BACKGROUND: Instability of distal radioulnar joint (DRUJ) following distal radius fracture is a treatment enigma with few options and uncertain outcome. Different studies have been conducted in this regard which came out with contradicting results. The aim of this study was to analyze whether immobilization of unstable DRUJ with above-elbow cast for 6 weeks has any advantages versus immobilization for 3 weeks similarly after anatomical fixation with volar plates. MATERIALS AND METHOD: We conducted a prospective study on patients with unstable distal radius fractures treated by open reduction with volar buttress plate from 2013 to 2016. Patients were grouped into Groups 1 and 2 depending on the postoperative immobilization protocol (each group with 21 patients). Group 1 patients were immobilized with above-elbow cast for 3 weeks and Group 2 patients for 6 weeks. Results were compared using wrist range of movements, patient-oriented Patient-Rated Wrist Evaluation (PRWE) and physician-based Sarmiento modified Gartland–Werley (GW) demerit scoring. All patients were evaluated for the persistence of DRUJ instability. RESULTS: Demographic data were comparable between the groups. AO type C fracture (67%) was common in both groups. The range of movements was comparable in both groups (P > 0.11). There was no statistically significant difference found in GW and PRWE scoring (P > 0.05). There were two patients with unstable DRUJ with decreased radial height and positive ulnar variance who needed further treatment. CONCLUSION: Prolonged immobilization (6 weeks) contributed no extra benefit when DRUJ is well reduced with anatomical fracture fixation. The instability recovered with healing of ligamentous injuries and fractures after stabilization of unstable bony fragments with surgical fixation of distal radius fracture.

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BACKGROUND: Fracture fixation accounts for majority of orthopedic surgical interventions with most procedures requiring variety of instruments as part of surgical armamentarium. Breakage of instruments during the operation is unwanted experience and may complicate or lengthen the procedure thus interfering with overall outcome. A study regarding the pattern of intraoperative instrument failures is thus important to gain fruitful insights for not only preventive strategies but for further studies in this context. MATERIALS AND METHODS: A retrospective study of all consecutive incidents of instrument breakage during a 2-year period (January 2017 to December 2019) were recorded with relevant details such as type of surgery, type of implant, type of instrument and the probable cause, management and key demographic details during 2-year period at a tertiary care center in North India. Knowledge about the risk factors was tried to be extracted from our observations. RESULTS: Out of a total 8132 elective major and minor cases during the study period, 30 (0.36%) cases of intraoperative instrument breakage were noted. The types of instrument broken in the descending order with numbers in the bracket were drill bits (5), guidewires (3), manual intramedullary reamers (3), periosteal elevator (3), screwdriver tip, and bone tap in two cases each. The power-driven flexible reamer, screwdriver tip, screwdriver handle, proximal jig for the intramedullary nail, bone nibbler, and bone lever were another instruments with singular incidents. In the general instruments, long artery forceps (4) was the most common to break followed by mosquito forceps (3) and one nose-plier in separate cases. Conclusion: The breakage of surgical and non-implant instruments during the operation is uncommon event but requires proper documentation and due acknowledgement for prohibitive and management guidelines.

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Technological advancements are rapidly changing the face of medical science in terms of knowledge sharing. It therefore becomes essential for medical professionals to remain up to date with recent trends and innovations in the field. Especially in India, this is even truer as the country is striving to foster the development of innovative tools and strategies to improve health outcomes in the country. It is therefore complementary to its other training initiatives to ensure medical professionals have access to avenues to disseminate their research, discuss their work, and network with peers. Continued medical education (CME) in the form of seminars and conferences is a good opportunity for sharing and discussing new insights and networking with peers and can be considered as scientific meetings. CMEs have been the backbone for spreading the knowledge and means to get updated regarding the innovations and treatment strategies. With the growing situation of COVID-19 pandemic that has glorified the need for “Social Distancing,” the idea of conduct of these in-person activities is farfetched. Also with the economy hitting the new low, the prohibitive traveling costs and increased logistics, it is not always feasible to organize and attend numerous regular seminars. In an increasingly interconnected world brought about by technological advancements in communications, other alternatives can be used to supplement the in-person experience. Webinar can serve as an important link for conducting CME in the era of “Social distancing.” Here, we review the webinars in orthopedics and spine surgery – its standard operating procedure and its future directions.

