Elbow fractures with dislocation are a challenge to treat and are associated with poor clinical outcomes as outlined in the literature. The terrible triad of the elbow is a combination of radial head fracture, coronoid process fracture, injury to collateral ligaments, and posterior dislocation of the elbow. The involvement of osseous and chondral supports around the elbow are considered as the variants in the terrible triad of elbow. We are reporting a brief review on such terrible triad variance of the elbow including cases who underwent management at our institute and a glimpse on other globally reported cases of similar variance. As it is necessary for the treating clinicians to get well-versed with such injuries, which can be easily missed during evaluation. The data available on these entities are limited and there is a further need to educate the clinicians regarding the same and its implications on the patients.

Background: With Most patients with Osteoarthritis needing bilateral TKR for optimal functional results, the debate on whether to do a single stage bilateral TKR or staged bilateral TKR has become common. The aim of this study was to review the safety of single stage bilateral TKR done in our institution. Materials and Methods: We did a retrospective review of 127 cases of single stage bilateral TKR that was done in our institution during a period of 38 months from 2015 to 2018.Electronic medical Records of patients who underwent single stage Bilateral TKR during this period were reviewed. Only patients who received cruciate retaining prosthesis and had subvastus approach were included. Results were analysed using Chi square testing in terms of ASA grade and age and incidence of complications. Results: ASA grade and age was seen to be correlating with incidence of complications during the intraoperative and immediate postoperative period. The incidence of complications was 42.9% in the ASA-III group with p value less than 0.00001. The Incidence of complications was 16 % in the above 70 years age group with P value less than 0.00982. In the ASA-III group, the incidence was 50% in the above 70 group when compared to the 60-70 group (40%) with P value of less than 0.00001. Conclusions: Judicious patient selection using ASA grade and age may minimise complications of single stage bilateral TKR. The use of Cruciate retaining prosthesis and subvastus approach may have contributed to the low incidence of complications.

Total knee arthroplasty is the leading surgical treatment for advanced osteoarthritis of the knee. Despite its efficiency, approximately twenty percent of the cases are dissatisfied with the outcome. Mal positioning of components results in loosening which has long-term consequences. As a result, proper sizing and placement are important for optimal functional and long-term outcomes. Achieving limb alignment, good soft tissue balance and pain relief are the primary goals of the surgeon upon completion of total knee replacement (TKA). The aim of this study was to determine the accuracy of placement of femoral and tibial components post operatively in relation to knee alignment using roentgenographic index. This is a prospective study conducted in a tertiary care referral hospital, we included a total of fifty cases who underwent total knee arthroplasty from the year 2019 to 2020. Post operative radiographic parameters were measured using digital software and compared using roentgenographic indexes as described by Lotke et al. Out of the fifty Total Knee Arthroplasty cases, twenty-eight knees had perfectly positioned tibial and femoral prosthesis, fifteen cases had good position of both the components. Tibial component alignment angle (β = 90°) in relation to mechanical axis in coronal plane was seventy six percent; fourteen percent of the cases were in native knee varus. Femoral component alignment angle (α) with acceptable anatomical valgus (0-7°) were more than eighty percent of the cases. 85.5 was the mean roentgenographic index which was strongly correlatable with other similar studies. With good clinical acumen and using conventional alignment system, near to normal knee alignment in total knee arthroplasty is achievable.