Context Increased bone fragility and reduced energy absorption to fracture associated with type 2 diabetes (T2D) cannot be explained by bone mineral density alone. This study, for the first time reports on alterations in bone tissue's material properties obtained from individuals with diabetes and known fragility fracture status. Objective To investigate the role of T2D in altering biomechanical, microstructural and compositional properties of bone in individuals with fragility fracture. Design Femoral head bone tissue specimens were collected from patients who underwent replacement surgery for fragility hip fracture. Trabecular bone quality parameters were compared in samples of two groups: non-diabetic (n=40) and diabetic (n=30), with a mean duration of disease 7.5±2.8 years. Results No significant difference was observed in aBMD between the groups. Bone volume fraction (BV/TV) was lower in the diabetic group due to fewer and thinner trabeculae. The apparent-level toughness and post-yield energy were lower in those with diabetes. Tissue-level (nanoindentation) modulus and hardness were lower in this group. Compositional differences in diabetic group included lower mineral:matrix, wider mineral crystals, and bone collagen modifications - higher total fAGEs, higher non-enzymatic-cross-link-ratio (NE-xLR), and altered secondary structure (Amide bands). There was a strong inverse correlation between NE-xLR and post-yield-strain, fAGEs and post-yield energy, and, fAGEs and toughness. Conclusion Current study is novel in examining bone tissue in T2D following first hip fragility fracture. Our findings provide evidence of hyperglycemia’s detrimental effects on trabecular bone quality at multiple scales leading to lower energy absorption and toughness-indicative of increased propensity to bone fragility.

Neglected fractures of the femoral neck, common in young adults in underdeveloped countries, may be complicated by nonunion or avascular necrosis (AVN). We treated 52 cases by open reduction, fixation by compression screw and a free fibular graft. The mean delay between injury and operation was 5.1 months. Of 40 fractures assessed at a mean of 58.8 months (24 to 153), 38 were found to be united and two, owing to surgical errors, were not. Seven of eight heads which were avascular before operation revascularised without collapse, while seven others developed AVN after the procedure. At the last follow-up considerable collapse was apparent in five femoral heads, and 11 hips had developed coxa vara. The fibular graft had fractured in four cases. The hip had been penetrated by the screw in six cases and by the graft in three. Hip function was excellent in seven patients, good in 21 and fair in seven. Five patients had poor results. Incorporation of the fibular graft was seen after four years: in many cases the graft had been almost completely resorbed. We recommend this procedure for the treatment of neglected fractures of the neck of the femur in young adults to reduce resorption of the neck, AVN and nonunion.

The intra-articular PRP injection is an effective treatment modality in low back pain involving SIJ.

Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. Being rare in foot and ankle, the unusual presentation of this lesion may sometimes mimic other lesions like lipoma, synovial sarcoma, malignant fibrous histiocytoma, synovial cyst and ganglion. Hence it is important to include this lesion in differential diagnoses especially if the lesion is found to be anchored to any of the surrounding tendons. This article describes the unusual occurrence of giant cell tumour of the tendon sheath of peroneus brevis which is rarely described in literature.

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N eglected fractures of the femoral neck, common in young adults in underdeveloped countries, may be complicated by nonunion or avascular necrosis (AVN). We treated 52 cases by open reduction, fixation by compression screw and a free fibular graft. The mean delay between injury and operation was 5.1 months. Of 40 fractures assessed at a mean of 58.8 months (24 to 153), 38 were found to be united and two, owing to surgical errors, were not. Seven of eight heads which were avascular before operation revascularised without collapse, while seven others developed AVN after the procedure. At the last follow-up considerable collapse was apparent in five femoral heads, and 11 hips had developed coxa vara. The fibular graft had fractured in four cases. The hip had been penetrated by the screw in six cases and by the graft in three. Hip function was excellent in seven patients, good in 21 and fair in seven. Five patients had poor results. Incorporation of the fibular graft was seen after four years: in many cases the graft had been almost completely resorbed.We recommend this procedure for the treatment of neglected fractures of the neck of the femur in young adults to reduce resorption of the neck, AVN and nonunion.

Radiological assessment is a valuable tool in the assessment, management and prognostication of Perthes disease. Radiological assessment, however, is not an easy task and all classification systems used in Perthes disease have some degree of interrater and intrarater variabilities. In the past, there were some isolated studies to find the reliability of the classifications used in Perthes disease. In this study, we comprehensively studied three most commonly used radiological classifications (Salter-Thompson, lateral pillar and Catterall). We had 44 patients' radiographs (anteroposterior and lateral) taken in the fragmentation stage, and two experienced observers assessed and classified the radiographs on two separate occasions. In this study, we found that the average interrater reliability of the Salter-Thompson, lateral pillar and Catterall classifications was 0.163 (0.08-0.236), 0.722 (0.581-0.824) and 0.433 (0.280-0.546), respectively. The intrarater reliability was 0.313 and 0.699 for the Salter-Thompson, 0.707 and 0.658 for the lateral pillar and 0.38 and 0.577 for the Catterall classifications. Further, we tried to determine the possible reason for the low reliability associated with the Catterall classification. We think that the quantitative method of lateral pillar has better intrarater and interrater reliabilities than other classification systems, and the reliability of the Catterall classification can be significantly improved if some radiological parameters such as metaphyseal reaction and identification of the junction of involved to uninvolved region can be optimized.

Knee dislocations are rare injuries. Posterolateral knee dislocations are only a small subset of them. There is a paucity of literature regarding the management of such neglected cases. We report here, a case of neglected irreducible posterolateral knee dislocation treated with open reduction and isolated posterior cruciate ligament reconstruction followed by gradual rehabilitation with good outcome at 3 years followup.