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Intramuscular hemangioma of the forearm (cavernous subtype) with phlebolith is less common in literature and only available as case report. Treatment protocol of intramuscular hemangioma is not established in literature due to sparsely available cases. Here, we discuss the case report with treatment regimen.

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Myositis ossificans traumatica is a non-neoplastic proliferation of bone and cartilage tissue at the site of a previous injury. Osteomylitis of Myositis Ossificans Traumatica mass is even rarer and literature review show that this is only the second case reported till now. A 61 years old male presented to our outpatient department with main complaints of discharging sinus left leg for 7 months. Clinical provisional diagnosis of chronic osteomyelitis of left leg was made. Standard radiograph shows a large mass around the middle and lower third of left leg with osteomyelitic changes in the lower third. Magnetic Resonance Imaging confirm the diagnosis as Infectious Myositis mass. The patient got operated with complete excision of myositis mass and infected tissue. Post operative follow up shows complete healing with no recurrence. Osteomyelitis of myositis ossificans can be a possible differential diagnosis of chronic discharging sinus in cases were there is associated myositis mass adjacent to the lesion. Prompt diagnosis along with excision removal of mass and infected tissue should be the treatment to avoid recurrence.

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Superior Labrum From Anterior to Posterior (SLAP) lesions refer to a tear of the superior portion of the glenoid labrum that begins posteriorly and extends anteriorly to the mid-glenoid notch. Patients who sustain traumatic injuries to the shoulder girdle and also who undergo repetitive, overhead motions are at risk for SLAP lesions. Among the various types of SLAP lesions, type 2 lesion is the most common lesion encountered and is defined by 'superior labral fraying with stripping of the superior part of the labrum and attached biceps tendon from the underlying glenoid cartilage”. In superior labrum anterior and posterior (SLAP) tears, a common concern for patients is being able to return to their previous levels of activity after surgery, whereas clinicians are concerned with providing a consistent prognosis of successful return to participation after surgery. Thus, return to play (RTP) and patient satisfaction can be used as a vital measure of treatment success which has been evaluated by significantly fewer studies, especially in isolated type 2 SLAP repairs. The published outcomes of surgical treatment are inconsistent, with variable and suboptimal patient satisfaction rates and RTP. Thus, we wanted to address and reevaluate the current treatment, rehabilitation protocols, and outcome following arthroscopic repairs in order to expand the knowledge and give further insight into providing better management plan in these patients. This study used a systematic review of papers reporting arthroscopic treatment of isolated type 2 SLAP lesions with the main objective in trying to assess the effectiveness of arthroscopic repair, to determine patient satisfaction and RTP at previous level of activity, and to analyze the rehabilitation protocols being followed among all athletes who underwent repair of type 2 SLAP tears using various types of fixation.

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INTRODUCTION: Distal humerus fractures in adults comprise 2% of all fractures and 30% of all humeral fractures. Intra-articular distal humerus fractures account for 37% and involve both medial and lateral columns. Most of the distal humeral fractures in adults must be treated surgically to get better functional outcome. The aim of this study was to assess the efficacy, technical requirements, functional outcome, radiological and clinical union, and complications of distal humerus fractures treated with bicolumnar plating. MATERIALS AND METHODS: This was a prospective study of 35 cases of distal humerus fractures conducted at a tertiary care hospital, who were treated surgically with bicolumnar plating using posterior approach with transolecranon osteotomy between 2016 and 2018. The Mayo Elbow Performance Score was used for the assessment of functional outcome. RESULTS: Thirteen (37.14%) patients got excellent outcome, 17 (48.58%) got good outcome, 4 (11.42%) got fair outcome, and 1 (2.86%) got poor outcome, and the complications observed were infections, nonunion, implant failure, and elbow stiffness. Distal end radius fracture was the common association with distal humerus fracture in our study. CONCLUSION: Open reduction and internal fixation with bicolumnar plating is the treatment of choice for distal humerus fracture mainly in type B and C fractures. Fracture types, use of locking plates, stable fixation, and meticulous repair of soft tissues along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion, and prevents stiffness.

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BACKGROUND: Bio-mechanical studies have shown volar locking compression plates (LCPs) to have higher rigidity and stability as compared to traditional plates, but lacunae exists with regard to the use of 2.7-mm volar LCP. AIMS: The aim was to prospectively assess the postoperative functional and radiological outcomes in a 2.7-mm fixed-angle volar LCP , to analyze factors influencing the functional and radiological outcomes, and to correlate patient's perception of recovery with the radiological outcome. SETTINGS AND DESIGN: This was a descriptive study with a prospective longitudinal study design conducted at a tertiary care hospital. MATERIALS AND METHODS: Thirty patients who underwent fixation of distal radius fracture with a 2.7-mm fixed-angle buttress-type volar LCP were followed up for functional and radiological outcomes at 6 weeks, 3 months, and 6 months after surgery using standardized scoring systems. STATISTICAL ANALYSIS: Descriptive statistics was used for statistical analysis. RESULTS: Use of 2.7-mm fixed-angle volar LCP was found to have good to excellent functional and radiological outcome in majority of the cases. A significant correlation existed between the functional and radiographic outcome. Patient-rated wrist evaluation had a significant inverse correlation with the radiological outcome. We did not find any significant association of the functional or radiological outcome with age, sex, dominance of the injured hand, and the fracture type. The fracture reduction achieved in the immediate postoperative period was maintained throughout the follow-up duration. CONCLUSION: This study effectively demonstrates the optimal results in terms of postoperative functional and radiological outcomes with the use of 2.7-mm volar locking plate for distal radius fracture fixation.

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The purpose of this case report is to describe an unusual cause of compartment syndrome of the foot that developed subsequent to the use of Graston technique in a patient who had recently underwent revision total hip arthroplasty (THA). A 60-year-old female presented for orthopedic follow-up care in the office, 10 days postoperatively following an explant of her right hip Prostalac^® spacer (DePuy) for previous infection and conversion to right THA (DePuy CORAIL^® Hip System) complaining of severe right foot pain, swelling with pressure in foot, paresthesia, and inability to bear weight. The patient had undergone Graston technique for bilateral foot swelling by her home physical therapist. The patient was clinically diagnosed with acute compartment syndrome (ACS) of her right foot and underwent intervention. The treatment consisted of acute fasciotomy of her right foot with vacuum-assisted closure application. Delayed closure was initiated once soft-tissue decompression occurred. Due to acute fasciotomy, ambulation was inhibited and physical therapy delayed. The postoperative course was uneventful following the release of tense compartments, weight bearing was resumed once incisions healed, and the patient was pain free while deep-venous thrombus prophylaxis was continued. No further issues occurred postoperatively, and the patient showed overall clinical improvement. Residual soft swelling can be expected following hip surgery, especially at the caudal end of limbs. Immobilization enhances this engorgement. However, due to the aggressive Graston technique performed by the therapist, the patient developed ACS of the foot. Graston technique has been documented to increase blood flow to treated areas. Early and aggressive intervention should be initiated if ACS is clinically or objectively found, as late detection may have disastrous results.

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BACKGROUND: The treatment for spinal tuberculosis (TB) remains a difficult and challenging decision-making process, given the lack of evidence and guidelines on the optimal treatment and management strategies. Conservative treatment options for spinal TB include methods such as immobilization using body casts or plaster beds, as well as a healthy diet. MATERIALS AND METHODS: The records of 26 patients who underwent posterior stabilization with pedicle screws and decompression with laminectomy for thoraco-lumbar TB with associated neurological deficit between January 2015 and December 2019 from hospitals were reviewed. The patients were followed up for a minimum of 24 months. In this study, we did not include patients with HIV co-infection. Results: In the present study, total 26 patients with thoraco-lumbar (T12-L1) TB. The study group consisted of 11 male and 15 female patients. The preoperative and postoperative mean kyphotic Cobb's angle were 23.1± 2.9° in males and 26.4 ± 2.4° in females and 8.9± 1.3° in males and 8.1± 1.4° females in the present study, respectively. At 1-year follow-up, the mean kyphotic angle was 11.2± 2.2° with a mean loss of kyphotic correction by 4.9± 1.1° in male. In our study, the C-reactive protein level decreased when compared preoperatively and postoperatively, 14.26 ± 1.8 in preoperatively, and 8.26 ± 1.2 postoperatively. Similarly, ESR value also decreased from 38.2 ± 2.3 mm to 21.6 ± 2.8. In addition, visual analog scale also decreased from 7.42 ± 1.1 to 2.9 ± 0.9. Conclusions: The procedure of one stage posterior debridement, decompression, and transpedicular screw fixation is effective and safe for treating thoracic and lumbar spinal TB.

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INTRODUCTION: Nonunion is one of the most common complications of fracture healing. The incidence of nonunion is believed to vary from 5% to 10%. AIM: The aim of the research is to study the risk factors affecting nonunion of fractures and analyze the treatment taken, and it is bearing on nonunion. MATERIALS AND METHODS: The study is a cross-sectional observational study with purposive sampling done in the orthopedic department. A total of 71 patients were selected, and a questionnaire was filled in with data obtained from the patient and medical records. Radiological evidence was also used to confirm the nonunion. RESULTS: The sample included 48 men and 23 women. Of the females, 21 had attained menopause (91%). About 58% of the patients had taken treatment from Traditional Bone Setters (TBS), and 49% of the patients first went to a TBS before coming to the allopathic physician for fracture treatment. About 45% of the patients had a very short duration of immobilization of their fractures. A history of previous malignancy, bone cyst, or other illnesses lead to a longer time for recovery and return to work (P = 0.0339). Patients who had infected fractures had a significantly more number of surgeries than those without infection (P = 0.015). Nonsteroidal anti-inflammatory drugs use during treatment of fracture was also associated with nonunion (P = 0.0077), especially in allopathic medicine. CONCLUSION: Nonunion continues to be a significant problem for all orthopedic surgeons despite their best ability to prevent them. A complete examination of the patient with relevant investigations and selection of the most suitable and appropriate treatment for each individual should be carried out; since each person is unique, and every fracture is not alike.

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BACKGROUND: Osteoarthritis (OA) is a degenerative disease of synovial joints; recently, it is also termed osteoarthrosis. High-molecular-weight hyaluronic acid (HA) has a better increase in fluid retention within the joint and stronger anti-inflammatory effect. OBJECTIVES: The objective was to assess the efficacy of intra-articular (IA) HA in primary OA of knee joint based on clinical outcome with visual analog score (VAS) and the Western Ontario and McMaster Universities OA Index (WOMAC) score and to determine the safety of IA HA in primary OA of knee joint. SUBJECTS AND METHODS: A single-group, prospective interventional study was conducted from November 2017 to May 2019 in a tertiary care hospital. A total of 36 patients with Grades I and II of Kellegren–Lawrence radiological grading were included in the study. IA injection of HA was given to these patients and were assessed using VAS and WOMAC scores. RESULTS: The mean VAS scores improved from preinjection score of 9.03 ± 0.94 to 2.61 ± 2.15 at 6-month follow-up. In addition, the mean WOMAC scores improved from 81.14 ± 6.43 to 35.81 ± 13.44 at 6-month post-IA HA injection. CONCLUSIONS: This study observed that IA injection of HA is a reliable, productive, efficient, and safe mode of treatment of Grade I and II OA knee, which also delays the disease and reduces the need for surgical intervention.

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OBJECTIVES: The objective is to know the prevalence of median nerve compression and determine the relationship of median nerve compression with wheelchair (WC)-associated parameters. MATERIALS AND METHODS: A cross-sectional study was carried out from December 2016 to September 2018, where a total of 50 patients of either sex, aged 20–70 years, with spinal cord injury (D2 or below) who were independent manual WC ambulators (for >6 months) were included. The detailed demography, clinical details, and the wheel ergonomics (height of the shoulder from the axle of WC, weight of the WC) were noted. Ultrasonography of the bilateral median nerve was done at three levels to determine the median nerve thickness. The data were entered into the MS EXCEL spreadsheet, and analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 21.0. A value of P < 0.05 was considered statistically significant. RESULTS: Median nerve compression was present in 12 (24%) patients who had significantly more weight of WC (kg) (19.42 ± 2.02 vs. 18.74 ± 7.38, P = 0.023); comparable mean duration of WC use (months) (31 ± 21.78 vs. 20.9 ± 20.02, P = 0.114); and comparable height between shoulder and axle of WC (inches) (28.17 ± 2.86 vs. 27.16 ± 2.32, P = 0.188). A significant positive correlation was seen between height from the shoulder to axle of WC (inches) and cross-sectional area (CS) of median nerve at carpal tunnel inlet (r = 0.517, P = 0.0001). CONCLUSION: The height of the axle with respect to the shoulder is important to limit the stress on the wrist to the minimum, thus preventing the median nerve compression.

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BACKGROUND: Acromioclavicular (AC) joint dislocation is most frequently encountered in contact sports and is far more common in males. Grade-III AC dislocation involves complete loss of contact between the clavicle and acromion secondary to the total disruption of both the AC and coracoclavicular ligaments, with loss of vertical and horizontal stability, respectively. The use of hook plate on open reduction and internal fixation of the AC joint dislocation had a little adverse effect on shoulder function and is an effective method for the treatment of AC joint dislocation. Hence, this retrospective study was carried out to assess the clinical and functional outcome of AC joint injuries treated with hook plate. AIM: The aim of this study is to assess and document the clinical and functional outcome of AC joint dislocation with or without lateral end clavicle fracture treated with hook plate. MATERIALS AND METHODS: This retrospective study of patients with Rockwood Type III AC joint disruption (dislocation) who were treated in our hospital. During the period from July 2013 to July 2018, a total of 33 patients with Type III AC joint disruption with or without associated lateral end clavicle fractures were included in this study, with 26 males and 7 females. The functional outcome was assessed using the CONSTANT scoring system during follow-up after hook plate fixation at 4 weeks, 3 months, 6 months, and 12 months. RESULTS: Thirty three patients with AC joint disruption were participated in the study after meeting the inclusion and exclusion criteria. There were 26 males (78.8%) and 7 females (21.2%) with a mean age of 44.7 years, eight patients had an associated lateral end clavicle fracture. All the patients were fixed with hook plate were followed up for a period of 1 year postoperatively. The mean Constant score improved progressively from a preoperative score of 44.5 to postoperative score of 68.3 at 4 weeks, 77.9 at 3 months, 89.4 at 6 months, and 93.3 at 12 months. CONCLUSIONS: In the current study, we conclude that the surgical and functional outcomes after AC joint stabilization with or without lateral end clavicle fractures using hook plate fixation yield satisfactory results. The hook plate also provides good horizontal, rotational, and vertical stability. Furthermore, the maintenance of reduction by the hook plate was significantly superior compared to the other modes of treatment. The hook plate also facilitates early mobilization and prevents stiffness of the shoulder joint.

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BACKGROUND: Chronic lower back pain is a chronic pain syndrome in the lower back region lasting for ≥12 weeks with the most common cause being intervertebral disc herniation. Epidural steroid injection is the most widely accepted treatment modality of all the surgical and non surgical methods at various sites such as translaminar, caudal, and transforaminal. It is ideal to start transforaminal epidural steroid injection (TFESI) early as chronic neural compression leads to irreversible changes in neural anatomy, which leads to a less favorable outcome. AIMS AND OBJECTIVES: To study the effectiveness of TFESI in chronic disc pain with radiculopathy in terms of duration of relief. MATERIALS AND METHODS: This is a retrospective study involving 50 patients with chronic disc pain who underwent fluoroscopic guidance TFESI in the year 2018 at Saveetha medical college. These patients are those who were administered TFESI under fluoroscopic guidance using 2ml of 40mg of Methylprednisolone with 1 ml of 2% xylocaine. Their initial pre injection and current pain scores were assessed using a visual analog scale (VAS score) by recording the medical history and follow-up, respectively. RESULTS: The most common level of involvement was L4/L5 (80%). The mean difference in VAS score was 3.14. The standard deviation of the mean difference in VAS score (σ) is 1.38. The mean duration of relief is 2.5 months. Around 14% (7 patients) did not have any relief in pain after the procedure. Around 76% of the patients were willing to recommend the procedure to others with a similar problem. Two individuals underwent surgery following the procedure, which suggests a failure of the procedure. CONCLUSION: TFESI is a very useful procedure for significant pain reduction in chronic disc pain involving a single level. In addition to corticosteroids, lignocaine is very useful in reducing local inflammation and pain due to its “washout effect.” Hence, TFESI with postoperative strengthening exercises is beneficial for short-term pain relief.

