PurposeTo compare two commonly used methods of temporary hemiepiphysiodesis (staples and figure of eight plate) in the management of coronal plane deformities of the knee in skeletally immature children.MethodsThis prospective study was conducted between November 2012 and November 2015. A total of 40 patients with 67 affected knee joints, having at least 1 year of skeletal growth remaining, were included in the study. Angular correction was measured by recording the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and anatomical tibio-femoral angle (TFA) (for the overall alignment of lower limbs). Implant removal was done after 5° of overcorrection was achieved. The rate of correction (° per month) and complications related to each technique were recorded.ResultsThe most common diagnosis was idiopathic genu valgum. The overall rate of correction (TFA) was 1.2° for staples and 1.4° for eight plate (p = 0.70, not statistically significant). The correction in mLDFA was statistically better in the eight plate group, whereas an opposite trend was recorded in mMPTA. Implant-related complications were present in two cases of the staples group.ConclusionAlthough the overall correction rate was similar in both groups, implant-related complications were lower with figure of eight plate. In idiopathic genu valgum (the most common diagnosis), the correction was statistically better in the eight plate group. We recommend figure of eight plate over staples in managing these deformities.

This study aimed to investigate the alignment based on deformity in knees affected by osteoarthritis (OA) at different stages and evaluate its association with OA.

BACKGROUNDSimultaneous bilateral femoral neck fractures are relatively rare injuries. They are usually associated with underlying metabolic bone disorders or systemic diseases. Long-term use of narcotics and bisphosphonates can also result in similar fracture patterns; however, association of this fracture type with long-term use of antiepileptic drugs is not very common. Only one such case has been reported in the literature. This article describes the second.CASE REPORTWe report a case of simultaneous displaced bilateral femoral neck fractures in a 50-year-old epileptic patient, who had taken phenytoin for the past 3 years. The fractures were a result of low-velocity injury following a fall from the bed. The fractures were managed with a bilateral hemi-replacement arthroplasty. Oral bisphosphonates were given to improve the bone quality in the post-operative period. The patient had a good post-operative outcome, that was sustained throughout the entire follow-up period of 1 year.CONCLUSIONAntiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.

The proximal femoral nail antirotation (PFNA-II) is designed for fixation of unstable proximal femoral fractures in Asian patients due to its superior biomechanical properties. The helical blade achieves purchase through bone compaction and requires less removal of bone than a screw. Medial migration of the helical blade with perforation into the hip joint without loss of reduction is a rare problem noted with PFNA. Past literature reporting the migration of the helical blade medially, perforating the femoral head has been addressed as a characteristic complication of the PFNA. A review of literature suggests various reasons for the same such as fresh trauma, fracture settlement and failure of lateralization of the blade. We report a case of postoperative medial migration of the helical blade perforating the femoral head due to loosening of the locking bolt of the helical blade without any signs of rotational or varus displacement of the fracture.

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Objective: The study was aimed at comparing the accuracy in length of insertion of umbilical arterial catheter in all new born groups stratified according to weight, by using two different methods, that is, Wright et al./ Case (Group I): (4 Â Body wt (BW) (kg)) þ 7; Shukla et al./Control (Group II): (3 Â BW (kg)) þ 9.Study Design: It was a randomized open label case control study in a Level III tertiary level Neonatal Intensive Care Unit over 9 months.Result: The babies in both the groups were similar in relation to weight, gender, prematurity and weight subgroups. Under insertion was seen in 8% (4/50) of babies in group I and over insertion was seen in group II where it was 32.6% (16/49). There was a reduction of 82% abnormal insertions and repositioning by using the Wright's formula as compared with the Shukla's formula in preterm babies. Statistically significant reduction in repositioning was seen in all babies <1500 g in Group I and under insertion seen in 8% of babies in group I did not attain statistical significance (P ¼ 0.34).Conclusions: There is no universal formula, which gives the accurate length of placement of an umbilical arterial catheter, but Wright's formula comes closer in neonates with different weight sub groups.

BackgroundProprioception is a specialized sensory modality encompassing the movement of the joint and its position in space. Reconstruction of the anterior cruciate ligament (ACL) does not always yield expected outcome, suggesting that successful reconstruction depends on not only the ultimate strength of the graft but also recovery of proprioception. Treatment delay is a significant concern in developing countries, e.g., in Asia. Thus, presence of mechanoreceptors is one of the factors having paramount importance for successful outcome. We conducted this study to identify mechanoreceptors via immunohistochemical staining and correlate their presence with duration of injury.Materials and methodsA total of 38 injured native ACL stumps were harvested from patients undergoing ACL reconstruction and stained with neurofilament protein stain to detect functional mechanoreceptors.ResultsOf the specimens, 44.7% stained positive for monoclonal antibody. No association was found between duration of injury and presence of mechanoreceptors (p = 0.897). No correlation was seen between age and side.ConclusionsNo correlation was found between duration of injury and presence of viable mechanoreceptors, hence it is beneficial to preserve the native ACL stump irrespective of the time interval between injury and surgery.Level of EvidenceIII.