reconstruction plate and prospectively followed up for 2 years. Out of these cases,17 patients were B2.3 and 13 patients were B2.1 (AO/OTA Classification) and all 30 were of Robinson Type 2 fractures as per the older Robinson classification. All 30, 26 males and 4 females with mean age 35 years with SD 11 years (range 18-60 years) operated with in a week of injury.

Results: All fractures united in 16 weeks or less in near anatomic position with complication in 2 (5%) patients, one deep infection and one frozen shoulder which on subsequent management recovered well. No nonunion or implant failure was observed. Average Constant score was 98 after 2 years follow up. All patients were satisfied with the treatment. The most common indication (25%) for hardware removal was young age of the patient, hardware prominence and occasional discomfort.

Conclusion: This small series shows that displaced midshaft clavicle fracture can be optimally treated with operative fixation.

Introduction: The aim of treating distal humeral fractures is anatomical reduction and stable fixation for early mobilisation. Open reduction and internal fixation with plating has been considered as the gold standard treatment for these fractures. However, this technique may not be suitable in compound fractures. External fixation appears to be a reasonable treatment modality in such cases. The aim of our study was to evaluate the role of JESS (Joshi's External Stabilization System) fixator in the treatment of open intercondylar distal humeral fractures.

Material and Methods: From May 2009 to August 2012, twenty patients (15 men and 5 women; mean age of 35 years) underwent closed reduction through ligamentotaxis and fixation with JESS. The patients were followed up for a mean duration of 14.44 months (range 12-18 months). Functional outcome was assessed using the Jupiter scoring system.

Results: The Jupiter score was excellent in 3 patients, good in 3, fair in 13 and poor in one patient. The mean time from injury to internal fixation was 3 days. Complications included one non-union, stiffness in two patients and ulnar nerve neuropraxia in two patients.

Conclusion: We found that the JESS fixator offers a promising alternative treatment for open intercondylar humeral fractures which are contaminated and infected. JESS fixator is a simple and minimally invasive method of fixation with few complications and high rates of union.

Background: Ultrasound (US) has been shown to be a promising technique for assessing deformity and for monitoring of clubfoot treatment. We conducted a study to ultrasonographically evaluate the deformity and to assess the changes in measurements with treatment by Ponseti method and to correlate these ultrasonogrphic variables with Pirani scoring.

Material and Methods: Patients with virgin idiopathic clubfoot and age <1 yr at the time of presentation were included. Pirani scoring was used for clinical assessment of clubfoot. All US measurements were made in neutral position. Normal feet data as collected by Aurell et al was taken as control group. Medial malleolar distance (MMN), Calcaneo-cuboid distance (CC Distance), Calcaneocuboid angle (CC Angle) and Talus length (TAL length) were selected as parameters and measured pre-treatment and post-treatment.

Results: A total of 26 patients with 39 feet (11males and 15 females) were evaluated which included 13 unilateral and 13 bilateral cases. Significant change was observed in each sonographic parameter and post-treatment measurements correlated well with the control group.

Conclusion: US is a widely available procedure that can improve pathomorphological documentation of nonossified Clubfoot. It allows for objective monitoring of the progressive correction of clubfoot.

Aims and Objectives: To compare functional outcome of intercondylar humeral fractures treated with different modalities of open reduction and internal fixation.

Material & Methods: This is a prospective study of 46 cases of distal humerus fractures in age group 18-60 yrs involving the articular surface (AO type C) who are admitted to SRN Hospital, MLNMC Allahabad between June 2012 and June 2014. Cases were taken according to inclusion and exclusion criteria. 20 cases of intercondylar fractures of distal humerus were treated with two, 3.5 mm precontoured anatomical plates/reconstruction plate (group I) and 26 cases of intercondylar fractures of distal humerus were treated with plate in one column and tension band wiring in other column (group II) using transolecrenon approach. For functional evaluation we used DASH and Jupitor&s elbow score.

