Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment. Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks. Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p = 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p = 0.03). Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.

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Background: Congenital posteromedial bowing of tibia (CPMBT), a rare anomaly, is characterized by a decreasing deformity and a gradually increasing limb shortening. Lengthening in CPMBT has not been studied extensively. Our series compares the duration and complications of lengthening in younger versus older children to determine early lengthening safety and benefits. Methods: We studied 28 tibial lengthenings performed by a single surgeon in 23 patients, divided into 2 equal groups of 14 segments: group A 5 years or younger (preschool) and group B above 5 years. All were lengthened with circular external fixators, of which 3 were lengthened over a nail. We measured preoperative (bo) and postoperative (po) sagittal, coronal, and oblique plane deformities, initial limb length discrepancy (LLD), percentage LLD (% LLD), amount of lengthening (AmtL), percentage lengthening (%L), external fixator duration (EFD), and external fixator index (EFI). We graded complications by Lascombes' criteria, results by Association for the Study and Application of the Methods of Ilizarov bone score. Results: The mean age was 8.8 ± 7.1 years; the mean follow-up was 7.9 years. Group A had significantly greater bo-sagittal, coronal, and oblique plane deformities. Mean LLD (3.4 cm in group A vs. 4.1 cm in group B) was similar in both. Expected LLD at maturity (LLD M ) using the multiplier method was greater than previously reported (mean, range in group A: 7.2 cm, 4.4 to 9.5 cm; group B: 5 cm, 2.5 to 9.7 cm). Though AmtL (3.5 and 4.1 cm) was similar in both, %L was 24% in group A and 15.7% in group B (P = 0.002). EFD (116.6 days) and EFI (33.7 days/cm) were lesser in group A compared with group B (200.3 days, P = 0.001; 50.2 days/cm, P = 0.01). Lascombes' triple contract was fulfilled in 11/14 lengthenings in group A versus 3/14 in group B. Association for the Study and Application of the Methods of Ilizarov bone score was good and excellent in both groups (P = 0.44). Conclusions:In a large series of lengthenings in CPMBT, we found younger children presenting with large deformities and large projected length discrepancies could be safely lengthened with significantly lesser EFD and complications than in older children.

Introduction: Supracondylar fracture of humerus in children is one of the most common fractures seen in Orthopaedic department all over the world accounting for 50 -70% of all elbow fractures in children in the first decade of life [1] . Traditionally this type of fracture is associated with high rates of malunion, nerve injury and vascular complications. Cross pinning has been presumed to be more stable but it can cause iatrogenic ulnar nerve injuries. Therefore this study was conducted to compare whether lateral pin construct if placed properly can provide the same stability like medial and lateral pinning, at the same time avoiding the possibility of iatrogenic ulnar nerve injury. Aims and Objectives: To evaluate whether lateral pin fixation provides the same functional outcome compared to medial and lateral pin fixation and to assess whether chances of iatrogenic ulnar nerve injury was more in medial and lateral pin fixation than lateral pin fixation alone. Materials and methods: All patients between 3 -12 of age who had sustained Type III Gartland supracondylar humeral fractures who satisfied the inclusion criteria coming to Orthopaedics OPD/casualty were assessed both clinically and radiologically. Patients were randomly selected by drawing lots with even numbers included in Group A (lateral entry) and odd number in Group B (medial and lateral entry). In all cases a posterior approach and triceps splitting method was used. A neurovascular examination was done preoperatively and in the immediate post-operative period. All the patients were evaluated clinically and radiologically in the immediate post operative period followed by examination at 1 week, 4 weeks, 3 months and 6 months. The final grading was decided by putting the values of the three parameters considered in the Modified Flynn's Criteria in the final scoring system Results and discussion: In this study in group A 21 patients had Excellent, 6 patients had Good, 3 patients Fair and one patient had Poor results. In group B 20 patients had Excellent, 5 patients Good, 3 patients Fair and one patient had Poor outcomes. The results of this study were comparable to a similar study done by Yi Meng Yen and Mininder S Kocher [9] although the study used closed reduction and percutaneous pinning as the procedure. Conclusions: From this prospective study we conclude that there is no significant difference between the stability and functional outcome provided by the medial and lateral pin fixation and two lateral pin fixation methods. But the medial and lateral pinning group shows one case of iatrogenic ulnar nerve injury. Therefore, the lateral pin fixation method for the treatment of Type III supracondylar fractures of humerus in children is a reliably safe method to avoid iatrogenic ulnar nerve injury which also provides adequate stability if the proper pin fixation principles are used.

