PurposeThe posterior cruciate ligament (PCL) presents commonly with avulsion fractures of its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. Various fixation techniques have been explored with use of lag screws, steel wires, absorbable screws, suture anchors and straddle nails. The purpose of this study was to evaluate the clinical and functional outcome of open reduction and internal fixation of tibial avulsion injuries of the PCL using cannulated cancellous screws.Materials and MethodsWe performed open reduction and internal fixation using cannulated cancellous screws in 14 patients (mean age, 33.9 years) with isolated PCL avulsion injuries. Patients with a duration of injury more than 12 weeks were excluded. The minimum follow-up period was 12 months. Results were assessed radiologically and clinically. Final functional outcome was assessed using the Lysholm knee scoring system.ResultsThe average follow-up period was 13.5 months. At the final follow-up, all 14 patients achieved fracture union. The average flexion was 121.7°±9.2° with full extension achieved in all patients. Mild instability (1+) was noted in 4 patients. The Lysholm functional score was excellent in 11 patients, good in 2 patients and fair in 1 patient with an average score of 97±7.6.ConclusionsStable early fixation for PCL avulsion injuries with early controlled mobilization provided excellent to good results. However, fixation should not be discouraged for late-presenting patients because good to fair results can be achieved in such cases.

Introduction: Anterior cruciate ligament (ACL) is a common injury which has been conventionally managed by various graft reconstruction using bone patellar tendon bone, or quadruple hamstring autograft, to name a few. However, all these grafts are associated with many complications. Lately, peroneus longus tendon (PLT) autograft has shown promising results in this field, although there is still a dearth of data on its use. We, therefore, aimed at carrying out a study to evaluate the functional outcome and knee stability results of ACL reconstruction using PLT graft. Patients and Methods: Patients with a completely torn ACL were included in the study. The PLT was harvested, and graft length, thickness, and harvesting time were noted intraoperatively. Knee stability and functional scores were evaluated clinically and using Lachman test (primarily) and KT-2000 arthrometer and subjectively with International Knee Documentation Committee (IKDC) score at 6, 12, and 24 months (secondary outcome) postoperatively. Ankle scores were also recorded by making use of American Orthopedic Foot and Ankle Score (AOFAS)–Hindfoot Scale. Results: Forty-eight patients met the inclusion criteria. The graft harvest time was 7.4 min (5–9 min). The mean thickness of the graft on doubling was 7.9 mm (7–9 mm). Ninety-six percent of the patients were satisfied with their results of the knee surgery, and 95% of the patients had no complaints of ankle joint. The mean IKDC score postoperatively was 78.16 ± 6.23, and the mean AOFAS score was 98.4 ± 4.1. None of the patients had any neurovascular deficit. Conclusion: ACL reconstruction using PLT graft yields a good functional score (IKDC, KT-2000 arthrometer) even at 2-year follow-up. It is a safe and effective autograft option for ACL reconstruction.

Background: The aim of the study was to evaluate results of hybrid fixation technique (radius nailing and ulna plating) in closed proximal radius and ulna fractures in adults. The hypothesis behind hybrid fixation is to provide rigid fixation and restoration of forearm length, by ulna plating and large diameter square nail in radius gives rotational stability without any posterior interosseous nerve palsy in proximal radius and ulna fractures. Closed nailing of proximal radius avoid posterior interosseous nerve palsy which has high probability in open surgical approach. Materials and method:We prospectively evaluated 25 patients with closed proximal radius and ulna fractures. 20 males and 5 females with mean age of 30.7 years underwent closed reduction and intramedullary nail fixation in radius and open reduction internal fixation in ulna with plating. The fractures were classified according to the AO/OTA system. The average follow up was 1 year (range 6 months -18 months). Results:The average time to union was 12.77 weeks (10-14 weeks). Union was achieved in all 25 patients in both radius and ulna. Using the Grace and Eversmann rating system7 patients were excellent, 16 good, 1 acceptable and 1 unacceptable results. Using Andersons scale 23 patients had an excellent, 2 unsatisfactory, 0 failure. None of the patients had intraoperative as well as postoperative complications and no posterior interosseous nerve palsy occurred in any of case. Conclusion: Closed reduction internal fixation with use of Hybrid fixation modality in closed proximal radius and ulna fractures has good results. Rigid fixation by ulna plating and rotational stability in radius by large diameter square nail provides almost the same construct as with dual plating with minimal invasive approach. Complication rates are lower as compared to plate osteosynthesis especially with similar union rates in terms of posterior interosseous nerve palsy.

