BACKGROUND Posterior Lumbar Interbody Fusion (PLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) create intervertebral fusion by means of a posterior approach. Successful results have been reported with allograft, various cages (for interbody support), autograft and recombinant human bone morphogenetic protein-2. Interbody fusion techniques facilitate reduction and enhance fusion. Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate. PLIF with cage gives better fusion on radiology than PLIF with iliac bone graft, but no statistical difference in the clinical outcome. Cage use precludes complications associated with iliac bone harvesting. The reported adjacent segment degeneration was 40.5% and reoperation was 8.1% after 10 years of follow up. MATERIALS AND METHODS 30 cases of spondylolisthesis who attended the Orthopaedic Outpatient Department of Andhra Medical College, Visakhapatnam, from 2014 to 2016 were taken up for study. All the cases were examined clinically and confirmed radiologically. The patient's age, sex, symptoms and duration were noted and were examined clinically for the status of the spine. Straight leg raising test was done and neurological examination of the lower limbs performed. All the patients were subjected to the radiological examination of the lumbosacral spine by taking anteroposterior, lateral (flexion and extension views), oblique views to demonstrate spondylolysis and spondylolisthesis. MRI and x-rays studies were done in all the cases to facilitate evaluation of the root compression disk changes and spinal cord changes.

BACKGROUND Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, plant tan humerus fixator plates, Polaris nails and blade plates. Complications of these techniques include cutout or back out of the screws and plates, avascular necrosis, nonunion, malunion, nail migration, rotator cuff impairment and impingement syndromes. Insufficient anchorage from conventional implants may lead to early loosening and failure, especially in osteoporotic bones. In general, nonoperative treatment of displaced three and four-part fractures of the proximal humerus leads to poor outcome due to intraarticular nature of injury and inherent instability of the fragments. Comminuted fractures of the proximal humerus are at risk of fixation failure, screw loosening and fracture displacement. Open reduction and internal fixation with conventional plate and screws has been associated with unacceptably high incidence of screw pull out. PHILOS (the proximal humeral internal locking system) plate is an internal fixation system that enables angled stabilisation with multiple interlocking screws for fractures of the proximal humerus. MATERIALS AND METHODS 30 patients with proximal humerus fractures who were admitted in the Department of Orthopaedics, Government General Hospital, Kakinada, during the period November 2014-November 2016 were taken up for study according to inclusion criteria. All patients were treated with PHILOS plate. These proximal humerus fractures were classified according to Neer's classification. Patients were followed up at 6 weeks, 12 weeks and 6 months' interval. Functional outcomes for pain, range of motion and muscle power and function were assessed using the Constant-Murley scoring system. Collected data analysed with independent t-test and ANNOVA test. RESULTS The outcome of the study was 1 case (3.33%) had excellent result, 12 cases (40%) had good results, 12 cases (40%) had moderate results and 5 cases (16.66%) had poor results. Collected data analysed with independent t-test and ANNOVA test. In our study, T-test value was 8.529. Probability (P value) was <0.001, which was significant.

BACKGROUNDFractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. . The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer's scoring system. 1 RESULTSTwenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients were with fracture on right side and 8 on left side. 3 patients had associated injuries. Of them, 2 patients had comminuted fracture of patella on same side and 1 had ipsilateral tibial fracture. All patients were treated with open reduction and internal fixation. All patients were operated within 8 days. Average time duration of surgery was 101 minutes with shortest duration being 80 mins. and longest being 120 mins. The size of plate was selected based on the type of fracture. Of 20 patients, 14 patients (70%) showed radiological union within 18 weeks. No patients had implant failure. Average flexion achieved in this study was 105 degrees with more than 45% patients having knee range of motion more than 110 degrees. Average knee extensor lag in this study was 5.8 degrees. Out of 20 patients, 3 had shortening, 2 patients with shortening of 15 mm and 1 shortening of 10 mm. In this study, 3 patients had significant virus and 3 patients had valgus malalignment with 2 patients had deep infection, which was treated with debridement and antibiotics. The duration of follow-up ranged from 3 months to 18 months. CONCLUSIONLocking compression plate is the optimal tool for many fractures in distal femur. It provided rigid fixation in that region of the femur, where a widening canal, thin cortices and frequently poor bone stock, which make fixation difficult. Min...

BACKGROUNDSupracondylar fractures of humerus in children are common injuries next only to clavicle and both bone forearm fracture in paediatric age group. They have a male predominance accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures. They classically occur as a result of fall on an outstretched hand. There is no controversy regarding management of undisplaced fractures. The treatment modalities of partially displaced and completely displaced fractures are many. Recurrence of displacement occurs in spite of accurate closed reduction and immobilization in flexion. The difficulty in adequately stabilizing a closed reduction without resorting to the extremes of positioning has led to the development of internal stabilization procedures. In literature the most notable evolution in the management of elbow injuries has been an increasing emphasis on early motion.