Background: Clubfoot is a developmental deformity stirring at ankle, sub-taloid, and metatarsal joints. This deformity includes three elements: the foot inversion; forefoot-adduction relative to the hindfoot; and equinus position. The need for this case study was to understand the effectiveness of various treatment/management programs. Methodology: The study was performed for relating the severity of congenital talipes equinovarus (CTEV) with the need of Achilles tendon tenotomy (ATT) in the management along with demographic parameters. Overall, 95 patients of both sexes having 159 clubfeet were included. Clinicodemographic data were recorded, and the severity of CTEV was analyzed (Pirani scoring). Patients only presented at the tertiary hospital King George’s Medical University (KGMU), Lucknow for the first time, were included in the study, were provided with the facilities including casting, taping, and in extreme scenarios were projected for surgical interventions. Cases who had already registered under the Rastriya Bal Swastha Karyakram (RBSK) program were projected to the non-government organization “CURE” within the O.P.D. of the Paediatric Orthopaedics Department, KGMU, Lucknow. Via “CURE” the treatment facilities offered to the cases were completely free. Result: The mean age of the included cases was 102.44 days. Out of the 95 included cases with 159 clubfeet, 67.37% were males, and 32.63% were females. The mean of the presenting Pirani score was 3.17, the mean of the pre-ATT Pirani score was 2.72, and the mean of the Pirani score at the completion of management was 0.043. From these 159 clubfeet, 73 feet were subjected to ATT, and the remaining 86 feet were managed via casts only. The mean duration of correction was 6.1 weeks, and the mean of the required number of casts was 4.68. The total relapse observed was 32.70%. These were further managed by re-casting 44.23% and re-ATT, along with re-casting 55.77%. We found that out of 95 cases, 70.53% were rural rest, and 29.47% were urban. Similarly, 64.21% were literate, and 35.79% were illiterate [Table 1] and [Table 2].{Table 1} {Table 2} Special Case Scenarios: The present clinical article is a type of an observational-descriptive case series, with the focus on two different but similar anomaly-based cases. The first case is based on the simple idiopathic CTEV; however, the second one represents the case of complex clubfoot, that s, the patient is suffering from the clubfoot along with other deformities as a secondary anomaly. Conclusion: Clubfoot is a genetic deformity targeting the lower limb, with an effectively high rate of incidence in live births.

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Introduction: The complications associated with open fracture make the task of a surgeon difficult and also increase the financial burden. Underlying bone is exposed to contaminating agents due to breakdown of the tissue barrier between the fracture zone and the environment. It leads to an increased risk of complications such as wound infections and nonunion. Materials and Methods: We performed a prospective observational study on 82 patients presenting with open fractures of long bones treated in the year 2019 in the Department of Orthopedics, Himalayan Institute of Medical Sciences. Patients presenting with long bone open fractures within 72 h from injury to the Emergency were included in the study. All patients were clinically and radiologically followed for a period of 6 weeks. Results: Of the 82 cases, 26 developed an infection (31.70%). Fracture classified as Type IIIa had the highest infection rate (50%), whereas Type 1 had the lowest infection rate (14.3%). Infection rate in patients presenting 24 h after injury was higher than those presenting within 24 h from injury but a significant association could not be established between infection rate and late presentation from injury. Enterococcus species were the most commonly identified organism in both intraop and postop swabs (31.57%). Discussion: Trauma patients can present with chest, abdomen, or head injury, which may require emergency intervention precludes early debridement for open fracture. In our study, no significant decrease in infection rate was observed in patients undergoing debridement within 6 h from injury. However, it was also observed that open fractures presenting 24 h after injury had a higher infection rate than those presenting before it, which is in accordance with previous literature. Organisms finally causing established infection in bone were isolated mostly from postop swabs and were gram negative, which further strengthens the fact that most infections are nosocomial in origin. Conclusion: This paper furnishes the literature by validating facts, theories, and guidelines given in the past to manage open fractures. The study has limitation that the numbers of patients presenting with open fractures were less, and especially patients having common risk factors such as diabetes and anemia due to which correlation with infection rate could not be assessed effectively.

