Background and Objectives: Tibia is a superficial long bone, with one third of its surface being subcutaneous. An increasing incidence of road traffic accidents, farm accidents, gunshot wound predisposes it for open fracture. Open fractures of the tibia are the most common open long bone fractures. High-energy trauma is the primary mechanism of injury, with over 50% of cases being attributed to road traffic accidents are frequently contaminated. The treatment of open tibia fractures is still controversial. This prospective study was conducted at a tertiary care trauma center to evaluate the functional outcome and complications following primary debridement and nailing in type I to type IIIA open tibia fractures. Materials and Methods: A total of 30 patients diagnosed with open tibial diaphyseal fractures, who underwent primary debridement and fixation with intramedullary interlocking nail were included in the study and type III B, type III C open fractures were excluded. Patients were followed for a period of 12 months and assessed using Modified Ketenjian criteria and Johner − Wruhs' criteria. Results: Out of 30 patients who underwent primary nailing for open tibia fractures, 66.67% had excellent, 26, 67% good, and 6.66% of patients had fair results. 93.33% of the patients had union within 9 months and 6.66% of the cases had delayed union. Conclusion: Primary intramedullary interlocking nailing in open tibia fractures is a good treatment option, it aids early patient mobilization and early resume to work. It avoids multiple surgical procedures and promotes early fracture union.

Background: Although being debated for many years, the superiority of either posterior cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior-stabilized (PS) TKA remains controversial. Materials and Methods: We conducted a prospective study on 40 knee replacements which were undertaken at our hospital between July of 2020 and July of 2021 out of which in 30 patients the cruciate ligament was sacrificed and the posterior cruciate ligament was retained in 10 of the knees undergoing surgery. The inclusion criteria were patients of age more than 50 years, with osteoarthritis and rheumatoid arthritis and Kellgren and Lawrence Grade of 3 and 4. The posterior cruciate ligament was retained if it was structurally intact, fixed flexion deformity of <15° a varus or valgus deformity of <10°. The overall average knee score was 84.9 for posterior cruciate-sacrificing and 74.6 for the CR patients as compared to the preoperative score of 43.9 and 37.6. Functional Knee Score was 97.87 and 98.4 for the CS and CR groups, respectively. The preoperative Functional Knee Score was 37.1 and 37.8 in these groups. The WOMAC Score also showed a marked improvement from 67.7 to 24.6 and 27.4 for CS and CR, respectively. Results and Conclusions: Analyzing the total knee scores, the average Knee Society Score for the PS group was 84.90 and that of the CR group was 74.60 and statistical analysis revealed a significant difference in the P value in favor of cruciate-sacrificing prosthesis, signifying that cruciate-sacrificing prosthesis has better functional outcome. The WOMAC Score also showed a marked improvement. In the CS group, it was 24.6, and in the CR group, it was 27.4. Statistical analysis showed a highly significant difference in favor of cruciate-sacrificing prosthesis.

Introduction: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using an autogenous quadrupled hamstring graft has been the standard of surgical treatment in ACL-deficient knees, particularly in young athletic individuals. There are two widely used methods for graft fixation, namely aperture fixation and suspensory fixation. Material and Methods: This prospective randomized single blinded clinical study was carried out with enrollment of 70 patients (35 patients in each group) who underwent simple block randomization process. Group 1 has 35 patients treated with suspensory fixation technique and Group 2 has 35 patients treated with aperture fixation technique. Result: It is observed that there is a statistically significant difference between the mode of injury and diagnosis in suspensory method. In the majority of the cases, patients who got injury by road traffic accidents (RTA) was diagnosis by 15 (51.7%) ACL Grade 3 and 3 (60%) ACL Grade 4. It is observed that there is a statistically significant difference between the mode of injury and diagnosis in screw fixation. In the majority of the cases, patients who got injury by RTA was diagnosis by 1 (100%) ACL Grade 2, 15 (51.7%) ACL Grade 3, and 3 (60%) ACL Grade 4. Conclusion: Arthroscopy-assisted ACL reconstruction with quadrupled semitendinosus tendon autograft using endobutton and bioabsorbable interference screw is an excellent treatment option for ACL-deficient knees.

