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There is no consensus on the timing for early surgery in spinal cord injury (SCI). On Pubmed, we found no primary research article from India evaluating the effects of timing of surgery on outcomes in SCI patients. This single-centre prospective observational study was done to evaluate the outcome of surgical decompression done > 72 h after traumatic incomplete SCI and assess prognosis over 6 and 12 months. Patients, with history of traumatic incomplete SCI of < 6-month duration and below C5 vertebra level, who had had late surgery (> 72 h after the injury) elsewhere were enrolled. A complete and standard neurological examination was done at presentation. Neurological and functional recovery was assessed at 6 and 12 months. Forty-two patients fulfilling the inclusion criteria were followed up of at least 12 months. At baseline, 31 had ASIA B and 11 had ASIA C grade. By 6 months, 4 patients improved by 1 ASIA grade. By 12 months, 14 patients improved by 1 grade and two by 2 grades. Mean motor recovery and overall functional recovery were significant (p = 0.03 and p < 0.001 respectively). Patients with lumbar injuries had significantly better overall functional recovery at both 6 (p = 0.006) and 12 months (p < 0.001). ASIA C group recovered significantly better than ASIA B group in terms of mean motor recovery percentage (14.33 vs 8.12, p = 0.014 at 6 months; 23.96 vs 16.56, p = 0.016 at 12 months) and mean spinal cord independent measures (SCIM) recovery percentage (43.01 vs 32.03, p = 0.039 at 6 months; 62.25 vs 38.4, p < 0.001 at 12 months). Surgery > 72 h after incomplete traumatic SCI, assessed at 2-4 months post injury, may still have encouraging outcomes. Our study may be the first from India to assess the outcome of delayed surgery in incomplete SCI patients but larger prospective studies involving multiple centres are needed for stronger evidence. Inclusion of non-operative cohort would have differentiated the result from spontaneous recovery.

Background: Congenital muscular torticollis (CMT), primarily a neck deformity resulting from shortening of the sternocleidomastoid muscle that leads the head to turn towards the affected side and the chin points to the opposite side. In developing countries, the parent often neglects and present late, when conservative management has a limited role. Various surgical procedures have been described for the correction of the deformity. The purpose of this study is to find out the result of SCM release followed by definite rehabilitation protocol. Materials and methods:Twelve cases confirming to inclusion criteria were operated on for congenital muscular torticollis. The affected side, either unipolar or bipolar sternocleidomastoid muscle release was done, depending on preoperative assessment. The sternal head was lengthening by Z-plasty method to maintain the shape of suprasternal notch. Postoperatively all the patients had followed a definite rehabilitation protocol.Results: Clinical and functional results were assessed using modified Lee's scoring system and Tanabe's assessment criteria for torticollis. Results were satisfactory in all the cases except two cases. Conclusion:The sternocleidomastoid release is an effective technique for the management of congenital muscular torticollis. The procedure is relatively complication free and safe method with predictable outcomes.

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Introduction: Primary full thickness Peroneus Longus Tendon Graft (PLTG) for Anterior Cruciate Ligament Reconstruction (ACLR) has been used with good clinical outcome. Recently, it is designated as a promising graft option for ACLR. The effect of harvesting PLTG on donor ankle function is still not completely understood. Peroneus Longus Tendon (PLT) is thought to play a major role in proprioceptive regulation of the ankle joint. All the studies till date did cross-sectional assessments of ankle and foot function at or after 6 months that might have overlooked the timely detection of donor site morbidities. Aim: To evaluate the ankle function and compare the affected and sound limb function in subjects with an ACLR with autologous PLTG starting at an early postoperative visit upto six months. Materials and Methods: A prospective cohort study was conducted at a tertiary rehabilitation centre from March 2019 to March 2021 including the follow-up evaluation. As per the inclusion criteria, 63 participants after ACLR with PLTG were considered for assessment using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot scale and Foot and Ankle Ability Measure (FAAM) scale at 6 weeks, 3 months and 6 months post-ACLR follow-up. Comparison between sound and affected limbs was done during all follow-ups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 18.0. Both FAAM and AOFAS ankle and foot scores were analysed with non parametric tests. Results: Mean age of 63 participants were 29.25 years. Median of AOFAS and FAAM score at 6 week, 3 month, and 6 month post- ACLR follow-ups were (88, 98 and 100) and (97.22, 98.80 and 100), respectively. Statistically significant increase in AOFAS and FAAM scores were observed at 3 month and 6 month as compared to 6 week follow-ups with p=0.001 and p-value=0.001 respectively. The group comparison between the affected and sound side functional scores at different study visits showed statistically significant greater values for the sound ankle than the affected ankle (FAAM: 6 week: p-value=0.001; 3 month: p-value=0.001; 6 month: p-value=0.001 and AOFAS p-value=0.001; p-value=0.001; p-value=0.001, respectively). Conclusion: The evaluation of functional outcomes showed gradual and linear improvement at subsequent postoperative visits and restores fully to 100% at 6 month indicating a near- normal to normal donor ankle function following ACLR with PLTG by 6 months. The group comparison showed only marginal but significant difference between affected and sound ankle function.

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