Multidirectional instability of the shoulder is a complex condition that can be difficult to diagnose and treat. Clinically, it is characterized by symptomatic global laxity of the glenohumeral joint and may present either traumatically or atraumatically, unilaterally or bilaterally, and with or without generalized joint laxity. Capsular plication is a primary treatment option in these patients and is used to tension the redundant or lax capsule. We evaluated the role of rotator interval closure in restoring stability as a primary procedure in patients with multidirectional instability and a positive and painful sulcus sign.Twenty adult patients (16 men and 4 women) presenting with multidirectional instability were evaluated clinically and radiologically to assess the degree and direction of instability, were treated by arthroscopic rotator interval closure and inferior capsular plication, and were followed up for a minimum of 2 years. Clinical and functional results were excellent at 2-year follow-up. The results of the study indicate that the closure of the rotator interval in patients with symptomatic inferior instability will have a long-lasting effect on the stability and function of the shoulder, as the closure improves not only the static restraints but also the dynamic restraints of the shoulder through the improved proprioception secondary to restoration of the rotator interval structures.

Lengths of the ossified diaphysis of the humerus and femur were measured in 50 fetuses ranging from 65 to 290 mm Crown-Rump length. A significant correlation was found between the diaphyseal length and the CR length. No appreciable difference was noted in diaphyseal lengths of the humerus and femur i n fetuses of 85 mm CR length or below. Various growth phases were observed. The difference i n length of the femur and humerus is due to a comparative slow growth of the humerus during the later period of prenatal life. Diaphyseal growth rates of the humerus and femur are 0.18 mm and 0.21 m m respectively for every 1 mm increase in CR length. Regression coefficients for the lengths of the ossified shaft of the humerus and femur are 5.35 and 5.00 respectively. With the help of these coefficients, CR length of the fetus was estimated within a range of k 1 5 mm. From the estimated CR length, age of the fetus was determined with the help of a standard age and size curve with reasonable accuracy.Study of the correlation between linear growth of long bones and the CR (CrownRump) length of the fetus assumes importance in medicolegal practice, since the correlation can be used to estimate the age of the fetus from its available long bones.Growth of long bones during prenatal life has been studied in detail (Nishizuka, '26; Streeter, '49; Felts, '54). Radiographic studies on the prenatal ossification of human long bones recording the ratio of the lengths of the ossified shaft relative to the corresponding CR length have been undertaken (Bade, '00; Halonen, '29; ORahilly and Meyer, '56). Various phases of linear growth of long bones have been reported (Depreux and Fontaine, '51 ; Moss et al., '55) and a linear correlation between diaphyseal length and fetal height has been observed (Smith, '39; Saettle, '51; Olivier and Pineau, '60). Recently, Gray and Gardner ('69) and Gardner and Gray ('70) in their reports on the prenatal development of the humerus and femur published tables showing the lengths of the ossified shaft and the corresponding CR length in fetal specimens of 37 to 342 mm CR length. AM, J. PHYS. ANTHROP.. 36: 165-168.In the present study the lengths of the ossified diaphysis of the humerus and femur were measured in fetal specimens of 65 to 290 mm CR length and a formula derived to estimate the age of the fetus based on the correlation of the diaphyseal growth with the CR length. MATERIALS AND METHODSWe studied 50 apparently normal fetuses, 30 male and 20 female, delivered by normal women and having a CR length ranging from 65 to 290 mm. The CR length was measured, after fixation of fetuses i n 10% formaline for four to six months, with a specially prepared osteometric board to the exactness of 1 mm. Values were verified by recording several times. The limbs were detached and placed in 5% KOH solution at room temperature for about two weeks. After thorough washing in running tap water, the humerus and femur were dissected out and cleaned. The cartilaginous ends were removed gently. The remaining ossified ...

<p class="abstract"><strong>Background:</strong> Sciatica resulting from a lumbar intervertebral disc herniation is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, surgical treatment of lumbar disc prolapse has been done by open discectomy. We wish to assess the outcome of surgery in patients with lumbar disc prolapse undergoing lumbar discectomy.</p><p class="abstract"><strong>Methods:</strong> 40 patients were included in this study and were followed up for up to 1 year postoperatively. We assessed the outcome of each patient with ODI and VAS post-operatively and on follow-up at 3 weeks, 6 months and 1 year. Subjective evaluation of the patient’s satisfaction at the final follow-up was also done.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that males had higher incidence of PIVD with an average duration of symptoms before surgery about 8.62 months. Left side was most involved and level l4-l5 was most involved level. The mean ODI and VAS score pre-operatively were 26.85±4.20 and 7.73±0.88 respectively, which changed to 4.48±5.15 and 1.70±1.57, respectively at 1 year post-operative follow-up. These were statistically highly significant. Most of the patients (34) gave a subjective evaluation as excellent at 1 year follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients’ quality of life.</p>