Introduction: Subtrochanteric fractures occur in a zone extending from the lesser trochanter to 5 cm distal to the lesser trochanter, however, extension into the intertrochanteric region is common. The deforming forces on both the proximal and distal segments are difficult to control due to peculiar muscle insertion to the proximal and distal fragments. This study aims to assess the effectiveness of Proximal Femoral Nailing (PFN) for the treatment of subtrochanteric fractures of femur. Materials and Methods: This is a prospective study of evaluation of results of 32 patients who sustained subtrochanteric femur fracture treated with PFN at our institute from June 2018 to May 2020. All the patients in this study were above 18 years of age including both genders. All closed fractures and open Grade 1 and 2 fractures according to Gustilo–Anderson classification were included. Results: In this study of 32 patients, the mean age was around 3^rd and 4^th decade of life and Road traffic accidents was the major cause of injury (high-velocity trauma). The average radiological union time was 15.9 weeks. In 2 (6.24%) patients, there was postoperative infection and 3 (9.36%) patients had broken implant and 1 (3.12%) patient had nonunion. According to Harris hip score, 29 (90.6%) patients showed excellent-to-good results. Conclusion: PFN is a closed intramedullary nailing procedure which achieves biological fracture fixation with minimal blood loss, preserving the fracture hematoma and thus aiding in healing of the fractures. It provides good axial as well as rotational stability.

Introduction: Femoral neck fractures are a common entity in elderly patients. This commonly occurs following trivial injury and the insult is compounded by osteoporosis in this age group. Cemented hemiarthroplasty is recommended by several studies and by several registries, due to low comorbidities compared to uncemented hemiarthroplasty. Significantly improved mobility scores, low pain scores make this a treatment of choice. Materials and Methods: This study included 108 patients who presented with fracture neck of the femur with an average age of 68.30 years and were operated with hemiarthroplasty by two consultant orthopedic surgeons in a standard operative setting over 5 years with modular bipolar prosthesis using lateral approach (Hardinge approach). Patients on follow-up were evaluated using Oxford Hip Score and Forgotten Joint Score. Results: The mean Oxford Hip Score was 39.46 suggestive of satisfactory joint function which may not require any further treatment. The mean Forgotten Joint Score was 83.46 suggestive of high degree of forgetting artificial joint. Conclusion: A very high Oxford Hip Scores and very high Forgotten Joint Scores after surgery suggests that the patients have retained or regained their independence and are doing good. This goes on to suggest that in spite of advancements in surgical techniques and implants for osteosynthesis, hemiarthroplasty done in indicated cases gives a good functional outcome and a lasting solution for these fractures.

Introduction: The purpose of this study was to evaluate the outcomes of surgical management of chondroblastoma in appendicular skeleton treated with curettage and reconstruction. Materials and Methods: This retrospective study included 40 patients of chondroblastoma treated with intralesional curettage and filling of defect with bone graft or bone graft substitute or bone cement. The patients were prospectively followed to consolidation of bone graft or bone graft substitute. The mean age of presentation was 14 years (13–32 years). There were 24 were male and 16 were female patients. The mean follow-up was 11 years (4–17 years). Results: The location of chondroblastoma was proximal tibia in 12 patients, distal femur in 14 patients, proximal femur in 8 patients, and proximal humerus in six patients. The physis was found open (8), closing (12), and closed (20) patients. The tumour was of Enneking grade of tumour was 1 in 22, II in 14 and III in 4 patients. The mean union time in bone graft group and bone graft substitute group 3 months and 4 months, respectively. There was local recurrence in six patients (3 in bone graft group and 2 in bone graft substitute group, 1 in bone cement group). The other complications were surgical site infection (two cases). The mean Musculoskeletal Tumor Society score in both groups was 27. Conclusion: Intralesional curettage provides excellent functional outcomes with preservation of adjacent joint mobility. The methods of reconstruction with bone graft, bone graft substitute, and bone cement provide optimal results, and the outcomes were comparable in all these groups.

Background: The aim of this study was to evaluate the mechanical properties of distal humerus fracture fixation using extra-articular distal humerus locking plate osteosynthesis. There are numerous types of plates used in this region and one among them is the extra-articular distal humerus locking plate. This anatomically precontoured plate is specifically designed for the fixation of extra-articular distal humerus fractures. Usually, distal humeral extra-articular fractures are often associated with complications. This study reports satisfactory outcomes with the usage of extra-articular plate osteosynthesis for extra-articular humerus fracture management. It has now become a choice of management in our center for the management of extra-articular distal humerus fractures because of its advantages. We evaluated the clinical and functional outcomes of treating these fractures. Materials and Methods: We studied 20 patients who underwent fixation over 2 years. Mayo Elbow Performance Score was used to analyze functional outcomes. The time for union, range of motion at shoulder and elbow, and secondary procedures were recorded in follow-up. Shoulder and elbow function was assessed using the Mayo Elbow Performance Score. Results: During the study of 20 cases of distal humerus fractures treated by extra-articular distal humerus locking plate. Majority (40%) of the study participants were in the age group of 18–30 years. The mean age group is 39.8 years. Among 20 patients, thirteen were males and seven were female patients showing a male preponderance. About 14 and 6 patients with the right and left sides were involved, respectively. Eighty-five percent of the fractures united within 16 weeks, whereas for three patients (15%), fracture united at 18 weeks. The mean average time to union is 15.2 weeks. Eighteen (90%) patients had excellent elbow movement. Two (10%) patients had elbow stiffness. This was reduced to 32 weeks. All the patients were mobilized on day 2 after surgery. Eighteen patients (90%) had excellent results. Fair results were observed in two patients.