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In the current time of coronavirus disease-2019 (COVID-19) pandemic, orthopedic procedures have been shelved and guidelines to establish the safety of medical professionals and patients are still evolving. Although sports injuries are not life threatening, a spectrum of these injuries requires urgent intervention. To ensure the safety of medical professionals and patients of sports injuries in COVID times, the following guidelines are suggested. Such surgery needs to be performed only in COVID-free facility (green zone). Patients from red zone and containment zone should be avoided. Young, fit individuals without medical comorbidities should be considered. Wherever possible, regional anesthesia should be used. As COVID virus is present in all body fluids, aerosol generation (coughing, sneezing, intubation, use of power instruments, and cautery) should be minimized. Operation theater (OT) should be fumigated on the prior night and ideally between the cases. The number of cases per OT should be kept under three to get adequate time in-between for sterilization. The ventilation setup of OT should be negative pressure in addition to positive pressure. If there are hindrances in setting up negative pressure, a simple exhaust can be added to the existing setup. The ventilation system should ideally provide more than 20 air changes per hour. During surgery, movement of doors of OT and OT personnel should be minimal so as to minimize the air turbulence and eddy current. This will reduce the risk of infection. Surgical team should wear personal protective equipment (PPE) and helmet hood to reduce the chances of respiratory droplet infection. The doffing of helmet and PPE should be done with utmost care and should be discarded in a chloro-derivate solution. The motorized drill used for surgical procedure should be used at low revolution per minute (RPM). Usage of sterile transparent polythene hood while irrigating during drilling and sequential drilling will help in minimizing aerosol generation. Spillage of arthroscopic fluid should be avoided at all times. These basic norms will minimize the chance of accidental spread of COVID.

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Aim: So far, several studies have been evaluated in foreign countries via Patient-Reported Outcomes Measurement Information System (PROMIS) initiatives. PROMIS is a research tool for the evaluation of orthopedic disorders and is preferred for short-term and long-term performance. Fractured patients face many problems during a hospital stay, such as unhygienic wards, staff’s behavior, no hospital support, and a lot of expenditure, which adversely affects their social and mental status. Therefore, the Patient-Reported Outcome Measures (PROMs) capture the health status of patients that making it a more important tool in the health-care evaluation. Thus, the study aimed to assess the level of depression anxiety and anger by measuring the T-score of the same in hospitalized fractured patients with other factors during a hospital stay. Purpose/Hypothesis: The purpose of this study was to examine the association between PROMIS depression anxiety and anger with the atmosphere of the hospital, fracture conditions, and demographics. We believe that these variables play an important role in the quality of life of patients after having fractures and that they had to remain in the hospital unexpectedly. Study Design: This was a cross-sectional pilot study among fractured patients based on hospital environment. Materials and Methods: PROM assessment tool was used to measure depression anxiety and anger domains having seven and five items categorized as mild, moderate, and severe based on T-score. Results: A total of 113 patient’s response was obtained. The mean age was 34.84 years. Seventy-two patients were male (63.71%) and 41 patients (32.28%) were female. The mean and standard deviation (SD) of PROM T-score depression, anxiety, and anger was 57.67 (13.60), 50.56(11.47), and 57.08 (15.49), respectively. PROMIS anger and PROMIS anxiety were significantly correlated in many factors. Depression and anxiety were correlated in male patients. Anger and anxiety were significant in patients facing hospital hygiene and no support from the hospital (P = 0.008 and 0.05). Conclusion: PROM is an emerging tool to diagnose the level of depression anxiety and anger the patient faces during the hospital stay. Demographical factors like nuclear family and reason for fracture also play a significant role in anger and anxiety. Hospital hygiene significantly plays an important role in depression anxiety and anger in fracture patients.