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The anterior cruciate ligament is the weaker of the two cruciate ligaments stabilizing the knee joint, and therefore gets torn easier than the posterior cruciate ligament. Reconstruction of ACL and restoration of musculoskeletal function is a fundamental goal of orthopaedic treatment. This study was conducted to determine pattern of anterior cruciate ligament injury and its management in a tertiary care center and to assess the long term outcome of knee function after anterior cruciate Ligament reconstruction. 28 patients with ACL injury were included. In this study. A detailed history regarding the pattern of injury was noted and ACL reconstruction was done using BT Bone graft with mini-arthrotomy and arthroscopic assisted ACL reconstruction. The clinical follow-up evaluation was done following the surgery and postoperative rehabilitation. International Knee Documentation Committee (IKDC) and Lysholm Score were used to assess the functional outcome. The mean age of the study subjects was 30.6±7.3 years and majority were males. Majority of the ACL injury was sports related and was on the right knee. 64% underwent arthroscopic assisted ACL reconstruction; majority of them had normal range of motion of the knee. According to the IKDC rating scale, 80% of the patients had normal or nearly normal final outcome. The mean Lysholm score was 80. About 10 of the patients had anterior knee pain, as classified by the IKDC. Patients with early reconstruction had less degenerative changes in the tibiofemoral joint, were subjectively more satisfied to the result, and could return to the pre-injury level of activities. Our present study concludes that most common age group involved was 20-30 years and ACL injury was more common among males. Patients with an early ACL reconstruction were more satisfied with the end result. Also, ACL reconstruction techniques using BTB auto graft leads to good ligamentous stability and function of the knee. Mild anterior knee pain and osteoarthritis after reconstruction was a common finding.

AC joint dislocation is a common shoulder injury confronted by an orthopaedic surgeon as a diagnostic as well as therapeutic challenge. Still there is no gold standard treatment and no sufficient evidence from randomized control trial to guide for the treatment. Many fixation methods were studied, used and rejected as per experimental and clinical evidences. Aim of our study in this path is to assess functional outcome and complications of mini invasive double endobutton for the treatment of acute ACJ dislocation grade III and V in means of Constant score. Material and Methods: Anatomical reconstruction was done in 23 patients by using double endobutton and polyester no. 5 suture assembly with minimum follow up of 12 months. Constant score was used for functional outcome. Results: Twenty three patients were operated for acute ACJ dislocation. Loss of reduction was noted major complication in 5 patients and superficial infection occurred in 1 patient. Constant score at final follow up was 91.17. Conclusion: Double endobutton is an impressive modality to treat acute ACJ dislocation with high functional scores and low complications.

The hip allows mobility of the entire extremity in 3 planes. Therefore any little derangement in the anatomy of the hip can affect it's functioning and can cripple & severely affect daily living of the person. The most common causes of disability are trauma and degenerative disease, and till date the most successful2 treatment for joints severely damaged has been replacement by artificial parts. Today replacement arthroplasties are very commonly performed by orthopedic surgeons the world over. In India too this procedure has gained wide acceptance among both surgeons and patients. The primary goal of this procedure is to restore normal anatomy of the hip joint so as to provide painless free mobility with a stable hip, and immediate functional outcomes of this procedure are very satisfactory. Technically there is little debate that the results of revision procedure are less satisfactory and the primary THR offers the best chances of success. Therefore it would be rational to assess and eliminate the human/iatrogenic factors that would-be influencing and jeopardizing the longevity of the implant since such surgeries in Indian patients are mostly once in a lifetime job. Also since the indications of arthroplasty have expanded and more surgeries are being done, so there is a statistic increase in the percentage of loose implants, which ever the reason. Although definite evidence and impact of loosing manifests late but the parameters reflecting the causative factors can be detected early in the form of altered anatomy and function. And repetitive cyclical loading of the implant in an unfavorable mechanical environment will over time, ultimately build up to a negative result.