Background: Fractures around the trochanteric region of the femur are one of the commonest fractures encountered in orthopedics in elderly and young patients. In younger patients, the fractures usually result from high-energy trauma like RTA or fall from height and older patients suffering from a minor fall can sustain fracture in this area because of weakened bone due to osteoporosis. Methods: Forty-nine patients, aged above 40 years with closed intertrochanteric fractures who were operated using proximal femoral nail anti-rotation (PFN-A) were evaluated for functional outcome and analyzed for the technical problems and complications associated with surgery. Results: Nineteen patients were less than 60 years of age group and all patients of this group had excellent and good outcome. 25 patients who belonged to more than 60 years of age group of which 7 patients had fair and poor outcome and it was statistically significant (p=0.0139). Conclusion:Closed reduction and internal fixation using PFN-A is an excellent method of treatment for an intertrochanteric fracture, to provide rapid recovery and good functional outcome. Age is a significant predictor of final outcome following surgical treatment. Younger is the age better the outcome.

Background: Rotator cuff muscles play an important role in movements of the shoulder joint as well as in stabilizing the joint. The causes of rotator cuff tears are multifactorial. It can be due to degeneration or secondary to trauma. Rotator cuff repairs can be performed through either arthroscopic or open approaches. Complete arthroscopic Rotator Cuff repair have been promising and evolving. Methodology: Fifty patients between age of 25 to 80 who underwent arthroscopic repair of rotator cuff tears with single row technique using bioabsorbable anchors were analysed for functional outcome and the influence of age, gender and hand dominance as factors influencing functional outcome. The functional outcome of arthroscopic repair of rotator cuff tear with single row technique by using SPADI score and Constant shoulder score. Results: All the pre-op patients had poor score. After 3 months, 46 (92%) patients were having poor score and 4 (8%) were having fair score. After 6 months, 28 (56%) patients were having fair score, 11 (22%) patients with good and 11 (22%) patients with poor score. In 1 year follow up, 23 (46%) patients had good score, 22 (44%) patients were having excellent score, 4 (8%) patients with poor and 1 (2%) patients had fair score. Conclusion: Arthroscopic rotator cuff repair with single row technique demonstrates significant reduction in pain and improvement in shoulder function during medium term follow up. We found that age, gender and association of hand dominance are not significant predictors of outcome of surgery.

Tubercular dactylitis, defined as Tubercular osteomyelitis of the short tubular bones of the hand and feet is an uncommon condition seen predominantly in children. The condition is characterised by cystic expansion of the bone due to filling up of the medullary canal with granulation tissue and pus and thinning of the overlying cortex, a condition radiologically termed as 'spina ventosa'. We report a case of a 10-year-old girl who presented with a painful, slowly progressive swelling of two months' duration in the index finger of right hand, without any associated history of trauma. The plain radiographs of the hand showed extensive destruction of the proximal phalanx of index finger with thinning of the overlying cortex. Magnetic Resonance Imaging (MRI) showed diffuse enlargement and focal cortical break in the proximal phalanx with thick organised fluid in the medullary canal with a small area of cortical breech. The finger was debrided and the digit stabilised by a K-wire which was removed at three weeks. Biopsy of the debrided material confirmed the clinical diagnosis of Tubercular osteomyelitis. The child was started on anti-tubercular drugs with aggressive mobilisation of the finger at three weeks. At one-year follow-up, the lesion had healed well with functional range of movements of the right index finger.

Background: Arthroscopic reconstruction of torn ACL using the quadruple hamstring auto-graft has become the gold standard in treating ACL tears due to its robust stiffness & compatibility with contemporary surgical & fixation techniques. Recently, graft diameter has received increased focus as a source of ACLR failure. A higher failure rate for the reconstructed ACL with grafts smaller than 8 mm in diameter have been noted. Preoperative prediction of the sufficiency of the hamstring graft size for ACL reconstruction would be useful in order to plan alternative graft choices & alternative fixation methods to ensure the graft diameter is minimum 8mm. However, currently there is no well documented standard to accurately predict the diameter & length of quadruple hamstring auto-grafts for ACL reconstruction and existing studies present controversial findings. Materials & Methods:The prospective study consists of 191 patients who had undergone Arthroscopic ACL reconstruction using quadrupled hamstring auto-graft at the Department of Orthopedic Surgery, Manipal Hospital, Bangalore, from January 2011 to May 2015. Several anthropometric preoperative measurements were obtained for each patient including height, weight, BMI, thigh length & thigh circumference. Activity was assessed using the Tegner activity score. A sub-group of patients (44 out of 191), whose MRI of the affected knee was performed in our institute has been included in the study. In these patients, MRI studies were performed using a standardized protocol. Results: In our study, there is no correlation between weight, thigh circumference, activity level & BMI when correlated for males & females combined. There is a positive correlation with height in both males & females when considered separately. Taller patients tended to have thicker quadrupled hamstring grafts. However, weight, thigh circumference, BMI, activity level & CSA of combined ST+GT did not correlate with graft thicknes. There is a positive correlation with MRI measurement of CSA of combined GT+ST graft thickness when measured combined for both sexes. There is a positive correlation with individual CSA of GT & ST with graft thickness when measured combined for both sexes. The regression equation that allows prediction of graft thickness based on individual MRI measurement of CSA of GT & ST is GRAFT THICKNESS= (0.2105) CSA OF GT+ 6.8684; GRAFT THICKNESS= (0.0973) CSA OF ST + 6.9645 Conclusion: Our study overwhelmingly concludes that height is the most reliable single predictive parameter for graft diameter & length, both for males & females. MRI done by a standardized protocol is an excellent pre-operative predictor of graft size. Thigh length showed a positive correlation with graft diameter in the combined male & female group & in males & females considered separately. Other anthropometric parameters including body weight, BMI & thigh circumference have no predictive value with regard to graft diameter & length. Preoperative activity level failed to demonstrate a positive correlation with graf...

Results: This study comprised of 25 patients and followed for minimum of 6 months. Success rate is 100 %, with 92% graded as excellent to good and rest 8 % with fair functional results. Conclusion: We conclude that Anterior Cruciate Ligament reconstruction with quadrupled semitendinosus graft has good functional results and high success rate.