Introduction: Open reduction and internal fixation is indicated in patients with displaced patella fracturesand loss of the extensor apparatus.Transverse fractures of the patella are commonly treated with modified tension band wire (MTBW). Loosening of the wires along with the implant construct and soft tissue irritation by the wires had already been reported. The newer technique, tension band wiring through cannulated cancellousscrews(TBWCCS) is soft tissue friendly and gives better stability.  Objective: The objective of this study is to compare the outcome of treatment of patella fractures by modified tension band wiring with k wires and tension band wiring through parallel cannulated cancellous screws in terms of union rate, functional outcome and complication rate. Methodology: We performed acomparative study between the two procedures from September 2017 to January 2019 at Nepal Medical College Teaching Hospital. Total of 40 patients, 20 in each groupware enrolled in the study.Allthe patients were followed at regular intervals. Time taken for radiographic union was recorded. Variables of Modified Hospital for Special Surgery Knee Score (MHSSKS) were recorded and graded till the last follow-up at 24 weeks. Complications of each procedure were recorded.The data was analyzed using SPSS version 16. Results: All fractures united at 12.20±3.03 weeks in MTBWgroup and 11.20±2.78 weeks in TBWCCS group. Complication rate was significantly higher in MTBW group. In TBWCCS group, 90% patients had good to excellent MHSSKS score whilein MTBW group, 75% had good to excellent results at 24 weeks. Pain during walking was significantly better in TBWCCS group.  Conclusion: On the basis of our study, tension band wiring through cannulated cancellousscrews is an effective method of treatment of patellar fractures.

Synovial chondromatosis in association with ankylosing spondylitis is extremely rare and has been reported only once before and this case report is presenting a similar case. The knee is the preferential site of involvement with involvement of the hip being reported sparsely. We herein report a case of a 52-year-old male who came with complaints of the lower back pain for 5 years and left hip pain for 1.5 years who was diagnosed with synovial chondromatosis of the hip joint with axial ankylosing spondylitis and was managed operatively. We here review briefly the clinical manifestations, pathogenesis, diagnosis, previously reported cases as well as treatment of synovial chondromatosis in patients with immune-mediated inflammatory arthritides. There should be a high index of suspicion to diagnose synovial chondromatosis in association with inflammatory arthritides. We also believe that surgical management is an effective method of treatment of an established synovial chondromatosis of the hip joint.

Introduction: Diabetic foot has been defined by the International Working Group on the Diabetic foot and World Health Organisation as a Diabetic patient’s foot, associated with neuropathy, ischaemia or both, which has lead to ulceration, infection and/or deep tissue destruction An association of diabetic retinopathy with risk factors of Diabetic foot ulcer has been seen. Hence it is important to assess diabetic patients for risk factors leading to diabetic foot and tally these risks with diabetic retinopathy to help early diagnosis and management of diabetic foot and diabetic retinopathy. Methodology: This is a community based survey of a cohort of randomly presented patients examined on a first come first service basis limited to maximum of 100 patients to be reviewed in a day in a free health camp in Jaishi Dewal, Kathmandu, Nepal. The data of the patients were noted in a proforma documenting risks of diabetic foot and diabetic retinopathy. Results: Out of the 82 patients reviewed in the medical camp 38 were diabetic (type 2) with a mean age of 60.29 years being more common in females. Risk of Diabetic foot did have a definite association with level of education more common in the lesser educated and occupation (commonest in housewives). Awareness of risk of diabetic foot was only among 39.5% of the diabetic patients. Diabetic retinopathy was also seen only among 18.4% of the diabetic patients, being more common in the educated. Conclusion: Education and awareness programmes towards diabetic foot protocol are important despite the level of education or occupation. In diabetic patients, it is important to screen for risks of diabetic foot especially if patient has a history of hypertension and also screen for diabetic retinopathy.