Background:Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application.Materials and Methods:Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6–60 months).Results:Clinical results were evaluated according to the Rasmussen's criteria. Average healing time was 13.69 weeks (range 12– 28 weeks). Mean knee range of motion was 122.60° (range 110°–130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor.Conclusion:We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.

Avulsion fractures of tibial intercondylar eminence is a rare injury mainly affecting the pediatric population between 8 to 14 and is even rarer in adults with very few cases reported in literature. It occurs with high energy trauma in adults and may be associated with knee dislocation and neurovascular injuries. A 30 yr old male presented with a painful swollen left knee, limited knee motion, and difficulty with weight bearing after a history of fall from motorcycle. Imaging revealed Type 3 Meyers and McKeever tibial spine avulsion of both ACL and PCL. A two staged surgical procedure was performed: (a) Arthroscopic reduction and fixation with headed cannulated screw of ACL tibial fragment; (b) ORIF with headed cannulated screw of PCL tibial fragment via posterior approach to knee. Good functional outcome and early mobilization was achieved. Diagnostic arthroscopic helps to evaluate the condition of the cruciate ligaments as well as fracture bed. Simultaneously fixation of ACL fragment with cannulated screw can be done, which is a simpler procedure to suture fixation. ORIF of PCL fragment in a staged manner has helped to address the injury in a detailed manner achieving goal of anatomical reduction and early mobilization.

BACKGROUND: Distal radius fracture is one of the most common fractures. Acute distal radius fracture results in pain, tenderness, swelling and potential deformity. Patients may be faced with substantial morbidity if fracture healing is delayed. The recovery period for distal radius fracture can be substantial and the impact of the method of fixation on activities and daily living can be significant. The majority of osteoporotic fractures in old age occur as the result of a fall, while the majority of injuries in the younger patients are secondary to motor vehicle accidents and sports. The Purpose of this study was to assess the functional outcome of stable distal end radius fractures treated by extra focal percutaneous pinning versus closed reduction and plaster application. METHOD: A comparative randomized study of functional outcome of Distal End Radius fracture treated by extra focal percutaneous pinning and closed reduction and plaster application of 12 months duration and comprised of 50 subjects 25 from each group, who were evaluated on second week, sixth week & after six months. The functional outcome of both groups was assessed at end of 6 months from the initiation of the treatment as per patient rated wrist evaluation criteria. Stable types of distal end radius fractures were taken into consideration for this study. RESULTS: Patients who were treated by extra focal percutaneous pinning had no better functional outcome than the patients who were treated by closed reduction and plaster application the average scores for both the groups that is closed reduction and cast was127.28 at the end of two weeks, 74.68 at the end of six weeks and 26.68 at the end of six months. As for the group treated by closed reduction and percutaneous pinning and slab application was 103.52 at the end of second week, 69.80 at the end of six weeks and 23.64 at the end of six months. CONCLUSION: Both methods are equally effective method in treatment of Stable distal end radius fractures as functional outcome is nearly same.

Aim: The study was conducted to evaluate the therapeutic effects of platelet-rich plasma (PRP) injections in promoting healing of rotator cuff tendinopathies over short term by evaluating pain, range of motion (ROM) using Constant–Murley score (CMS). Design: This prospective, cohort study was conducted in the Department of Orthopedics at a tertiary care teaching hospital between December 2013 and April 2015. Patients with supraspinatus tendinopathies (partial tear) based on either ultrasonography (USG) or magnetic resonance imaging (MRI) were included in the study. Patients with complete rotator cuff tear were excluded. Materials and methods: Thirty consecutive patients with supraspinatus tendinopathies were administered subacromial injections of PRP. Platelet-rich plasma was made from 20 mL of patient's blood after subjecting it to two centrifugal spins and injected into the supraspinatus tendon. All patients were evaluated at the end of 3 months. Results: Shoulder function was assessed by CMS in present study. Mean score at baseline was 33.87 ± 5.91. After 1 and 3 months, significant reduction in CMS was found with mean score of 27.80 ± 5.17 at 1 month (p < 0.0001) and 21.93 ± 6.17 at 3 months (p < 0.0001). There was a significant difference in score at 1 and 3 months (p < 0.0001). At 6, 12, and 17 months, the CMS was still significantly low but there was no difference in scores when compared with scores at 3 months. Conclusion: Platelet-rich plasma injection for supraspinatus tendinopathies gives good results at the end of 3 months.

Background:The aim of this study was to evaluate the functional outcomes with intramedullary fixation using flexible nails and to follow up for any other complications. Methods: Study was a prospective study in Lata Mangeshkar Hospital, Nagpur during 2014 to 2016. All the patients enrolled in the study were briefed about the nature of the study. All cases in this series were operated by combined antegrade and retrograde approach. Results: Total of 30 patients of closed diaphyseal humeral fractures was studied. Maximum i.e., 16 (53.33%) were in the age range of 21-40 years, followed by 10 (33.33%) patients in the range of 41-60 years. 21 (70%) cases had fracture union between 10-16 weeks with a score of 8 points, followed by 8 (26.67%) patients with fracture union duration of less than 10 weeks with a score of 10 points. Only one of the patients landed up with non-union. The mean functional score of patients at 3rd month was 64.03±4.99, 9th month was 73.46±2.56. 86.66% patients had good to fair outcome, 3.33% patient each had excellent and poor outcome. Conclusions: Comparing results of our study with other studies, we found that our results are almost comparable but not better than open reduction and plating. Complications encountered in our series are comparatively less compared to those encountered during interlock nailing. The trauma to rotator cuff is minimum and this method is good alternative method. Thus, multiple nailing gives better functional outcomes as compared to locked nail.

Aim:The aim of this study was to find out the therapeutic correlation between cervical dysfunction and myofascial pain dysfunction syndrome (MPDS). Materials and methods:The study included 46 patients out of which 23 had MPDS with cervical pain (group I), and 23 patients had only MPDS (group II). Detailed history and examination of the patients were carried out, and the factors taken into consideration were pain and tenderness of muscles of mastication and neck muscles, maximum comfortable mouth opening, and cervical range of motion. All the patients were randomly divided and advised physical exercises, light amplification by stimulated emission of radiation (LASER) therapy, and the combination of both exercise and LASER. Patients were assessed for the relief of signs and symptoms of myofascial pain and cervical pain posttreatment, every month for 2 months.Results: Both the groups showed a similar response to all the different treatment modalities. In group I, the patients also had relief in their cervical pain although the treatment was directed for MPDS. Patients from both the groups who were advised LASER and combination of both exercise and LASER showed better response in terms of reduction in visual analog scale, number of tender muscles, and increased maximum comfortable mouth opening posttreatment and during the follow-up, as compared with the patients who were advised only exercise. Conclusion:Patients having cervical pain showed significant improvement comparable with patients having no cervical pain. Hence, the conclusion drawn was that there is a positive Clinical significance: Cervical pain showed significant improvement to physiotherapy in the form of exercise, LASER, and combination treatment, though the effective modality was LASER and combination of exercise and LASER therapy.

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