Introduction: Incidence of fracture in acetabulum is rising and requires anatomical reduction and fixation for proper functioning hip joint. Earlier majority of such fractures were treated conservatively with occasional satisfactory results. Its surgical management is technically demanding but is evolving fast. Material and Methods: Eighteen surgically managed patients in last 2 years were included in the study. On admission, patients were stabilized first the associated dislocation was reduced and maintained on traction. Surgery was planned as soon as general condition permitted after radiological evaluation. Surgical approach depends upon site and pattern of fracture. Postoperative radiological results were assigned according to the criteria described by Matta (Matta JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996;78:1632-45) and functional results were evaluated using Merle d'Aubigne and Postel's system modified by Matta et al. (Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum: A retrospective analysis. Clin Orthop Relat Res 1986;230-40) after a minimum 6-month follow-up. Results: According to the Merle d'Aubigne and Postel scoring system modified by Matta, the clinical outcome was excellent in 9 cases (50%), good in 5 cases (27.7%), fair in 3 cases (16.6%), and poor in 1 case (5.5%). In our series, the overall incidence of sciatic nerve palsy was seen in 2 cases (11%), and other nerve damage was not seen. In our study, all patients received mechanical prophylaxis, and just one patient developed pulmonary embolism. This is in concordance with result of an Indian study. (Shrestha D, Dhoju D, Shrestha R, Sharma V. Acetabular fracture: Retrospective analysis of thirty three consecutive cases with operative management. Kathmandu Univ Med J (KUMJ) 2014;12:279-87.) In our study, deep infection was seen in one case, i.e., 5.5%, and two cases (i.e., 11%) had superficial infection. Conclusion: Nowadays open reduction internal fixation is the gold standard for the displaced acetabulum fractures. A good-to-excellent functional outcome was seen in more than 60% of the patients and a good-to-excellent radiological outcome was seen in more than 50% of the patients treated surgically.

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Introduction: Platelet-rich plasma (PRP) is promoted nowadays as an ideal autologous biological blood-derived product. It enhances wound healing, bone healing, tendon healing and is currently being widely used. Aims and Objectives: A prospective cohort study was conducted to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in the treatment of plantar fasciitis (PF). Materials and Methods: Fifty patients were included in the study and divided into two groups. Group I (25 patients) received PRP injection and Group II (25 patients) were given steroid injection. Patients were clinically assessed at different intervals. Functional outcome was evaluated on the basis of the visual analog scale (VAS) and foot and ankle ability measure (FAAM) scores. Plantar fascia thickness was assessed pre- and post-injection by ultrasound. Results: PRP and corticosteroid injection groups at the initial visit had VAS score of 8.86 and 8.60, respectively, which was reduced to 1.52 and 3.10 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.2 and 30.8, respectively, which increased to 84.2 and 68.3 at the end of 6 months. After injection, the PRP group had a significant reduction (34.80%) in the thickness of plantar fascia as compared to corticosteroid group (29.54%). Conclusion: Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up.

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Background: Tibial plateau fractures are complex injuries produced by high- or low-energy trauma and principally affect young adults. In view of the ever-increasing high-velocity road traffic accidents, there is an increase in complex, multifragmentary periarticular fractures of the tibia. The goal of proximal tibial fracture treatment is to obtain the early union of fracture in the most acceptable anatomical position with the early and maximum functional return of activity. The use of more modern implants with locking screws and precontoured locking plates provides better stability and may further improve outcome. In this regard, this study was undertaken to study the functional outcome and radiological outcome of closed proximal tibial fracture Schatzker's type I, II, and III treated with variable angle-locking compression plate (VA-LCP). Methods: A hospital-based prospective study was undertaken among the 54 adult patients with closed proximal tibial fracture Schatzker's type I, II, and III requiring surgical intervention and treated by VA-LCP. A predesigned, self-administered pro forma was designed to keep the objectives of the study at the center point. The patients were categorized based on their relevant age, gender, fracture type, and complications. Qualitative data were represented in the form of frequency and percentage. The final outcome was obtained using modified Rasmussen clinical and radiological score as well as the total healing period of the subjects followed up for a period of 24 weeks. All care and caution were exercised while utilizing the patient data for the current research as outlined in the hospital guidelines pertaining to the usage of patient data for this study, and confidentiality was maintained throughout. Results: The maximum study population belonged to the age group of 50–59 years, which comprised about 44.5%. 26 (48.2%) of the tibial fractures were diagnosed to have Schatzker's type II fractures followed by 15 (27.7%) type III and 13 (24.1%) type I. Group I (30–39 years) showed faster healing with a mean healing period of 18.6 ± 1.9 weeks, followed by Group II (40–49 years) with a mean healing period of 19.6 ± 4.1. Mechanical failure (7, 12.9%) and some secondary complications (12, 22.2%) were also observed during follow-up in the outpatient department. At the end of follow-up, 35 patients (64.8%) had excellent clinical result, 19 (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 29 patients (53.8%) with excellent, 18 (33.3%) with good, 7 (12.9%) with fair, while none with poor results. Conclusion: Treatment of proximal tibial fractures is challenging because of limited soft tissue cover and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a VA-LCP should be considered as an option in tibial plateau fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.

