The term "robot" describes a machine that carries out a variety of tasks either automatically or with a minimum of external impulse[l]. It is derived from a Polish word meaning "Forced labor". The use of robotics in the operation theatre is probably one of the major technological breakthroughs of the 20th century [2,3] . It was wayback in 1950s that the robot Unimate was discovered[4]. Robotic surgery systems are of two types: haptic and autonomous. Haptic also known as tactile systems is surgeon dependent and requires constant inputs from the surgeon to complete the procedure. Contrary to this, autonomous robotic systems requires surgeon to set up the machine first, but once engaged, there is no need of surgeon's help and the robot itself completes the surgery[5]. It was in the early 1990s that the robotic surgery first came into Orthopedic use, where it was used for planning of total hip replacements and optimal positioning of final implants[6]. Recently the use of robotics in Orthopedics has been extensive.

Background: With changing trends in the treatment of clavicle fractures, plating remains the standard procedure for fixation. An attracting alternative method of fixation is the titanium elastic nailing (TEN). We assessed the effectiveness of minimally invasive antegrade TEN and plating technique for the treatment of clavicle fractures. Materials and Methods: Hundred unilateral displaced clavicle fractures operated between July 2015 and August 2017 were included in the study. This prospective comparative study was approved by the local ethical committee. Follow-ups were at the 2nd and 6th weeks and subsequently at the 3, 6, and 12 months postoperatively. The primary outcome was measured by the Constant score, union rate, and difference in the clavicular length after fracture union. The secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results, and complications. Results: During analysis, we had 48 patients in the plate group and 42 patients in the TEN group. There was no significant difference in Constant scores between the two groups. However, faster fracture union (20.1 ± 2.47 weeks vs. 28 ± 4.56 weeks, respectively, P = 0.0003), lesser operative time (41.95 ± 13.08 min vs. 68.63 ± 14.90 min, respectively, P = 0.0001), lesser blood loss (73.48 ± 38.87 ml vs. 131.75 ± 43.36 ml, respectively, P = 0.0001), greater clavicle shortening (6.85 ± 4.16 mm vs. 3.04 ± 2.26 mm, respectively, P = 0.0003), easier implant removal, and fewer complications were noted in the TEN group. Conclusion: The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal, and fewer complications, although for comminuted fractures, plating remains the procedure of choice.

Introduction: Hip fractures have become an increasing health problem throughout the world due to an increase in the aging population [1]. Hip fracture leads to pain and immobilization with numerous complications ranging from delirium to functional loss and even death. Objective: The objective of the study was to study the morbidity and mortality associated with proximal femoral fractures with reference to fracture type (intracapsular and extracapsular) and identify the cause which increases the risk of mortality in postoperative period. Materials and Methods: All patients age more than 60 years of age who underwent surgery for proximal femur fractures from July 2015 to October 2017 at our tertiary care center were studied. A total of 120 patients (70 extracapsular and 50 intracapsular fractures) were included in the study. Patients were assessed at different intervals of follow-up. Mortality was assessed and identified the cause of mortality within 1 year treatment of the hip fracture. To measure the morbidity, we studied - mobility score, dependency on walking aids and degree of residual pain. Results and Observation: In intracapsular fractures mortality was at 1 month (6%) at 6 months (14%) and 1 year (16%) and compared to the extracapsular fractures at 1 month (7%) at 6 months (14%) and 1 year (20%). The most common cause of mortality in 1st year of post-operative period being a cardiovascular disease (41%), followed by respiratory disease (23%), hepatorenal disease (14%), surgical sepsis and cerebrovascular accidents (9% each), and other causes retrauma (4%). Reduction in mobility was observed both in intracapsular fracture (preoperatively 6.78 ± 1.47-5.57 ± 1.4 at 1 year) and extracapsular fracture (preoperatively 6.57 ± 1.41-5.50 ± 1.38 at 1 year). At 1 year, it was more in case of intracapsular fracture as compared to extracapsular fracture. Conclusion: During the 1st year of post-operative period mortality is higher in cases of extracapsular fracture in comparison to intracapsular fracture. Despite the fact that intracapsular fracture was mobilized early postoperatively, they are having less mobility at 1 year point of time, comorbidity such as cardiovascular disease respiratory disease hepatorenal disease, septicemia, and cerebrovascular accident being the major cause of death in there patient.

