Intra-articular dexmedetomidine (2 μg/kg) has superior analgesic efficacy, delayed the first postoperative requirement for analgesia and decreasing the need for postoperative analgesics with no major adverse effects.

Elderly patients with hip fracture constitute Single Largest Group of Emergency Orthopaedics Admissions. In 2050, 6.26 million hip fractures worldwide, approximately 50%, will occur in Asia. Only small number of reports on incidence of hip fractures in the Asian population exist. India lacks data registry for fragility hip fractures, therefore, the magnitude and standard of patient care are not known. A prospective multicenter study was conducted from January 2012 to April 2014 to describe population-based longitudinal trends, namely, age-specific incidence, fracture type, timing of presentation, kilometers traveled, timing of surgery, hospital stay, man hours lost, pressure ulcers, weight bearing, 30-day return, 3-month mortality, and so on, of fragility hip fractures. A total of 1031 patients were included with 59.7% females and 40.3% of male patients, with a female-male ratio of 1.5:1. Commonest mode: Falls 45%. 56.4% IT fractures. 66.2%patients operated, Operative/Conservative Ratio of 2.8:1. Patients travel a mean distance of 86.4 kilometers for quality treatment. Of the patients, 85.9 % presented late due to ignorance and misguiding quack practice. Incidence of delayed surgery was 69.3%. Persistent electrolytes imbalance and hyperglycemia normalized in 81.2% by second or third postoperative day. The man hours lost was 157.85 hours/person. Medical complications was more (90%) in patients who had delays in surgeries and presentation. Mortality rate was 6.2 %. Patients travel long for quality treatment, most of them are misguided, present late with significant complications and sufferings, and their pockets half drained depriving them off best treatment. Early presentation and operation have better prognosis and rehabilitation, facilitates early return to work, and independence. Increased pressure sores, infections, hospital stay, treatment cost, depression, and mortality are directly related to delays in surgeries and presentation. Estimated losses according to lost man hours may go up to 10 million dollars.

Background:Multiligamentous injuries of knee are a complex problem in orthopaedics. Combined ACL-PCL injuries are uncommon, usually associated with knee dislocations. Extremity vascular status is essential because of possible arterio-venous compromise. These complex injuries require a systematic evaluation and treatment. Single setting simultaneous arthroscopic ACL and PCL reconstruction or a staged approach can be adopted to treat these cases.Objectives:To evaluate functional outcome of simultaneous arthroscopic ACL and PCL reconstruction with hamstring tendon autograft in multiligamentous knee injuries.Patients and Methods:This prospective study was performed on 20 patients with combined ACL-PCL injuries who underwent simultaneous arthroscopic ACL-PCL reconstruction with hamstring tendon. Evaluation of functional outcome was by IKDC and Lysholm-Tegner scores.Results:In 20 patients, mean age 34 years, return to full-time work and to full sports was 8 weeks and 6.2 months respectively. All patients had full range of motion except 2 patients with < 5 degrees flexion loss; 90% had negative Lachmann test; 95% had negative pivot shift and 10% patients had mild posterior drawer at 90 degrees (1+) at final follow up. Mean IKDC score was 90 (range 81 - 94); mean Tegner activity score was 7 and mean Lysholm knee score was 89. 85% returned to preinjury activity level and a 90% satisfaction rate.Conclusions:Simultaneous arthroscopic ACL and PCL reconstructions using hamstring tendon for combined ACL and PCL injuries is a clinically effective, safe, time saving and cost-effective procedure with better patient compliance and reproducible for a timely return of motion, strength, and function with favorable outcome.

Early surgical intervention hastens recovery, rehabilitation and return to school and decreases the risk of developing avascular necrosis. We suggest Smooth Pins fixation in zones I and II (nearer to zone I) and cancellous screw fixation in zones II, III and IV. Decompression of hip joint by capsulotomy releases the tamponade effect and should be performed in all cases of paediatric femoral neck fractures.

Background: The aim of this study was to examine the correlation of the clinical examination, MRI and arthroscopic findings in cruciate ligaments and meniscal injuries of knee and to evaluate the accuracy of clinical examination and MRI with the gold standard arthroscopy. Methods: A prospective diagnostic double-blind study was conducted on 104 consecutive patients admitted to the outdoor/casualty with trauma to the knee complaining of knee pain/locking/ instability, from August 2012 to June 2014. All the patients were subjected to clinical examination, MRI scanning and diagnostic arthroscopy. Variables like sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical examination and MRI against arthroscopy were evaluated. Results: The sensitivity, specificity and accuracy of clinical examination for anterior cruciate ligament tears were 94.7%, 71.4% and 88.5% and for MRI were 94.7%, 78.6% and 90.4%, respectively; for posterior cruciate ligament tears 100%, 100% and 100% for clinical examination and for MRI 80%, 97.9% and 96.2%, respectively. These values for medial meniscus tears were 76.5%, 68.6% and 71.2% for clinical examination and 88.2%, 62.8% and 71.2% respectively for MRI. For lateral meniscus tears, 40%, 94.6% and 78.8% for clinical examination and 46.7%, 89.2% and 76.9% respectively for MRI. Conclusions: A skillfully performed clinical examination establishes a diagnosis on which an arthroscopic procedure can be planned, reserving MRI scans for patients where the clinical examination fails to establish a diagnosis or cannot be performed. Decision to use MRI should be based on the criteria that it would confirm, expand the diagnosis or change diagnosis in such a way that alters the proposed treatment.