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BACKGROUND: Osteoarthritis (OA) involves a progressive degeneration of the articular cartilage, remodeling of the subchondral bone, and synovitis. It typically affects diarthrodial (synovial) joints including the knee joints. Obesity, which represents a body mass index (BMI) of ≥30, has been linked to OA of the knee joint. A biomechanical theory which infers that repetitive application of axial loading at the knee joint is the mechanism through which obesity causes OA has long been put forward. However, metabolic factors (adipokines) may yet be a link between OA and obesity. AIM AND OBJECTIVES: This study was performed to establish if there is a correlation between serum leptin and radiological severity of OA of the knee joint in obese individuals. MATERIALS AND METHODS: This was a prospective study carried out after ethical clearance was obtained from the hospital's ethical committee. Written informed consent was obtained from all prospectively recruited participants. Patients who met the inclusion criteria were selected by random sampling into either the obese or nonobese group based on their BMI. The patients were radiographically evaluated, and data were collected using a well-designed and structured pro forma. 5 ml of blood was collected from each patient for the analysis of serum leptin level. RESULTS: A total of 100 patients were included into this study. Fifty of these patients were obese (BMI ≥30), whereas the other fifty were nonobese (BMI <30). The peak age of the occurrence of knee OA was 61–70 years. The mean serum leptin level in obese patients was 20.11 ng/ml, as opposed to that in nonobese patients of 4.88 ng/ml. The radiological severity was analyzed, and there was a positive correlation between serum leptin level and radiological severity in OA of the knee joint. A higher percentage of females in this study were obese (71%) as opposed to males (29%), and females had statistically significantly higher leptin levels when compared to males. CONCLUSION AND RECOMMENDATION: From the results of this study, it is concluded that there is a correlation between serum leptin levels and radiological severity of OA of the knee joint in obese patients.

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BACKGROUND: Bones are exposed to different injuries as well as chronic diseases, which can affect the health of them. Different variables affect healing method, as timing, quality, recurrence, and long-term effect. METHODOLOGY: This article is adopting the qualitative method as it is reviewing other researches; it is a scientific survey which is demonstrating the bullet points of each research, such as conclusions, methods, obstacles, and other future studies. RESULTS: The effect was found to be very promising as a quality of osteoblast and timing of healing with precipitating effects among long and short terms. DISCUSSION: The main objective of this study is to introduce the role of implants and grafts in orthopedic. The interventions are made based on the knowledge of the physiology of the bones, their injuries, and the response of the body toward it. Different metals were studied to be used in the implants, and advantages of their use were found. In addition to developing grafts from different tissues such as animal tissue, platelets, and others. CONCLUSION: It can be concluded from the previous studies that future interventions can be made from using different materials to develop grafts and implants which shall aid in the healing process.

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Osteoid osteoma is a small, benign, painful tumor. Its size is the main distinguishing feature between osteoid osteoma and osteoblastoma and varies between 1.5 and 2 cm. Computed tomography (CT) is usually the best technique for imaging osteoid osteoma because the tomographic nature of the images makes it easy to visualize a lucent nidus, among the surrounding dense bone sclerosis. Vascular supply of osteoid osteoma tumor and nidus are well described. A new CT finding that is vascular groove sign is highly sensitive and specific for osteoid osteoma. It was found that most of this sign was seen in the long bones with very few in the flat bones and only one case of vascular groove sign in the body of the vertebra. A 15-year-old girl presented to us with complaints of lower back pain of 15 months; Pain was a dull-aching type which subsides by nonsteroidal anti-inflammatory drugs and reappears in the middle of the night. She was evaluated and diagnosed to have osteoid osteoma on CT scan with typical vascular groove sign in the vertebral body of L5, which is not mentioned in the literature to the best of our knowledge. Vascular groove sign is highly sensitive and specific for the diagnosis of osteoid osteoma by CT scan; this sign is mentioned mostly in the long bones with only one case in the lamina of the vertebra. We report a case with vascular grove sign in osteoid osteoma of the vertebral body of L5.