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Coccydynia is disabling painful condition resulting from various factors and often not given serious importance. The chronic or recurrent pain affects activities of daily living and overall quality of life. Not only it is a poorly understood disorder with newer findings related to its anatomy, radiology, and the management periodically supplementing the medical literature but also it is managed in casual manner in clinical settings. There are various treatment options in both conservative and operative methods of its treatment and knowledge of which is important for its optimal management. A relevant topical review of recent advances on its management is presented here as handy guide for busy practitioners.

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Undisplaced distal end radius fracture is traditionally managed with conservative treatment, that is, closed reduction and immobilization. This approach has excellent result in undisplaced distal radial fractures and in displaced fractures where stable reduction can be achieved after closed reduction. Subjective results of conservative treatment are as good as the results of operative treatment in patients aged > 65 years at 1-year follow-up. Closed reduction is done mainly with two methods – direct reduction by manipulation and by ligamentotaxis. Immobilization is done mainly by a cylindrical plaster cast. Immobilization of the wrist in neutral radial-ulnar deviation and neutral or slight extension is recommended. Rehabilitation is a very important part of conservative treatment and is started from the day of the first visit in the form of mobilization of adjacent joints and limb elevation. The goal of rehabilitation is to achieve maximum range of motion and strength in the extremity with good fracture healing.

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The role of ultrasonic bone scalpel (UBS) in the field of spine surgery is well known. There are numerous studies in the literature advocating its use where bone cutting in the form of laminectomy, laminotomy, foraminotomy, or vertebral body resection is required. Its principal advantage is the relative sparing of the soft tissues. The literature mentioning the complications and technical difficulties of UBS use is scarce and scanty. We report a unique complication encountered during its use and discuss some of the technical difficulties which need to be addressed with the aim and intent to caution the surgeons regarding its proper use. While performing laminectomy we encountered a unique complication of breakage of the blade of UBS. Although well-known for greater accuracy, reduced bleeding, reduced operative time, and en bloc removal of the bone as compared to traditional bone cutting devices even then it has to be used with great caution, and there is a learning curve of the technique which needs to be mastered.

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Hip dislocation is a serious injury which most commonly presents as posterior dislocation. Inferior dislocation is a rare event with a few anecdotal case reports or series described in the literature. This has also been called luxatio erecta of the hip borrowing from similar affliction at shoulder. We report five cases of luxatio erecta of the hip managed by reduction and conservative care in all but one. All five cases were males (mean age 31.8 years, range 18–52 year) with three cases being isolated injuries, whereas associated fracture of ipsilateral superior ramus and shaft femur was found in two separate cases. All were managed conservatively following closed reduction, except the case with shaft femur that was managed by additional operative fixation following the reduction of hip. The results were excellent in all cases without radiological evidence of avascular necrosis during the mean follow-up of 7.6 months (range 4–10 months).

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Aims: Medial compartment arthritis is very common in the Asian population because of a preponderance of varus knees. High tibial osteotomy and total knee replacement are technically demanding procedures, while proximal fibular osteotomy (PFO) significantly relieves pain and improves joint function in knee osteoarthritis (OA). This retrospective study was conducted at Patna Medical College and Hospital. The objective of this study was to assess functional outcomes after PFO and its correlation with bone mineral density. Settings and Design: The study design was a retrospective study. Subjects and Methods: Twenty patients with unicompartmental OA with varus deformity were included in the study. Inclusion criteria included patients with moderate-to-severe symptomatic medial unicompartmental OA of the knee, who had an indication for a surgical procedure, and who were able to give informed consent for the surgery. Exclusion criteria included patients with posttraumatic knee OA or inflammatory joint disease and patients with a history of previous operations or fractures the primary outcome was measured by calculating the ratio of knee joint space. The secondary outcome measure was pain measured by the visual analog scale (VAS). Statistical Analysis Used: Statistical analysis was performed by measurement of study variable. Results: Immediate postoperative pain relieved was noticed in all twenty patients. While at 1-, 3-, and 6-month follow-up, pain relieved was noticed maximum in osteoporotic group patients (n = 12). At 9-month follow-up, pain relieved was noticed equally in all patients. Radiographs of the weight-bearing lower extremity showed an average increase in the medial knee joint space postoperatively compared with preoperatively. The ratio of the knee joint space (medial/lateral compartment) improved significantly from 0.50 ± 0.30 preoperatively to 0.58 ± 0.28 postoperatively. Conclusions: PFO is a simple, safe, fast, and affordable surgery to relieve pain and improve joint function and the medial joint space in knee osteoarthritis, particularly in osteoporotic individuals.

