Background: Proximal Femoral Nail (PFN) provides tangible evidence for its usage in unstable pertrochanteric fractures. There are a veritable number of references which show that PFN by virtue of its intramedullary fixation reduces the tensile strain thereby mitigating implant failure. Ours is a prospective study done on 50 subjects to assess the outcome of PFN usage in unstable pertrochanteric fractures. Methodology: 50 patients with Jensen Michaelsen type III, IV, V intertrochanteric and reverse oblique fractures were included in the study. The reduction obtained intra operatively was assessed using the modified criteria of Baumgaertner. Follow up evaluations were done at 6, 12, 24 and 52 weeks thereafter. Clinical evaluation was done using the Mobility score of Parker and Palmer. Radiographic parameters like fracture union, screw slide and degree of varus collapse were also assessed. Statistical analysis was provided by Friedman test. Results: Jensen Michaelsen type IV was the most common pattern observed (44%). The mean pre-injury parker score was 8.4. Patients with reverse oblique fracture morphology, type V fractures and patients with osteoporosis were treated with Long PFN (19 cases). The mean operating time was 92 minutes (range 60 -180), and the mean blood loss during the surgery was 145 ml (range 100ml -320 ml). The reduction was good in 40 patients (80%) and acceptable in the rest. The average time taken for fracture union was 15 weeks. It was observed that patients reached their preoperative mobility score of Parker and Palmer by 6 months post-surgery which was statistically significant (χ2 = 217.642, p < .001). Discussion: Proximal Femoral Nailing is done through a minimally invasive approach not disturbing the fracture hematoma which is a vital in fracture consolidation. The biomechanics of intramedullary fixation in cases of destabilised medial cortex is optimised by medialization of the fulcrum point and resultant reduction of the bending moment with respect to proximal fixation. Fracture reduction was good in 80% cases and in 10 cases the reduction was acceptable with a mean varus malalignment of 13.2 degrees.The mean intraoperative blood loss of 145 ml in our series compares favourably with previously reported values in the literature. Most of the fractures in our series (66%) united by 12-14 weeks. The mean preoperative mobility score of Parker was 8.4, which was reached by patients on their 6 th postoperative month (p & lt; 0.001). Each period showed statistically significant improvement over the previous period as evident from the rank total of the scores and the critical ratio.

Robotic assisted total knee arthroplasty is one the recent advance to improve its outcome especially to address the issue of precision. Longetivity of TKA primarily depends on proper implant alignment. The Aim of this study is to compare the precision of robotic assisted TKA with the ideally planned mechanical parameters in TKA. A total of 50 robotic assisted TKA patients were included retrospectively in the study. Patient’s post operative mechanical femorotibial angle (mFTA), Lateral distal femoral angle (LDFA), medial proximal tibial angle (mPTA) in AP radiogram.and anterior femoral offset ratio, posterior condylar offset ratio, femoral component flexion, posterior tibial slope in lateral radiograms were evaluated with ideal values for specific parameter. Number of outliers were counted separately with values beyond 3 of malalignment. The mean postoperative FTA, LDFA, mPTA recorded is 0.15 ±0.70, 89.78±0.79, 89.80±0.86 respectively. The mean postoperative posterior tibial slope, femoral flexion is 3.03±0.35, 3.14±0.60 respectively. All the parameters when compared with planned ideal values (i.e. mFTA= 0, mPTA=90, LDFA=90, Posterior tibial slope=3, femoral component flexion=3) did not show significant difference. Study shows promising results with near normal execution of planned TKA. Robotic assisted TKA can be a game changer and a handy tool to improve the alignment of mechanical axis in TKAs.

Introduction: Treatment of intertrochanteric fracture in elderly is not only to mobilise early but also to avoid complications and morbidity. With available treatments it is difficult to address all the issue with same surgical option. A recent advance for treatment of senile unstable intertrochanteric fracture is PFN antirotation which may help in early mobilisation with less complications. The purpose of this study is to compare the outcome of PFNA and hemiarthoplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA group and hemiarthroplasty group from January 2016 to January 2017 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthoplasty groups have better harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA provide less morbidity to patients with early mobilisations and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture.

<p class="abstract"><strong>Background:</strong> With growing demand on quality of life, there is drastic increase in total knee arthroplasty (TKA) surgeries and accordingly there is increase in research on TKA design to get the best possible outcome. Commonly known TKA designs are PCL substituting or retaining, fixed bearing or mobile bearing. Now the scientific research shifted to center of rotation of angulation (CORA) of knee i.e. medial or lateral pivot. 3D knee is based on lateral pivot system and designed to match the natural knee. The purpose of this study is to compare 3D knee with cruciate retaining (CR) knee functionally and also to assess the patient’s level of satisfaction.</p><p class="abstract"><strong>Methods:</strong> 20 patients each included in 3D knee and CR knee group from June 2016 to June 2018 who satisfied the inclusion and exclusion criteria. Patients were followed up for 1 year. Their functional outcome assessed using knee society score (KSS) part 1 and 2. Also patient’s knee range of motion documented separately.<strong></strong></p><p class="abstract"><strong>Results:</strong> Postoperatively there is improvement in knee society score in both the groups. 3D knee showed significant better KSS score than CR knee groups in first 3 months but as the patients followed up for 1 year both groups reached similar KSS score and also similar knee range of motion.</p><p class="abstract"><strong>Conclusions:</strong> 3D knee showed satisfactory outcome when compared with CR knee and definitely provides a step ahead in search of natural knee.</p>

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