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Background: Metaphyseal fracture of distal femur and proximal tibia results from high-velocity road traffic accidents. Using minimally invasive plate osteosynthesis (MIPO), the complex fracture zone is left untouched and length, alignment, and rotation are restored. As the fracture site is not explored, the osteogenic tissues surrounding the fracture are well protected and their blood supply is well preserved. This accelerates fracture healing. Materials and Methods: Thirty-five patients within the span of 3 years underwent internal fixation of distal end femur and proximal tibia by locking compression plate (LCP) using MIPPO technique. All the patients were assessed using Johner–Wruhs’ criteria and lower extremity functional scale (LEFS). Results: The mean time of partial weight bearing in fractures of distal femur was 10.14 weeks and proximal tibia was 9.71 weeks, respectively. The mean time of full weight bearing in fractures of distal femur was 16 weeks and in proximal tibia was 15.28 weeks. The mean time of bone union in fractures of distal femur was 18.14 weeks and in proximal tibia it was 18.57 weeks. The overall average LEFS score comes out to be 67 out of 80 points. According to Johner Wruhs’ criteria, results were excellent in 14 (40%), good in 16 (45.7%), fair in 4 (11.4%), and poor in 1 patient. Conclusion: MIPO techniques represent a fascinating new armamentarium in fracture fixation, which is made easier with the LCP technology and the different available minimally invasive surgical instruments, which were developed to cause less additional damage to the soft tissue and the bone.

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Objective: The objective of this study was to evaluate the effectiveness of transforaminal epidural steroid injection (TFESI) using a preganglionic Kambin’s triangle approach for treating lumbar radiculopathy caused by nerve root compression due to lateral recess stenosis or posterolateral disc herniation. Materials and Methods: This prospective observational study was conducted between July 2018 and March 2021. A total of 70 patients were included in the study. However, 20 patients were lost to follow-up and 50 patients were followed up for 6 months post-injection. The epidural space was approached through the neuroforamen using 22-G spinal needles in 70 adult patients with lumbosacral radicular pain, and a mixture of 40 mg methylprednisolone and 0.25% plain bupivacaine (2 mL per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores, respectively, at the first visit, 3 months, and 6 months. Results: There was a mean reduction of 4.7 points in NPRS from a mean of 8.2 preinjection to 3.5 at 6 months follow-up (P = 0.001). Likewise, a mean ODI score of 29 was recorded at 6 months follow-up (mean reduction of 13.7 points in ODI score) as compared to 42.7 at baseline (P = 0.001). Conclusion: TFESIs provided significant pain relief and improved function in patients with low back pain with radiculopathy caused by nerve root compression due to intervertebral disc herniations.

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Background: Proximal tibial plateau involvement is one of the most common intra-articular fractures. Bicondylar fractures have both tibial plateaus fractures, usually with depressed fracture of lateral tibial plateaus, meniscal tears and anterior cruciate ligament avulsions. Internal fixation in bicondylar proximal tibia fractures using plating devices are usually done using lateral plate along with supplementary postero-medial plate (orthogonal plating) and lateral plate along with medial plate (parallel plating). Objectives: The comparison of functional and radiological outcomes. Materials and Methods: 60 cases of bicondylar tibia plateau fracture were included. Group A (orthogonal plating) were cases treated with orthogonal plating and Group B (parallel plating) were cases those treated with parallel plating. A clinic-radiological comparison of results of these two groups were done. Clinical evaluation for at least 6 months and radiographically for at least 1 year. Results: Our clinico-radiological result showed that knee range of motion (mean) (P = 0.002) and Hip-Knee-Ankle angle (HKA) were significantly better in group B while non-significant difference in Varus/valgus angulation, fracture union status, post-operative loss of reduction and residual articular surface depression, implant position and other surgery or implant related complications. Conclusions: Our mid-term results showed that treating above fractures with parallel plate resulted in better functional and radiological outcomes with an acceptable complication rate as compared to orthogonal plate

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