Results: With mean follow-up of 9.91 months, the average DASH was 20.16±15.6 in group I and 18.79±13.5 in group II. According to jupitor&s grading system, results were excellent in 2 patients; good in 10 patients; fair in 7 patients; poor in 1 patient in group I, whereas in group II - excellent in 3 patients, good in 14 patients, fair in 7 patients, poor in 2 patient, with mean range of motion 114.83±9.60° (range, 90-130°) in group I. In group II, the range of motion was 115.75±10.17° (range 85-130°) in follow up at 6 months.

Conclusion: Stable fixation allows early, active and aggressive postoperative mobilization. Both of the method of internal fixation provide rigid fixation to allow early physiotherapy and no statistically significant difference were identified between functional outcomes of two methods

Proximal femoral fractures may be subdivided into intracapsular and extracapsular. Two types of implants had been used for the surgical fixation of proximal femoral fractures are intramedullary nails (kuntscher, PFN etc) and extramedullary implants (e.g. the sliding hip screw). In our study we compared the results of intramedullary nails with extramedullary implants for proximal femoral fractures (extracapsular) in adults. Out of 40 patients with proximal femoral fractures, 15 were treated by intramedullary nails while 25 were treated by extramedullary plates. Fixation of proximal femoral fractures with the intramedullary nails were significantly stronger and more rigid than that with the extramedullary screw plate devices. The intramedullary nail insertion requires less operative time and thus less intraoperative complications (anesthetic complications, blood loss etc). Owing to significantly stronger and rigid fixation and less operative time with intramedullary nails in comparison with extramedullary plates, an intramedullary nail appears superior for proximal femoral fractures. Further studies are required to determine if different types of implants produce similar results, or if specific implants have advantages for selected fracture types (e.g. intertrochanteric, subtrochanteric or basicervical femoral fractures).

Background: Infected non union of long bone in post operative cases is a chronic and debilitating disorder. Release of antibiotic from the bone cement at high concentration prevent bacterial growth , biofilm formation and its penetration to surrounding tissue, including cortical and cancellous bone prompted the use of antibiotic cement in control of bone infection.

Aim and objectives: The aim of this study is to summarize our experience with the use of antibiotic cement impregnated intramedullary nail (ACIIN) for control of infection and to achieve union in post operative infected non union of long bones. ACIIN was used in all patients after adequate debridement. Infection control was judged on the basis of clinical, radiological and hematological parameters. All patients were followed up with an average follow up of 18 months. The mean duration of retention of intramedullary nail was 11.4 weeks.

Results: Infection controlled in 17 patients as primary procedure. Union achieved in 4 patients without any need of secondary procedure. Union achieved in 15 patients after exchange nailing and bone grafting.

Conclusion: ACIIN are useful for infection control in infected non union of long bones.

Objective: To evaluate the results and functional outcomes of Double Angle Barrel Plate fixation along with valgus osteotomy and non-vascularised fibular grafting in old cases of fracture neck of femur

Methods: A total of 36 patients with more than 3 weeks old injury and less than 60 years of age were enrolled in the study. Out of 36 patients 4 were lost in subsequent follow-up, 32 patients of old and neglected intracapsular femoral neck fractures were treated with valgus osteotomy with double angle barrel plate with strut fibular grafting. Patients were followed up for 8 months to 2 years (mean 1.1 years). Evaluation of patients consisted of both clinical and radiological examination. The functional outcome was assessed on the basis of modified Harris Hip Score.

Results: The results were excellent in 12 patients, good in 8 patients and poor in 10 patients (according to modified Harris Hip Score) and in 2 patients non-union occurred due to fulminent infection finally managed with girdle stone arthroplasty.

Conclusion: Repositioning valgus osteotomy and internal fixation by double angle barrel plate along with non-vascularised fibular strut grafting is an effective procedure in neglected fracture neck femur in young adults.

Background: Several systemic factors, including Vitamin D may actively participate in the regulation of calcium homeostasis and bone metabolism and also thought to regulate the fracture healing process.

Objectives: To analyze the early change in serum vitamin-D level and its correlation with fracture healing outcomes.

