<p class="abstract">A 7-year-old patient presented with acute onset spontaneous common peroneal nerve (CPN) palsy due to osteochondroma of fibular head. Osteochondroma was excised resulting in complete neurological recovery. As per our knowledge, this is the first case of an acute onset CPN palsy in a child due to osteochondroma. 14 studies reporting patients with CPN palsy due to osteochondroma were analyzed. Of 24 patients reported with this condition in literature, 19 (79%) recovered completely from CPN palsy. Incomplete recovery after surgery was associated with a longer mean duration between symptoms and surgery (26 months versus 5 months for complete recovery).  </p>

Treatment of stiff, arthrofibrotic knee is challenging for the orthopedic surgeon, physiotherapist and for the patient. Various treatment modalities exist from conservative physical therapy, manipulation under anesthesia to surgical management with variable outcome. Our study aims to analyze the outcome of such knees with arthroscopic arthrofibrolysis and also its co relation to etiology and interval between treatments. Our study is analysis of 22 case of stiff knee which were treated with arthroscopic arthrofibrolysis. Analysis was done by using modified Blauth and Jager scoring system. As per Modified Blauth and Jager Scoring, 14 cases (63.6%) had grade IV decrease in range of motion preoperatively, 8 cases (36.4%) had grade III (severe) and none were in grade II (moderate) or grade I (mild). Out of 14 patients who had preoperative Score of IV, 10 improved to Score III and 4 had score II postoperatively at 6 months, which was significant (P<0.001). Similarly, all 8 patients who had preoperative score of III has significant improvement to score II postoperatively at 6 months (P<0.001). All patients had a range of flexion limited to less than 70 0 preoperatively. The mean flexion was 34.77 0 ± 21.70 0 preoperatively, improved to 86.36 0 ± 19.47 0 post-operatively at 6 month. 15 out of 22 patients (68.18%) had a range of flexion 90 0 and above postoperatively at 6 months, with mean gain in flexion 51.591 0 (P<0.001). In our experience arthroscopic treatment of fibroarthrosis in the knee joint is a successful procedure. The goal of arthroscopic fibroarthrolysis is primarily to provide functional range of motion. However, our experience showed that the function of the joint can be improved even in cases with complex pathologies and after a prolonged interval between treatments.

Failed surgical treatment of hip fractures presents a significant challenges in elderly osteoporotic population typically leads to profound functional disability and pain. Revision internal fixation and a salvage treatment with hip arthroplasty are two accepted treatment options. The purpose of this study was to assess the intra operative difficulties encountered and to evaluate the functional outcome of hip arthroplasty performed after failed internal fixation of intertrochanteric (IT) and fracture neck of femur (NOF). 20 patients with failed internal fixation (June 2012 to October 2013) were enrolled and operated during the study period. Functional assessment was done using the Harris Hip Score (HSS) and complications, if any, were documented. There were 11 cases (55%) with failed IT fracture and 9 cases (45%) of failed fixation of NOF fractures. Total hip replacement (THR) was performed in 13 patients (6 cemented and 7 uncemented) and bipolar hemiarthroplasty was done in 7 patients (4 cemented and 3 uncemented). The mean time interval to failure was 3.31 years (SD ± 3.17). The Harris hip score improved from preoperative 32.95 (SD ± 7.54) to 77.80 (SD ± 9.22) at final follow up which was significant (p < 0.001). Also the mean difference of improvement in preoperative Harris hip score and any postoperative score or between any two successive post-operative Harris hip scores was significant (P value <0.001).Complications were seen in 8 of 20 cases (7 I/T group and 1 NOF group). Mean HHS was higher in NOF group than I/T fracture group preoperatively as well as at final follow up (P value 0.003 preoperative and 0.013 postoperative). Our conclusion is that hip arthroplasty is an effective salvage procedure after failed fixation of proximal hip fractures despite the technical challenges and complications associated with it.

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation