Background: The paediatric flat feet are diagnosed on an OPD basis or during screening school campus. Early and correct diagnosis is vital for proper treatment of this condition. This study was conducted to validate the arch index measured by podogram as an indicator of presence of flat foot over the observational diagnosis made of this condition. Method & Material: 68 children as case and 100 children as control were studied. Plantar arch index was calculated by taking weight bearing podogram on OPD basis. All data were noted and analysed. Observations & Results: The difference between the average values of arch indices in cases with both clinical and podogram positive parameters for flat foot (61) and those with clinical deformity with normal range of arch index value (7), was statistically significant (p< .05). Conclusion: The study validated arch index as an indicator of flat foot.

[ABSTRACT]   Full text not available  [PDF]

Background: DEXA is considered Gold standard for diagnosis of osteoporosis but is costly and not available everywhere. Singh’s index is a simple method but controversial. A study was done to compare both methods. Method: Radiographic assessment of Singh’s index and DEXA were done in 70 patients. Radiographs were assessed by four observers and the results compared. The mean femoral BMD measured by DEXA ranged from 0.536 gm/cm² to 1.163 gm/cm². We correlated the mean femoral BMD with Singh index grading by an observer with highest strength of intra-observer agreement. Results: There was positive correlation between Singh index and bone mineral density measured by DEXA. The sensitivity and specificity of the Singh index method in diagnosing osteoporosis were 55.56% and 93.44% respectively, denoting Singh index method of diagnosing osteoporosis has low sensitivity but relatively high specificity. The percentage of variance of BMD explained by Singh index was 23.58%. Conclusion: We conclude that Singh’s index is a good method for diagnosing osteoporosis in general population. DEXA can be reserved for severe cases.

[ABSTRACT]   Full text not available  [PDF]

Full text not available  [PDF]

Background : The conservative method with ponseti technique is now the gold standard for the treatment of clubfoot. The objective is to give the patient functional, pain free, plantigrade foot, without callosities and no need for special foot ware. Overall efficacy of the ponseti technique approach nearly 90-95% in most of the studies. But its efficacy in different age group in children less than 1 year of age is not determined. The purpose of this study is to see the efficacy of the ponseti technique in children of different age group below one year. Material and methods : It is the level I study of 100 patients with 158 feet below one year of age. The patients were further divided into three groups 0 to less than 1 month of age, 1 month to less than 6 month of age, 6 month to 1 year of age. Clinical assessment of the foot was according to grading system of the Dimeglio et al. Percutaneous tenotomy to correct equinus were performed in feet which did not reach neutral position. This is followed by bracing with Denis Brown Splint for continuous period for 3 months, followed by the night time bracing till three years of age. Results : We achieved good results in 96.3% clubfeet in the age group of 0 to < 1 month, 96% in 1 month to < 6 months, 93.4% in 6 months to 1 year with overall success rate of 95.6%. Relapse was more common in old age group patients, 4.4% of club feet had relapse in age group 6 months-1 year as compared to 2% in 1 month to 6 months and 0% in 0-1 month. Conclusion : Ponseti is the efficacious way to correct the clubfoot deformity in all the age groups less than 1 year of age but the early intervention and the use of elastic property of the ligaments decreases the number of cast applications and need for tenotomy.

[ABSTRACT]   Full text not available  [PDF]

The aim of this study is to evaluate the objective and subjective outcome after fixation of displaced metacarpal fractures with mini fragment implant system. We prospectively evaluated 22 patients (16 males and 6 females) with 23 closed metacarpal fractures. The patients were followed up for 3 months. The objective assessment included Range of Motion, Total Active Motion and Sensory function of the involved digit. Functional outcome was evaluated using the Michigan Hand Outcome Questionnaire at the end of 3 months. At the end of 3 months, the average Range of Motion of the involved digit was 252° (Range 226°-270°), average Total Active Motion was 88.6% (Range 78-100%) with 87% patients reporting no sensory loss in the digit. The Michigan Hand Outcome scores for mean Overall Hand Function was 80.4% (Range 70 -92%), mean Activities of Daily Living was 80.5% (Range 58-90%), mean Work % was 75.3% (Range 62-84%), mean Aesthetics score was 82.2% (Range 60-100%), mean Satisfaction score was 88.9% (range 60-90%). Complications like minor extensor lag, delayed union and malunion were noted in 26% of fractures. The results of this procedure are highly encouraging. This modality of treatment can certainly be advocated for treatment of such fractures to prevent prolonged immobilization, unsightly malunions or impaired hand function.

[ABSTRACT]   Full text not available  [PDF]

Background: The floating shoulder is defined as ipsilateral fractures of the midshaft clavicle and the neck of the scapula, although ligamentous injuries are also considered in it, While acceptable results can be expected with non-operative management of minimally-displaced fractures, displacement at one or both sites is best managed with surgical reduction and fixation. Methods: It is a prospective study of 25 patients of floating shoulder. Follow up ranges from 24 to 36 (average 30) months. Thirteen patients were managed conservatively and twelve operatively. Patients were followed up clinically and radio logically at regular interval and the clinical outcome including glenopolar angle was measured. Results: Shoulder stiffness was the main complication found in our patients. Patients in the surgical group had better results than the conservative group. No significant change was observed in Glenopolar angle before and after clavicular fixation. Road traffic accident was the most common cause of floating shoulder injury in our series. Conclusion: Fixation of the clavicle alone in floating shoulder gives excellent results and provides better clinical outcome and quality of life compared to conservatively managed patients, with early mobilization and return to activity. Level Of Evidence - Treatment study level III

[ABSTRACT]   Full text not available  [PDF]

We treated 18 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Four fractures were open, and sixteen patients had complex injuries were treated by ligamentotaxis and percutaneous fixation, by limited open reduction and four by extensive open reduction. Patients were followed from 4 months to 18 months. All the fractures united, with an average period of 14.38 weeks. Ten patients achieved full extension and fourteen patients achieved more than 110° of flexion of knee. Sixteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except one. Two cases have pin track infection. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis. Thirteen patients had excellent result, four cases were good at the end of follow up. Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated because of trauma to the soft tissue, and bony comminution with without minimal bone loss.