Patients and Methods: This prospective cohort study included of 57 patients with simple diaphyseal tibial fractures in the institutional trauma centre between Feburary 2011 to November 2013. The serum vitamin D levelwas assessed at the end of 1^st week and at the end of the third week of injury. By the clinico-radiological evaluation, the patients into 2 groups - normal union and impaired union and further correlated with vitamin-D level. All statistical analyses of any change in serum vitamin D level were performed using the SPSS software.

Results: Out of 57 patients, analysis of 43patients were done as 14 patients were excluded because of vitamin D deficiency. In total (N=43) patients, the mean serum levels of vitamin D at the end of the 1st and third week were 37.36 ng/mL and 29.75ng/mL respectively, which is significant. Also, patients with normal union (N=31), the mean serum levels of vitamin D at the end of the 1st and third week were 36.17 ng/mL and 24.38 ng/mL respectively, which also significant. However, patients with impaired union (N=12), the mean serum levels of vitamin D at the end of the 1st and third week were 35.85 ng/ml and 30.05 ng/ml respectively, which is statistically insignificant.

Conclusions: Change in serum vitamin D levels suggests that vitamin D plays a vital role in fracture healing and its outcomes.

Background: Various treatment modalities for herniated disc include conservative management, minimally invasive procedures and surgical management. Minimally invasive treatments aim for chemical, mechanical or thermal methods to decompress and/or reduce the inflammation around the nerve roots. The present study was done to evaluate the effectiveness of oxygen-ozone injection in treating lumbar disc herniation and its role in pain alleviation as well as improving the pain associated disability.

Material & Methods: A consecutive series of 60 patients with lumbar disc herniation who satisfied the inclusion criteria and did not respond to conservative management were treated with oxygen-ozone mixture injected percutaneously in the affected disc under fluoroscopic guidance. Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) were recorded before the treatment and at 3 weeks, 6 weeks, 3 months and 6 months after the treatment with a single session of ozone - oxygen mixture and the scores were compared at the end of the study.

Results: Out of total sixty patients included in the study, two patients could not be followed up for at least 6 months. Out of the remaining fifty eight patients, five patients had to undergo surgery and nine patients had to undergo alternative medical treatment and physical therapy due to unsatisfactory relief of their symptoms. The reduction in the mean VAS scores and mean ODI scores at 3 weeks, 6 weeks, 3 months and 6 months was found to be statistically significant at p<0.0001. The overall success rate at the end of the study at 6 months follow up was 73.33%. Complication was observed in one patient (1.7%)

Conclusion: Intradiscal Ozone-Oxygen administration is an effective, safe, cost effective and minimally invasive treatment modality in treating patients having symptoms due to lumbar disc herniation.

Displaced tibial spine fracture, being intra-articular and associated with disruption of ACL complex, requires fixation in order to maintain the knee kinematics. Method of fixation of the fracture has shifted from open to arthroscopic assisted. Deficit of a few degrees of movement is a noted complication of this injury due to arthrofibrosis, which often requires arthrolysis. We are presenting a case of a 12 year old male patient with type III tibial spine fracture who underwent arthroscopic assisted fixation using a 7 mm cannulated cancellous screw. Functional outcome was excellent.

An unusual pattern of trochanteric fracture involving ipsilateral posterior hip joint dislocation in a young patient who sustained injury following fall from roof (height) is described. There are few cases of similar type of fracture-dislocation involving hip region described in literature. However, mechanism of injury and controversies regarding management, surgical approach and fixation has been a subject of discussion. In our case, after fixation of previous injury, patient again sustained injury and presented with a fracture at subtrochanteric region.

Fibular hemimelia (FH) is a rare long bones disorder; with incidence of 5.7 to 20 cases per 1 million births. It may occur as an isolated anomaly or as a part of a malformation syndrome. It consists of a spectrum of anomalies, the least severe being mild fibular shortening and the most severe being total absence of the fibula associated with defects in the foot, tibia, and femur. Here, we are reporting a case of fibular hemimelia and presenting a brief review of literature.