Background: Non-sterile tourniquets which are used repetitively on patients without cleaning may be a source of infection. Contamination of medical equipment including phlebotomy tourniquets [4, 5], stethoscopes [6], blood pressure cuffs [7], and auroscope earpieces [8] has been identified as a potential source of cross-infection between patients. Recent evidence has raised concern relating to contamination of tourniquets used in orthopedics [3], due to the potential for cross-infection, wound problems, and deep sepsis around implants. We planned a study to check and compare the bacterial contamination of tourniquet and surgical site infection (SSI) by routinely used repetitive non-sterile tourniquet and tourniquet treated with the isopropyl alcohol. Materials and Methods: A total of 400 patients between 20 and 50 years with the orthopedic condition requiring pneumatic tourniquet for lower limb surgeries were included in the study. We used only one pneumatic tourniquet, in the first 200 patients were used the non-treated tourniquet, and in other 200 patients, we used the same tourniquet treated with 70% isopropyl alcohol every time before surgery to avoid any bias due to different organism growth in the different tourniquet. Tourniquet was treated and prepared with 70% isopropyl alcohol swab wiped for 1 min and dried for 15 min from either side and wrapped in sterile paper and in rest 200 without isopropyl alcohol. A swab from tourniquet taken from four sites, two from either side were swiped and were taken for all cases before each case. Swab for culture from patients was taken on the 4th post-operative day when dressing was removed to see stitches or any discharge occurring within 30 days of operation. The swab was taken from over the stitch line or of any discharge from the wound. Results: Swab from over untreated tourniquet resulted in average colony-forming units 13. Swabs from overtreated tourniquet resulted in average colony forming 2. In patients with the untreated tourniquet, we found culture positive in nine patients of 200. In the treated group, only two patients of 200 were culture positive, with risk ratio is 4.5, percent relative effect is 350%, P = 0.032, and confidence interval level = 0.95. We have seen a significant reduction in Gram-negative infections in the second group. The amount of bacterial growth was turned from heavy (in Group 1) to moderate (in Group 2). Conclusions: We recommend the routine treatment of orthopedic tourniquets with a disinfectant 70% isopropyl alcohol swab wiped for 1 min and dried for 15 min from either side and wrapped in sterile paper significantly decreases orthopedic SSI.

Background: Tibial anterior cruciate ligament (ACL) avulsion fractures are a common injury in children and adolescents. Operative treatment is indicated for types 2, 3, and 4 fractures. Arthroscopic fixation is the preferred method, and numerous fixation options are described. The purpose of this study is to evaluate the results of a new technique of arthroscopic fixation. Methods: A retrospective study was done involving six patients having displaced ACL tibial avulsion fractures. The arthroscopic suture “bridge” pull-out technique was used to fix these fractures. Patient symptoms such as knee pain, locking, clicking, sensation of giving way and clinical signs such as tenderness, range of motion, McMurray’s test, stability test, and Lysholm knee scores were evaluated preoperatively and post-operatively at 3 months and 6 months. Patient satisfaction was noted at latest follow-up. Results: One patient had type 2, 4 patients had type 3, and 1 patient had type 4 tibial ACL avulsion fractures. All the fractures united, and all patients achieved full knee range of motion by 2.5-month post-operative. The clinical symptoms and signs improved postoperatively. The mean Lysholm knee score at 3-month follow-up was 91.4 and at 6-month follow-up were 98.2. At the latest follow up, all the patients were satisfied with their knee function. Conclusions: The arthroscopic suture “bridge” pull-out technique is an effective method for fixation of ACL tibial avulsion fractures with respect to knee stability, range of motion, and resumption of pre-injury activity level.

Introduction: Intra-articular fractures distal end radius poses a therapeutic challenge to the treating orthopedic surgeon. Volar Barton fractures are intra-articular distal end radius fractures with radiocarpal instability with an incidence of 1.2-4.2% among all distal end radius fractures. Conservative treatment of these fractures is associated with early osteoarthrosis, deformity, subluxation, and instability. Recent advances offering stable internal fixation have claimed to improve the treatment outcome of these fractures. The purpose of the present study is to assess clinicoradiological outcomes of volar locking compression plating for volar Barton fractures. Materials and Methods: In a retrospective study, 23 patients (M:F - 17:6) with mean age of 36.8 years with volar Barton fractures who were treated by open reduction and internal fixation using volar locking compression plate (LCP). The average follow-up period was 1 year. Final outcome assessment was based on modified Gartland and Werley criteria. Results: According to Gartland and Werley criteria of 23 patients, 11 (47.8%) had excellent results, 9 (39.1%) had good, 2 (8.7%) had fair while 1 (4.4%) had poor outcomes. Overall, satisfactory outcomes were seen in 86.9%. Conclusion: Open reduction and rigid internal fixation using volar LCPs in volar Barton fractures provides satisfactory functional outcomes in majority of cases.

A healthy shoulder is the most mobile joint in the human body. One of the most common causes of pain and disability of the shoulder is frozen shoulder. It significantly reduces the range of motion in every direction, thus severely disabling the use of the upper extremity. Recent studies have shown excellent results, both in terms of pain relief and range of motion gain, with arthroscopic release of adhesive capsulitis which is considered to be a reproducible method and enables better access to the entire joint capsule of the shoulder having low rates of complications, since the release is done by minimal access under direct vision. Arthroscopic capsular release was done in twenty patients, and its efficacy was evaluated in terms of change in the Constant-Murley Score (CMS) over a period of 6 months. The improvement in CMS is found to be statistically and clinically significant. The results were found to be favorable and comparable, as mentioned in literature.

Isolated traumatic anterior glenohumeral dislocation in children <10 years of age is rare with an incidence of only 1.6%. The close differential diagnoses include the relatively common atraumatic shoulder dislocation and pseudo dislocations as a result of traumatic proximal humeral epiphyseal separation. This paper presents an isolated case of traumatic anterior glenohumeral dislocation in a 2-year-old child with a discussion of differential diagnosis and brief review of relevant literature. Emergency department physicians should keep in mind that though rare shoulder dislocation can present even in very young children.