<p class="abstract"><strong>Background:</strong> Distal femur is a complex fractures and most of times a personalized approach is needed for these fractures. Over a period of time variety of approaches and implants have been used for these fractures. The use of retrograde femur nail for fixing femur fracture, using entry from inter-condylar notch of femur, is a known method of treatment, but most surgeons are apprehensive of making an entry from the knee joint because of possible complications like knee pain, arthro-fibrosis, infections etc .The aim of this study was to investigate its effectiveness in fixation of distal 1/3^rdfracture of femur with special emphasis on the outcome and inherent surgical challenges<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study of 40 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from July 2010 to January 2016, after obtaining required approval from the Institutional ethical &amp; research committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that mean age of patients was 35.8 years (18 years to 62 years) where 87.5% were male and 12.5% were female. Average duration of healing was 17.75 weeks (ranging from 10 weeks to 36 weeks) with 100% healing achieved. Mean knee range of motion was 124.5 degree (70 to 140 degree), rate of knee pain 10% (4/40), re-operation rate 5% (2/40), infection rate 2.5% (1/40), and fat embolism 2.5% (1/40)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Retrograde femoral nailing is a reliable alternative to antegrade nailing or plate fixation for diaphyseal fracture distal one third femur, and may be in some situations even advantageous when antegrade nail entry is challenging like ipsilateral hip fractures, previous implant in hip &amp; proximal femur, ipsilateral pelvi-acetabular injury, bilateral femoral shaft fracture, floating Knee injuries, poly-trauma and obese patients<span lang="EN-IN">.</span></p>

No abstract

Covid-19 can disrupt a person’s circadian rhythm, which can impair his sleep, leading to insomnia and snowball into depression, anxiety and other cognitive changes, not infrequently a panic disorder .Present pandemic also witnessed the shortage of essential medicines including oxygen ,unavailability of intensive care beds ,making the patients and attendants panicky, alike. It has been observed that all the efforts are being put forth to understand the epidemiology, clinical symptoms, transmission patterns and the management of the covid-19 outbreak ,but there has been a little concern put forward over the traumatizing effect on one’s mental health. This pandemic witnessed the utter paucity of qualified medical personnel to serve in wards hence forcing physiotherapy students and interns to compliment their medical counterparts. We understood the need of psychological counselling for these admitted patients and we deputed physiotherapists to render the same. The benefit of counselling was quantified as the fall in the incidence of weekly panic attacks. This study was undertaken to evaluate the efficacy of physiotherapists posted in covid wards in reducing the panic attacks, since physiotherapist do have a basic knowledge of the psychology as a subject and they usually also have ample spare time in the wards, after they have completed their specialized duties. We studied 552 admitted patients of covid-19 in two medical colleges, identified patients with frequent panic attacks, who were then counselled psychologically. The effects of counselling sessions were observed for average 7 days of admission. We found on an average 64% fall in the number of panic attacks in the psychologically disturbed patients. We hence conclude that the physiotherapists posted in the covid wards should also be utilized in rendering psychological counselling to minimize occurrence of the panic attacks. Keywords: psychological, physiotherapists & Covid.

No abstract

Xantho-granulomatous inflammation is a rare type of chronic inflammation, when seen in the bones it is known as xanthogranulomatous osteomyelitis (XO). Here we present a rare case XO of the manubrium sterni, to best of our knowledge this is the first diagnosed. XO of the manubrium sterni mimics radiologically as tuberculosis and as eosinophillic granuloma. We have a 23 year old lady who presented with pain and swelling in the anterior chest, radiology was done and finally the lesion was biopsied. We accepted the patient as Xanthomatous Osteomyelitis and planned for into excision of manubrium sterni, with a flap comprising of ribs and muscle advancements to cover the midline gap in the chest wall, that would have been created. Meanwhile she was put on a short course of antibiotics. It had been observed that the first open biopsy scar had exhibited a tendency for keloid formation. Hence, the risk of final surgery incision producing a disfiguring keloid was informed to the patient, which unfortunately led the patient deter surgery indefinitely, since she was to be married soon. We proposed a local injection of steroid into the lesion to minimize the inflammation. Under image intensifier we injected 40 mg of methyl prednisolone into the tumor. There was some tolerable discomfort the next day of injection that eventually subsided in 3 days. However, the biopsy came inconclusive second core needle biopsy came as XO. Since 1984 with the first case by Cozzutto et al, only 17 cases have been reported in the worldwide literature including us.