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Lipoma arborescens (LA) is a rare clinical condition presenting mostly as an intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of sub synovial fat. We report a case of a multifocal LA localized in the knees and the hips in a 20-year-old man symptoms being present for the last 3 years and initially mimicking an inflammatory arthropathy. On physical examination a discreet joint swelling of the left knee with effusion, and limited movements in the left hip were observed. Laboratory tests presented normal acute phase reactants of inflammation as well as the rheumatoid factor, CK, and negative results for antinuclear and anti-CCP (ELISA) antibodies. Magnetic resonance imaging of the knees and hips showed articular effusion and synovitis, and a pattern of LA. The histopathologic study confirmed the diagnosis. Arthroscopic synovectomy for the knee and open synovectomy for the hip brought some improvement to joint mobility and pain.Although rare, this condition must be differentiated from inflammatory arthropathy, particularly in the absence of response to clinical treatment, and absence of positive biochemical markers, since the therapeutic strategy is radically different.

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INTRODUCTION: Orthopedic infections have been a major complication; despite numerous advances in prophylactic measures, infections still remain a major complication in orthopedic and trauma surgery. The progressive infection of the bone and the surrounding tissue results in bone infarcts with abscess and sequestrum formation. Adequate treatment can be an implant removal and a radical debridement with a long-term course of systemic antibiotic, but these prolonged therapies can result in side effects or toxicity. The primary reason for using local antibiotic delivery vehicles is its ability to achieve high local concentrations without associated systemic toxicity. MATERIALS AND METHODS: This is a prospective study conducted over 2 years. Thirty-five patients were studies in which 33 patients were managed with calcium sulfate + antibiotic, 1 was managed prophylactically with beads, and one was managed with Abgel + antibiotic as a biodegradable carrier. The aim was to evaluate the efficacy of biodegradable materials as antimicrobial carriers in localized orthopedic infection. OBSERVATIONS: A prospective study consists of 35 cases of orthopedic infections with major number of patients belonged to the age group of 20–40 years, with a mean 37.66 ± 19.9 years. One patient was included with soft tissue infection and rest all the patients had bone infections. It was observed that there is statistically significant improvement in ASEPSIS score at 0 week to ASEPSIS score at the end of 9 weeks. CONCLUSION: In the present study, the patients showed evidence of excellent control of infection and osseous repair, and further, none of the patients required follow-up. In our series, we have used calcium sulfate as a biodegradable antimicrobial carrier with appropriate antibiotics and achieved good-to-excellent results in local orthopedic infections.

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BACKGROUND: Hand injuries are often overlooked and are not given the importance that they deserve. Decision-making in the management of phalangeal fractures is crucial rather more difficult than long bone fractures; as no treatment will lead to deformity and over treatment will cause stiffness. AIM OF THE STUDY: Compare the results of both conservative and operative managements of proximal phalangeal fractures for decision making while dealing with these innocent looking injuries. SUBJECTS AND METHODS: This was a prospective study of 60 patients of unstable extra articular proximal phalangeal fractures over 2 years. Fifty percent of the patients managed conservatively and 50% surgically. Results were analyzed by the assessment of total range of movements (TROM); functional score of Belesky et al.; grip strength; time of return to work and complications associated with each methods. RESULTS: There was no statistically significant difference between conservative and operative group (TROM P 0.063; Belesky score P = 0.135). Among all modalities best results was achieved with Close Reduction and Internal Fixation (CRIF) with percutaneous k wires which was statistically and clinically significant as compared to conservative and Open Reduction and Internal Fixation (ORIF) group (TROM P = 0.012; Belesky score P = 0.024]. Complications were mostly malunion with conservative methods and infection; implant failure; CRPS were more common in operative methods. CONCLUSION: Conservative management is preferred over surgery for unstable proximal phalangeal fractures. If surgery is needed for stability than close reduction (CRIF) with percutaneous k wire is preferred over open techniques (ORIF).

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Osteoporotic vertebral compression fractures (OVCF) are one of the most common fractures seen in a day-to-day practice. We present a unique case of failure of pedicle screw instrumentation in OVCF revised by sublaminar wiring (SLW). A 70-year-old female with old operated osteoporotic fracture with the sagittal imbalance and implant loosening was revised with a single spinal rectangular loop and sublaminar wires (SLW). Pedicle screw constructs for short-segment fixation are rigid and biomechanically superior with the greatest pull-out strength, which mainly depends on the bone mineral density. However, sublaminar wires should be considered far more superior in severely osteoporotic bone.

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