Prospective study of sixty patients with distal tibia fracture who underwent surgical fixation at Sri Ramachandra University between June 2010-June 2013. Of the 60 patients included in our study 30 underwent closed intramedullary interlocking nail and 30 were treated with plate osteosynthesis (MIPO). Patients were followed up for clinical and radiological evaluation using modified Klernn and Borner scoring system at 6 weeks, 3 months, 6 months, 1 year and 2 year. Plate osteosynthesis by minimally invasive technique and intramedullary interlocking nailing are equally effective methods of stabilisation for distal tibia fracture when considering the union rates and final functional outcome. However malunion, nonunion and secondary procedures were more frequent after intramedullary interlocking nail. Concurrent fibula fixation with plate osteosynthesis will minimise the incidence of malunion for distal tibia fractures. Randomized prospective evaluation of distal tibia fractures may clarify the efficacy of plate versus nail treatment and optimize the patient care.

Introduction: Total knee replacement (TKR) surgery has become the most successful surgery for patients with severe debilitating arthritis. The guidelines for rehabilitation progression should be tailored respecting the tissue healing parameters. Hence, the current literature states a need for protocol to mitigate these impairments and ultimately result in improved functional outcomes.Objective: The present study aimed to validate the content of TKR rehabilitation protocol in Indian population. Materials and Methods:The process of content validation involves development stage and expert judgment stage. The protocol was designed into three stages with extensive review of literature. After designing the protocol, nine experts in field of musculoskeletal Physiotherapy performed the judgemental process. The process of validation includes rating of experts in a 5 point likert grading on two parameters namely relevance and ease of performance. Based on expert's inputs on TKR protocol, the level of agreement, content validation index and kappa value was calculated. Results:The three staged TKR protocol almost exhibited an excellent agreement on all stages. However, muscle activation exercises (except Vastus medialis obliques activation), stretching, strengthening program and functional training showed 100% agreement than other stages. Conclusion:The structured TKR protocol exhibited excellent content validity to its use in Indian population.

Context  Osteoporosis is a silent disease until it is complicated by trivial fall fractures. There is an increasing interest within the orthopaedic community in the noninvasive cost-effective measurement of the bone mineral density. Aims  The aim of the study is to assess whether urinary N-telopeptide level can be a new diagnostic tool in diagnosing osteoporosis. Methods and Material  This prospective study was done at Sri Ramachandra Medical Centre (SRMC) hospital from October 2015 to October 2017. The study was conducted among patients who comes to SRMC as inpatient or outpatient with suspected osteoporosis and underwent dual-energy X-ray absorptiometry (DXA) scan and urinary N-telopeptide. The inclusion criteria were women aged 65 or older, women aged less than 65 with risk factors, younger postmenopausal women with one or more risk factors, men aged 70 or older, men less than 70 with risk factors, and any above group patients who comes within 24 hours following trivial fall fractures. The exclusion criteria were pathological fracture, history of any illness affecting bone metabolism. The results from DXA scan were taken as gold standard against urinary N-telopeptide. Then the patients were divided into two groups control and study. The control group contains patients who had normal DXA, while study group contains patients having either osteopenia or osteoporosis. Based on our inclusion and exclusion criteria, 110 persons were included in the study. We had 60 study and 50 controls patients. We had 88 females and 22 males. The results obtained were statistically analyzed. Statistical Analysis Used  The collected data were analyzed with IBM SPSS statistics software 23.0 version. To describe about the data descriptive statistics frequency analysis, percentage analysis was used for categorical variables and the mean and standard deviation were used for continuous variables. To find the significant difference between the bivariate samples in independent groups, the unpaired sample t -test was used. To find the significance in categorical data, chi-square test was used. In both the earlier statistical tools, the probability value of 0.05 is considered as significant level. Results  In our study, we had 18.2% osteopenic and 36.4% osteoporotic patients. The mean value of urinary N-telopeptide in control was 49.8 and in case was 182.5. The standard deviation of urinary N-telopeptide value in case was 159.9. Conclusion  Urinary N-telopeptide can give reproducible results and be able to assist in the evaluation of the quantity as well as the quality and be a good judge of someone's risk of fracture. Hence, urinary N-telopeptide can be used as a diagnostic tool for diagnosing osteoporosis.

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