Background: Fractures of the distal humerus continue to challenge surgeons due to their complex nature and the multiple options of fixation. The olecranon osteotomy approach is considered the gold standard, especially in those fractures with an intra-articular comminution, but is associated with complications. In selected cases, utilizing the triceps-on or paratricipital approach should allow adequate fixation while decreasing the incidence of complications. Methods: Patients with distal humerus fractures were treated with open reduction and internal fixation via the paratricipital approach. All patients were evaluated based on their preoperative and intraoperative parameters. Postoperative rehabilitation was implemented and the functional outcome was assessed based on the range of motion and Mayo Elbow Performance Score. Results: The current study encompassed thirty patients with a mean age of 47.5 years. AO/OTA C1 type fracture was encountered in 13 patients. The mean operative time was around 90 min. The mean elbow flexion at 2 months was 127.5°. Union was achieved in all patients, and one patient had surgical site infection. Conclusion: Metaphyseal and simple inter-articular fractures may be adequately visualized and managed with the above approach. Early rehabilitation allows faster return to normal function.

Aims: The aim of the study is to evaluate the functional and radiological outcome of total knee replacement for osteoarthritis knee with varus deformity, using medial parapatellar approach and posterior stabilized (PS) design. Settings and Design: This is a prospective observational study and nonprobability sampling technique. Materials and Methods: In this prospective study, 20 patients with osteoarthritis knee of Grades III and IV were selected according to Kellgren-Lawrence Grading system. In this study, we assess the functional outcome of total knee replacement using Knee Society Score and radiological outcome using radiographic alignment. The patients were regularly followed up for both functional and radiological outcome at 1^st, 3^rd, 6^th, 12^th, and 18 months and then yearly. Statistical Analysis Used: The collected data were analyzed by SPSS 20.00 using the Chi-square test. Results: Preoperatively, our overall mean Knee Clinical and Knee Functional Score was 30.9 and 36.45 which improved to 87.7 and 84 postoperatively with the significant P < 0.001. Our study shows that we have 80% of excellent and 15% good results following total knee replacement. Radiologically all patients have a near-normal radiographic alignment which in turn improves the functional outcome of the patients. Conclusion: Total knee replacement using nonconstrained, PS design and medial parapatellar approach gives functionally excellent pain relief, increased range of motion, restoration of normal function, low prevalence of patellofemoral complications, correction of varus and fixed flexion deformities, and restoration of normal mechanical alignment. Postoperatively, patients with near-normal radiographic alignment like femorotibial angle, posterior condylar offset, and posterior tibial slope have good functional outcome and faster rehabilitation. Correct positioning of the components axially and rotationally improve both the functional and radiological outcome. However, longer follow-up is needed to determine the long-term effect of Posterior Substitute Design.

In the olden days, clavicle fractures have been treated with conservative management like strapping and bed rest. Fractures of the clavicle are one of the most common injures of the human skeleton. This study was undertaken to observe the rate of union, functional outcome and complications of fracture middle third clavicle treated with open reduction and internal fixation (ORIF) with precontoured superior plate placement. Methods: A total of 30 patients were operated with anatomical precontoured plates from December 2018 to December 2020 and functional outcomes were assessed through 6 months. Results: A total of 30 patients were included in the study. There were 27 males and 3 females. The mean age of the patient in the ORIF group was 31.03 years (age between 20 and 50 years). The mean time to union was 15 weeks. In our study, none of the patients had nonunion, implant failure and infection. Four patients developed scar hypertrophy, Three patients developed hypoesthesia below the incision site and one patient developed screw loosening. Conclusion: It is possible to obtain a good fracture union, less soft tissue stripping and good patient satisfaction with superior plate placement for fracture middle third clavicle.