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Introduction: Medial compartment Osteoarthritis is an age related chronic disturbance of weight distribution over the articular surface of the knee joint. The compensatory Varus deformity which develops leads to "bowing" of the legs. Traditionally, treatment involved conservative regimen of analgesics, physiotherapy and lifestyle modifications. Before the advent of Arthroplasty, Osteotomies were the mode the treatment. The treatment modality is divided into two phases. The first phase involves in correcting the mechanical axis deviation, through a high Tibial Osteotomy. The second phase involves stabilizing this accomplishment with an Ilizarov external fixator and achieving the co-linearity of the Mechanical axis of the lower extremity through angular correction using distraction Osteosynthesis. Aim: The aim of present study was to evaluate the results of High Tibial osteotomy using Ilizarov technique in medial compartment osteoarthritis of the knee. Materials and Methods: In this prospective study, thirty cases of medial compartment osteoarthritis of the Knee with genu Varus deformity were treated using monofocal corticotomy and ring fixator. Bone and functional results were evaluated clinically using the Knee Society score (knee score and functional score) and radiologically using the mechanical tibiofemoral angle and the Mechanical axis deviation from the Fujisawa point. Results and Discussion: In the present series of thirty cases, there were 20 females and 2 males with a maximum age of 52 years and minimum of 32 years. There was a predominance of Varus deformity seen on the right knee. The mean follow up was 30 months. The results observed were 60% excellent, 33% fair and 6.7% poor by knee society score. The mean knee society score (Knee score) at 12 months was 71.27 ± 5.32 (p<0.001) and at 24 months was 78± 6.42(p<0.001). The mean Tibio femoral angle was 3.40 ± 1.07º of valgus (p˂0.001) at 12 months postoperatively and at 24 months was 3.7 ± 1.35º of valgus (p˂0.001). The mean Mechanical axis deviation from Fujisawa point was 0.76± 0.42 millimetres (p˂0.001) at 12 months postoperatively and 0.75 ± 0.45 millimetres (p˂0.001) at 24 months postoperatively. The correlation between Knee society score and the Tibiofemoral angle was significant at 12 months (r= 0.368) compared to the correlation between Knee society score and the deviation from Fujisawa point which was non significant at 12 months(r= -0.340) and was significant at the end of 24 months (r= -0.552).At the end of 24 months, 93.7% of the cases showed excellent to good results after the intervention and only 6.7% of the cases showed poor result. Conclusion:In the light of these results, it was concluded that high Tibial osteotomy by Ilizarov technique, despite few unfavourable results and complications, can be used to treat angular deformity correction about the knee.

Introduction: Improved understanding of open fracture pathology, techniques of fracture fixation, softtissue care, and antimicrobial treatment has resulted in a significant reduction of morbidity and mortality associated with open fractures. Yet, the most severe open fracture types, even in the hands of experienced trauma surgeons, are still fraught with complications and impaired function. Major advances over the last century have moved the focus of management of such injuries beyond the preservation of life and limb to preservation of function and prevention of complications. In this series, we present a two year experience in the management of severe open fractures, Gustilo types IIIA and IIIB, with the use of free muscle flaps and overlying skin graft for their soft tissue reconstruction. Aim: The study was conducted to assess the functional outcome of severe open fractures treated by primary soft tissue/flap coverage and bony fixation.Materials and Methods: 35 patients with single segment (i.e thigh, leg, arm, forearm) injury were selected for the study and treated in a tertiary care hospital. Patients were evaluated clinically and radio graphically and those with type 3A and 3B Gustilo-Andersons injuries were selected and treated by thorough and radical debridement, bony fixation and soft-tissue coverage within 72 hours. Patients were followed up for a minimum period of 12 months. The post-operative complications, time taken for bony union, stability of scar, the range of movements of proximal and distal joints and the SMFA (Short Musculoskeletal Functional Assessment Questionnaire) were taken for the assessment of functional outcome. Results and Discussion: Results of SMFA were good in 20, fair in 9 and poor in 6 patients. Conclusion: This Fix and Flap protocol leads to a drastic reduction in infection rates and primary flap coverage has several other advantages both to patients and care givers in the form of reduction in length of hospital stay, cost of treatment, time spent in rehabilitation and most importantly the number of surgeries or debridements a patient must undergo. This method thus leads to a drastic reduction in physical, psychological, financial and social repercussions on the individual.