These results suggest that even a 4-mm screw should be used carefully at the midthoracic level; 5-mm screw seems to be safe at upper and lower thoracic spine. Because of very small sagittal and transverse angle at mid and lower thoracic levels, the pedicular screw should be inserted along almost perpendicular line in these planes; 25-mm and 30-mm screw length appears to be safe at upper thoracic and lower thoracic levels, respectively. Pedicle entrance point lies along the midtrans-verse line at upper thoracic levels and along the upper border of transverse process at lower thoracic levels.

On the basis of this limited study in a subset of the Indian population, it appears that the transverse diameter and pedicle entrance point differ from those in the white population. The results suggest that a 5-mm screw would be safer in the upper lumbar levels (L1, L2), and 6-mm screw in the lower lumbar levels (L3-L5). The pedicle entrance point migrates laterally for lower lumbar levels, especially at L5. The medial pedicle cortex can be safely sounded while the pedicle is probed.

Thoracic spondylosis, better termed 'degenerative thoracic spine disease', is rare and failure to recognize it is mainly due to its rarity and to the complexity of symptomatology which can lead to prolonged and continued morbidity. During the past 4 years, the authors have treated 28 patients with thoracic spine degeneration with varied clinical manifestations, ranging from local pain, radiculopathy to radiculomyelopathy. In six patients, myelopathy developed gradually, four showing features of pseudoclaudication. Two had an acute onset of myelopathy after minor trauma. Radiological examination, including CT scans in a few patients, demonstrated face tal hypertrophy, ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. One patient had posterior osteophytosis of thoracic spine at multiple level. Surgical decompression for localised stenosis yields good results, but the prognosis for those with diffuse or segmental stenosis is guarded.

<p class="abstract"><strong>Background:</strong> Various modalities of fixation are available for management of distal end radius fractures. Assessment of the functional and radiological outcomes of intra-articular distal end radius fractures managed with volar locking plate was attempted with the present study.</p><p class="abstract"><strong>Methods:</strong> In this prospective interventional study, thirty adult patients with closed distal radius fractures with intra-articular extension were comprehensively evaluated and managed. Open reduction and internal fixation (ORIF) was performed via volar approach (modified Henry`s approach) using 2.7mm volar locking compression plates (LCPs). Patients were followed up at 2 weeks, 1 month, 3 months and 6 months after surgery. The patients were evaluated functionally by Mayo score and radiologically by Lidstrom classification.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 18 (60%) patients having excellent, 8 (26.7) good, 2 (6.7%) fair and 2 (6.7%) with poor result according to Mayo scoring. According to Lidstrom scoring, at the last follow up, 16 (53.3%) patients had excellent, 11 (36.7%) patients good, 2 (6, 7%) patients fair and 1 (3.3%) patient had poor result. The functional status of the patient improved significantly from at 1month (20±3.47) to 6 months post-operative follow up (23.67±2.91). The mean range of motion improved significantly at 1 month, 6 months and last post-operative follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Volar locking plate gives good to excellent clinico-radiological and functional outcomes in most of the fractures of the distal end radius with intraarticular extension.</p>

Introduction Classical characteristics of osteoarthrosis are reduction or loss of articular cartilage, new bone formation, accompanied by synovial proliferation resulting in pain, loss of joint function, and disability. Platelet rich plasma (PRP) has been used to provide stimulus for local regeneration and healing. The present study was conducted with the aim of evaluating the clinical outcome and efficacy of injecting PRP intra-articularly in early primary osterarthrosis knee. Objective Prospective study was conducted with the aim of evaluating the clinical outcome of efficacy of injection of PRP in early primary osteoarthrosis knee with respect to pain, stiffness, function and quality of life, in short-term follow-up. Attempt was made to standardize protocol and formulate PRP. Materials and Methods Patients were divided into two groups: one treated with two autologous PRP injections at 2 weeks interval and second received symptomatic treatment with physiotherapy. Patients were prospectively evaluated at baseline and then at 1 month, 3 months, and 6 months of follow-up using the visual analog scale (VAS) score, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, and range of movements. Results There was reduction in VAS score in group 1 patients compared with group 2 patients with the p-value <0.0001 which was highly significant. There was a significant improvement in WOMAC score at 1 month, 3 months, and 6 months in group 1 compared with group 2 patients. Conclusion Autologous PRP in osteoarthrosis of knee has emerged as a simple technique, sensitive procedure, and cost-effective treatment option. Administration of intra-articular PRP injections reduced the VAS score significantly and also a significant improvement in the WOMAC score was observed in patients who were treated with PRP injection. The two doses of injection of PRP were found to give adequate relief in short term of 6 months and further long-term studies are required.

Bone is a dynamic tissue that is remodelled constantly throughout life. The arrangement of compact and cancellous bone provides strength and density suitable for both mobility and protection. Osteoporosis is defined as a reduction in the strength of bone that leads to an increased risk of fractures. The World Health Organisation operationally defined osteoporosis as a bone density also referred to as a T-score of <–2.5 and is associated with increased risk of fractures. Bone remodelling is regulated by multiple hormones, including oestrogens (in both genders), androgens, Vitamin D and parathyroid hormone (PTH), as well as locally produced growth factors, such as IGF-I, transforming growth factor β, PTH-related peptide (PTHrP), interleukins, prostaglandins and members of the tumour necrosis factor superfamily. The risk of fracture can be predicted by the Fracture Risk Assessment score. Several non-invasive techniques are available for estimating skeletal mass or bone mineral density including single energy X-ray absorptiometry, dual-energy X-ray absorptiometry, quantitative computed tomography and ultra-sound. Total daily calcium intakes <400 mg are detrimental to the skeleton. The recommended daily required intake of 1000–1200 mg for adults accommodates population heterogeneity in controlling calcium balance. For optimal skeletal health, serum 25(OH)D should be >75 nmol/L (30 ng/mL). Bisphosphonates have become the mainstay of osteoporosis treatment. Calcitonin preparations are approved by the FDA for osteoporosis in women >5 years past menopause. Denosumab was approved by the FDA in 2010. Parathormone analogues augment trabecular bone mineral density and reduce fracture occurrence. PTH (1–34) (teriparatide) produced substantial increments in bone mass. Abaloparatide is a synthetic analogue of human PTHrP, which has significant homology to PTH and also binds the PTH Type 1 receptor increasing the bone mass. Ageing is associated with progressive decline in overall muscle strength and bone loss. Resistance training increases bone strength and density, reducing the risk of fracture during a fall. Increased levels of endurance, strength and balance with exercises increase the threshold for disability and dependence as we age. Inactive and sedentary lifestyle should be discouraged. Treatment accessibility could be improved and treatment adherence should be encouraged.

Background: Distal humerus fracture accounts approximately 2%-6% of all fractures and 30% of all elbow fractures, intra articular distal humerus fracture are rare accounting 0.5% of all fractures. These fractures had bimodal distribution, with respect to age and gender, with peaks of incidence in males aged 12 to 19 years and females aged 80 years and over. Methods: Patients were randomly divided into two groups, one undergoing perpendicular plating with 17 patients and the other parallel plating with 17 patients. Patients were followed up minimally for 12 months. Results: We observed that time of union for parallel plating method was 12.82 weeks and 12 weeks in orthogonal plating. In our study functional outcome based upon Mayo elbow performance score, in group 1 (Parallel plating) was excellent in 7 patients (41.17%), good in 6 patients (35.29%), fair in 4 patients (23.52%). Conclusions: In terms of arc of motion and stability a good to excellent functional outcome was achieved in >85% of the study group. In cases of osteoporotic and comminuted bones, a rigid construct must be achieved.