Autosomal dominant chondrodysplasia (Conradi-Hunermann disease) is a type of an uncommon inherited group of disorder that is chondrodysplasia punctata. It is characterized by stippled calcification in epiphyseal region. This is due to defect in peroxisomal function and manifest as asymmetrical limb shortening, facial dysmorphism, and mental retardation. It can be diagnosed by clinical and radiological features. Here, we are reporting a case of four week old female infant with features suggestive of Conradi-Hunermann disease, with brief review of literature.

Giant cell tumor 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 epiphysio-metaphyseal ends of long bones. It rarely involves small bones of hand and foot. Among the tarsal bones it involves the talus and calcaneum commonly.

Here we report a case of 23 year old male patient who had complaints of pain and swelling over dorsum of foot for last 5 months. Plain radiograph and histopathology confirmed the diagnosis of giant cell tumor. Intralesional curettage and autogeneous bone grafting from iliac crest was done. After 3 months of follow up, patient was able to walk, bearing full weight on the affected limb, without any pain.

Chondroblastoma is a benign bone tumor of the immature skeleton seen in the epiphysis. We report a case of chondroblastoma of distal femur in a young child associated with inflammatory synovitis of the knee joint mimicking an infective process.

Shoulder dislocations are mostly the anterior and can be easily reduced by manipulation under anaesthesia. However, the shoulder dislocation that is missed or neglected for a long time becomes a difficult surgical problem and a rare entity. We report a case of neglected dislocation of shoulder associated with greater tuberosity fracture without neurological involvement in a 37 years old patient, which was treated satisfactorily by open reduction.

Extraskeletal Ewing's sarcoma (EES) is the sarcoma originating from tissues other than bone, and is constituted by primitive small round cells with piece or lobular distribution. It is rare and rapidly growing malignant round cell tumour that arises from soft tissues anywhere in the body. Diagnosis usually confirmed on histopathological examination with immunohistochemistry. Recommended treatment for EES is chemotherapy with surgical resection and radiotherapy. Hereby, we are reporting a 25-years-old female who presented to us with swelling of left distal thigh and diagnosed as a case of Extraskeletal Ewing's sarcoma.

Split notochord syndrome (SNS) is an extremely rare disorder. This syndrome usually involves vertebral column, central nervous system and gastrointestinal tract. This report presents the case of a male infant with SNS associated with lumbar meningomyelocele, a prolapsed loop of bowel just below the meningomyelocele and imperforate anus.

The authors describe an unusual case of a large aneurysmal bone cyst (ABC) in the left iliac bone, occurring in 12-year old child. The patient presented with 5-year history of painless swelling in left iliac region with recent pain and change in size. Plain radiograph and MRI showed large, expansile, multiloculated lytic lesion with evidence of multiple air fluid levels. FNAC and biopsy was performed and diagnosis of aneurysmal bone cyst was confirmed.

Giant cell tumor of tendon sheath (GCTTS) is a rare, solitary benign soft tissue tumor which may arise in the tendon sheath tissues of the hand and wrist as well as the ankle and foot. These masses occur most commonly along the volar aspect of the hand and fingers and more commonly adjacent to the DIP joint. The clinical differential diagnosis may include foreign body granuloma, necrobiotic granuloma, tendinous xanthoma, fibroma of the tendon sheath, infection, ganglion cyst, rheumatoid nodule, epidermoid cyst, lipoma, and a knuckle pad, among other less common entities. Thus there is often a diagnostic dilemma. These tumours are treated by complete, meticulous excision of the entire lesion. Intralesional margins are acceptable, as long as complete excision is not compromised. Recurrence has been reported in up to 45% of cases, but with careful removal, recurrence can be reduced to 10 to 20%.Thus differential diagnosis of GCTTS should always be considered in such clinical scenario for proper management. We report a case of a GCTTS in the dorsolateral aspect of base of left thumb in a 42 yrs. female which was first treated as a ganglion of the hand and later the diagnosis of GCTTS was recognized and managed accordingly.