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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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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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Literature defines multiple noncontiguous vertebral injuries, as “injuries to the vertebral column involving ≥1 site, and these injuries are separated by an apparently normal area of the spine.” In the present article, we report an unusual case of two nonadjacent levels traumatic dislocation, involving the cervical spine managed through the posterior-only approach.

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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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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: 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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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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