INTRODUCTIONFractures of the proximal humerus are the most common fractures of this bone and constitute 5-6% of the total fracture incidence in adults; and this incidence increases with age.1 Complex fractures of the proximal humerus are often difficult to treat and result in considerable shoulder dysfunction unless adequately treated.2 According to the Neer's criteria for the proximal humerus fractures, fractures with fragments separated more than 1 cm or with more than 45 degree angulation are considered as displaced fractures; 3,4 and hence need open reduction and internal fixation. Most of the surgeons are familiar with the traditional deltopectoral approach, which utilizes the internervous plane between the pectoralis major and the deltoid; and hence this is the most commonly used approach for proximal humerus fracture fixation. 2 But in certain fractures in which the fragments especially the greater tuberosity fragment is displaced, usually posterolaterally, reduction through this approach is difficult. In addition, the application of plates on the lateral surface of proximal humerus requires a lot of soft tissue dissection and retraction. Hence an access from the lateral aspect would be far more convenient in certain circumstances. The transdeltoid or the deltoid splitting ABSTRACT Background: The deltopectoral approach is the most commonly used approach for the reduction and fixation of proximal humerus fractures. But it provides inadequate access to the posteriorly displaced fragments in comminuted fractures and to the lateral surface where the plate is to be applied. These disadvantages can be obviated by a direct lateral transdeltoid approach. There have been concerns regarding postoperative axillary nerve palsy and deltoid dysfunction with this approach. This study had been conceptualized to assess the outcome of fixation of proximal humerus fractures with deltoid splitting lateral approach. Methods: A total of 20 patients with Neer's type 2 and 3 fractures of proximal humerus were included in this study. Lateral transdeltoid approach was used for exposure, with either an extended incision or a "two window" less invasive incision, depending upon the fracture anatomy. Functional outcome was assessed using the Constant Murley shoulder score. Results: The fracture was classified as Neer's type 2 in 30% and type 3 in 70% of the cases. The mean Constant Murley score at final follow up was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, the results were excellent in 60%, good in 35% and fair in 5% of the cases. No case of postoperative axillary nerve palsy was encountered. Conclusions: The functional outcome was either excellent or good in 95% of the cases and no case of axillary nerve palsy was seen. Hence, Lateral transdeltoid approach is a convenient and useful approach to proximal humerus fractures.

Elbow stiffness is a common problem encountered by orthopedic surgeons. Various management options have been described in the literature, including conservative measures and open and arthroscopic surgery. Arthroscopic management of stiff elbow remains controversial. The purpose of this study was to evaluate the functional results of arthroscopic management of stiff elbow.Thirty patients with stiff elbow underwent arthroscopic release surgery and were followed up for an average of 27.3 months. Surgery included anterior and posterior capsular release, coronoid process debridement, bony spur excision, and loose body removal. Postoperative outcome was assessed using the Mayo Elbow Performance Score and range of motion at the elbow. Mayo Elbow Performance Score increased from a mean 64.5 preoperatively to a mean 83.17 postoperatively. Range of motion also improved, from a mean preoperative extension and flexion of 22.83° and 96.83°, respectively, vs a mean 10.83° and 120.84°, respectively, at final follow-up. No intra- or postoperative complication was seen in any case. Underlying etiology and timing of surgery influenced the end result, with better results seen in patients with traumatic etiology and those with a shorter duration of symptoms.Arthroscopic release allows good visualization and rectification of intra-articular pathology and is a safe and effective tool for the management of stiff elbow.

Results: This study comprised of 25 patients and followed for minimum of 6 months. Success rate is 100 %, with 92% graded as excellent to good and rest 8 % with fair functional results. Conclusion: We conclude that Anterior Cruciate Ligament reconstruction with quadrupled semitendinosus graft has good functional results and high success rate.

We set out to assess the efficacy of radiofrequency-induced intradiscal nucleoplasty in reducing pain in symptomatic patients with MRI-defined lumbar disc herniation and their satisfaction with the procedure. We compared the patients’ pain intensity and severity of disability scores before and after undergoing the procedure in a retrospective questionnaire. These patients reported statistically significant reduction of pain intensity and disability level after the procedure. We conclude that radiofrequencyinduced intradiscal nucleoplasty is an acceptable alternative minimally invasive procedure in relieving the symptoms of patients with lumbar disc herniation.Key WordsRadiofrequency-induced intradiscal nucleoplasty, coblation therapy, percutaneous lumbar disc decompression, intervertebral disc herniation, low back pain

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