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Introduction: Trauma is the major cause of death and disability in developing country, is responsible for more years of life lost than most human diseases. This study aims to establish the value of a trauma registry by measuring, monitoring, and analyzing etiological factors of common musculoskeletal injuries caused due to several forms of trauma. Materials and Methods: This study has been conducted retrospectively. The patients attending the emergency department in tertiary care hospital were included in this study. Personal data and pattern of injuries sustained were extracted from the casualty admission register of emergency department and trauma unit, case records, and operation records. Results: A total of 6574 injured patients were seen in the emergency department. The most common injury was bony injury (65.38%, n = 4298) and soft-tissue injury 34.62% (n = 2276) and the most common sites were lower limbs in 41.39% of cases, amputation/crush injury in 7.82%, and 32.03% of cases (n = 1377) were of compound fractures. The most common soft-tissue injury was lacerated wound 45.21%. Most commonly associated injury was the head injury in 5.53% of cases. Maximum cases were in the age group of 30-59. Conclusion: Fractures were the most common pattern of injuries frequently associated with other injuries, especially head injuries, particular age group, and time period need special attention, and we need more such institutes near highways.

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Introduction: Giant cell tumors around the knee joint are the most common aggressive benign tumors. Several limb sparing and limb ablation surgeries are practiced with varying level of success. Here we present an original outcome study conducted on 14 patients with giant cell tumor around the knee joint, treated with intralesional curettage, bone grafting and bone cementing with or without internal fixation. Material and Methods: This is a retrospective study carried out in an institutional set up. Fourteen patients were operated and Internal fixation was used in five cases. the patients were followed up for 2 years minimum. Results: Total fourteen patients were treated with giant cell tumors around knee joint. Phenol cauterization showed reduced recurrence compared to no phenol cauterization. Collapse was noted in cases done with curettage and only cementing or only bone grafting. plating group showed no collapse. No collapse was noted in cases with subchondral bone more than 5 mm. Conclusion: For giant cell tumor, campannaci grade III, internal fixation is suggested if subchondral bone is less than 5 mm and articular involvement is more than 50%.

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Brodie's abscess is an uncommon condition presenting as a subacute type of bone infection leading to localized pus collection. The common clinical presentation ranges from mild pain to serious functional impairment. The judicious radiological investigation helps in early diagnosis in suspected cases. The presence of a well-defined lytic lesion surrounded by sclerotic margins is a typical radiological feature that after exclusion may lead to a provisional diagnosis. The use of magnetic resonance imaging may prove supportive in further characterization of lesions and exclusion of related disorders. Final confirmation requires culture or histopathological evaluation following aspiration or biopsy following surgical drainage. The overall outcome has been good, following the appropriate diagnosis and management. This article attempts to give readers an overview of the reported cases or small series in the last decade (2010 onwards) in PubMed. This shall serve as a recollection of the spectrum of the clinical presentation and management of Brodie's abscess for educative purposes.

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Distal radius fractures are a very common fracture. They occur mostly due to fall on an outstretched hand. They represent around 17% of all adult fractures. They occur most commonly in young males due to high energy trauma and older females due to osteoporosis. There are various treatment options available for fracture fixation, such as close reduction and manipulation, followed by cast application, close reduction and external fixator application, close reduction with percutaneous K-wire fixation, and open reduction and internal fixation with distal radius plate. Displaced intra-articular fractures are mostly managed with open reduction and distal radius plate fixation. Different fracture patterns require different types of distal radius plates such as T-plate, buttress plate, and variable angle plate. This article outlines the role of plating in distal radius fractures.

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Distal end radius fractures are the most common fracture encountered by orthopedic surgeons, accounting for 17.5% of all adult fractures. Numerous complications arising during the course of management of these fractures are broadly categorized as immediate (nerve injury, compartment syndrome, and skin injury), early (loss of reduction, tendon rupture, stiffness of joints, and infection), and late complications (maluinon, delayed/nonunion, complex regional pain syndrome, and joint arthropathy). It is imperative for a surgeon to have thorough knowledge of these complications and methods required to prevent and manage them.

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Distal radius fractures are increasingly managed by operative means now. Hence the anatomy and surgical approaches are of utmost importance. Distal end of radius articulates with carpal bones forming radiocarpal joint and distal ulna forming distal radio ulnar joint. Presence of multiple tendons and neurovascular structure makes the dissection of this area difficult. Authors have reviewed the anatomy and surgical approaches of this area.

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Fracture neck of femur continues to be neglected in rural India. Several salvage options tried in the past are now out of local interest in favor of some sort of arthroplasty. Although the long-term viability of this policy is not known, only the future will guide to a definite path.

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