[ABSTRACT]   Full text not available  [PDF]

The study was conducted on 21 fractures of lower end of femur treated by precontoured distal femoral locking compression plate. Most of patients had fracture following RTA predominantly on right side. 15 cases were simple fresh #, 2 compound # & 4 of implant failure. We preferred MIPPO over open technique since to reduce periosteal damage. Bone grafting with/without CHA block was done in 6 cases (4 of implant failure & 2 compound #).Quadriceps and knee flexion-extension exercises were started post operatively as early as patient was able to tolerate pain. Average union time was 17 weeks (range: 10 weeks - 28 weeks). Range of follow up was 7-22 months. Maximum knee flexion achieved in extraarticular # was 110 -140 degrees & with intraarticular extension was 100 - 120 degrees. 1 case of grade-ll compound comminuted # & 1 simple comminuted # end up with shortening of 2 cm and varus deformity of 10 degrees, while 2 cases of previous implant failure now treated by DF-LCP & bone grafting had shortening of 1-1.5 cm. 11 had very good, 6 had good, 3 had fair & 1 had poor result.

[ABSTRACT]   Full text not available  [PDF]

Surgical fixation of intertrochanteric femur fractures remains the standard of care. Proximal femoral nails have been introduced relatively recently but have begun to compete the traditional DHS. Problems related to peri- implant fracture about first-generation short intramedullary nails used for intertrochanteric fracture have, at the very least, been significantly improved by new designs. One such redesigned implant is the ultra-short PFN or Traffon nail. The mechanical strength of the nail and less invasive procedure have made the procedure preferable. We performed a prospective study on 19 patients of intertrochanteric fractures treated by Traffon nail in last two years. We compared functional outcome, rehabilitation, and complication rates of patients who underwent fixation with Traffon nail. The post-operative course was favourable and patients could start early mobilisation & rehabilitation. A careful surgical approach and technique with a stable osteosynthesis have markedly contributed to a more rapid mobilisation of a patient and, thus, to the decrease of post-operative complications. The operating time was found to be short, less blood loss was seen during surgery and few early complications were noted. A radiological assessment was done with serial X-rays. All cases were relatively free from long term complications. Traffon nail is a suitable implant for intertrochanteric femoral fractures needing open reduction internal fixation. It has low per operative and post operative morbidity.

[ABSTRACT]   Full text not available  [PDF]

Background: Clubfoot has been an unsolved clinical challenge for the orthopaedic surgeons. lt is one of the commonest congenital deformities in children. More than 100,000 babies are born worldwide each year with congenital clubfoot. Around 80% of the cases occur in developing nations. Methods: 53 feet [mean Pirani score (total) 5.57] in 40 children were treated by the Ponseti method from June 2006 to December 2009. A prospective follow-up for a mean duration of 19.5 months (range 6–30 months) was undertaken. Evaluation of the deformity by Pirani score and goniometry was performed, before and after the treatment and the results were assessed through Wilcoxon signed rank test. Results & Conclusion: The average number of casts applied before full correction was 4.9. The duration of casts for more than 85% feet was <7 weeks. 95% patients needed tenotomy before full correction. There was a significant difference in the pre-treatment and the post-treatment Pirani score and goniometry values. Ponseti method of manipulation and plaster casting is very effective in correcting clubfoot deformity. It is especially important in developing countries and well-trained physicians and health personnel can manage the cases effectively by manipulation and cast application.

[ABSTRACT]   Full text not available  [PDF]

We studied twenty two patients having posttraumatic internal derangement of either Rt or Lt knee the clinical diagnosis of internal derangement of knee was made and patients were subjected to MRI. The clinical and MRI findings were correlated with arthroscopic observation the strength of correlation between MRI and arthroscopic finding confirms the value of MRI in assessing internal knee structures. Out of twenty two clinical cases two cases were not similar with MRI finding partially or totally however skilled clinical examination rates similar to MRI, where as modern imaging technique can be invaluable in diagnosis and competent and preferably repeated serial physical examination can sometimes play the same role. Out of twenty two clinical cases only in six cases clinical and arthroscopic diagnosis differed to some extent. The accuracy of MRI scan in medial meniscal lesion is higher than for other structures of the knee joint. As we do not recommend the routine use of MRI scan to confirm diagnosis as the positive predictive value of the scan is low for all lesion. In two cases MRI and arthroscopic finding were not similar. In the presence of positive clinical sign we would recommend diagnostic arthroscopy in place of MRI and the same sitting management of lesion for cost effectiveness should be done to avoid second surgical procedure.

[ABSTRACT]   Full text not available  [PDF]

Full text not available  [PDF]