Objectives: To compare the outcomes of patellar replacement and patellar neurectomy in Patients undergoing Total Knee Replacement . Materials & Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. Total 30 Patients were enrolled in this study and they were divided into two groups. Group A constitutes of 15 Patients underwent Post tibial neurectomy. And Group B consisting of 15 Patients went through Tibial Resection. All the patients have been assessed through the Tinel test on the painful area and self-administered Patient-Reported Outcome Measurements (PROMs): Patellar replacement also known as patellofemoral arthroplasty, is a surgical procedure that is performed in conjunction with total knee replacement (TKR) to relieve pain in the knee joint caused by patellofemoral arthritis or other conditions affecting the patella. All the patients of Group B were given anesthesia to numb the area. An incision was made in front of the knee to expose the patella and surrounding structures. Removal of the patella: The patella was carefully removed from the knee joint. The underside of the patella was reshaped to fit a prosthetic component that was implanted in its place. The patellar component was attached to the reshaped surface of the patella using bone cement. The patella was repositioned in the knee joint and attached to the femur using sutures. The incision was closed using sutures or staples. The goal of patellar replacement is to reduce pain and improve function in the knee joint. All the group A participants went through Patellar neurectomy. Patellar neurectomy is a surgical procedure that involves cutting or removing the nerve endings that supply sensation to the patella. Results: Total 30 Patients participated in this study. In Group A =15 Patients who underwent patellar Neurectomy and 15 Patients in Group B who experienced Tibia Resection. Total 5 months follow up was done. Group B participants showed excellent Results. NRS score decreased to 0 in Group B. While in patellar Neurectomy group A two patients experienced still moderate pain, Remaining 13 patients although did not experienced pain but felt numbness on limbs. Practical Implication: Patellar neurectomy involves cutting or removing the nerve endings that supply sensation to the patella, interrupting the transmission of pain signals from the patella to the brain. Although it is less time consuming but can cause numbness or altered sensation in the skin over the patella, which may affect the patient's quality of life Does not address underlying patellar instability or misalignment, which can still cause pain and functional limitations Can be associated with a risk of complications such as neuroma, infection, stiffness. Conclusion: Patellar Resection with TKA has better outcomes than Patellar Neurectomy. Patellar denervation with electrocautery is effective in reducing pain and opioid consumption after total knee replacement. Postoperative range of motion is significantly better in patellar denervation group, which means that patellar denervation significantly improves clinical outcome Keywords: Total Knee Replacement, Patellar Replacement, Neurectomy, Neurectomy, Tibia Resection, Pain, Prosthesis

Objective: Treatment of Schatzker Type 6 fractures is to use a posteromedial buttress plate as part of a double-column fixation technique. Materials & Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. patients with posterior medial fracture of Schatzker type 6 and having associated damage of some soft tissue present within the joint underwent surgery at our institutional operation theatre. In this Study setting we included total 20 patients (14 male [70%] and 6 females [30%]) who came with Bicondylar fractures having Comminuted Posteromedial Fragments of tibia. Results: Of the Patients, 12 (60%) had excellent results, 5(25%) had good results , and 3 (15%) had fair results. In total, 17 patients (85%) achieved cheering results. Walking, Stability, and motion were good or excellent in all cases. Practical Implication: One of the main advantages of the posteromedial buttress plate fixation technique is that it provides support to the medial column of the tibia, which is an important weight-bearing structure in the lower extremity. By restoring the structural integrity of the medial column, the technique can help promote early weight-bearing and facilitate early rehabilitation. All displaced posteromedial tibial plateau fractures should be surgically stabilized and buttressed using plate to restore joint congruity and prevent late subluxation and early arthritis. The aim is to study the role of posteromedial plating in the management of complex tibial plateau fractures with a posteromedial fragment Conclusion: Use of a posteromedial buttress plate as part of a double-column fixation technique can be an effective approach for treating Schatzker Type 6 fractures. Keywords: Fixation of Posterior Column, Buttress plate, Schatzker 6 fracture

Aim: The purpose of this study is to measure the sciatic Nerve injuries in Total Hip Replacement after the old trauma of femur fracture more than 3 months. Materials and Methods. The design of this study was retrospective study design and this study was conducted at DHQ Teaching Hospital Gujranwala. Data was collected of Total 50 patients who underwent Total Hip Replacement following trauma of NECK of femur fracture. All Patients underwent through Total Hip Replacement surgery. Sciatic nerve traction injuries were noted. SPSS – 16 was used for statistical analysis of the data and for the calculation of the mean and SD. Mann-Whitney U test and Student's t- test were also used for the analysis of the mean and SD in consideration with the p-value of (< 0.05). Results: Out of 50 patients, 5 patient developed Sciatic nerve injuries and 1 developed Femoral nerve injury. Out of these 5 Patients, cause of sciatic nerve injury in 3 patients was formation of hematoma and the cause of 2 sciatic nerve injuries and femoral nerve injury was trapping of the nerve due to scarring. However, the outcome of 4 out of 6 (66.66%) patients was Good, 1 (16.66%) had satisfactory result while the one patient (16.66%) with sciatic nerve injury developed total paralysis with poorer prognosis. Practical Implication: Sciatic nerve traction injuries can occur as a complication of total hip replacement (THR) surgery, especially after old trauma such as neck of femur fracture that occurred more than 3 months prior to the surgery. Such injuries can result in significant pain, weakness, and other functional impairments that can affect the patient’s quality of life. Therefore, it is important for surgeons to carefully evaluate the patient’s medical history and perform appropriate diagnostic tests to identify the risk of nerve injury before THR surgery. Furthermore, during surgery, surgeons should use techniques to minimize the risk of nerve injury, such as careful placement of implants and avoiding excessive traction on the sciatic nerve. Early detection and prompt management of sciatic nerve traction injuries can help to optimize patient outcomes and prevent long-term disability Conclusion: Sciatic Nerve injuries are common in THR after trauma to the neck of femur. So, these must be ruled out and proper management should be done. Keywords: Total Hip Replacement, Femur Neck Fracture, Sciatic Nerve Injury, Trauma.

Objectives: Cementless hemiarthroplasty is advised because it reduces the risk of morbidity and mortality in older individuals who use cement. For older patients with high-risk clinical issues who had femoral neck fractures, we assessed the effectiveness of cementless hemiarthroplasty. Materials and Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. 48 patients, including 19 male and 29 female, with an average age of 88-years. using cementless hemiarthroplasty to treat patients with femoral neck fractures. 30 patients (62%) had porous-coated femoral stems, while 18 patients had modular femoral revision stems (38 percent). All patients had bipolar femoral heads. Following surgery, the follow-up radiologically was performed at yearly intervals. Results: The average number of followup years was 4.2. There were no hospital-related deaths among the patients. Six patients (12%) experienced medical difficulties during the period of follow-up, and 4-patients (8%) passed away. Due to acetabular degradation, only the 2 hips were changed to the total hip replacements. One patient was scheduled for a femoral revision due to a sinking of greater than 3 mm. No patients developed heterotopic ossification or acetabular protrusion. The HHA (Harris-hip average) score is 84. One patient experienced dislocation (2 percent). Practical Implication: The advantages of the cemented technique seem to be offset by its mortality risk and the advantages of the cementless option by its increased morbidity. Thus, in some of these very elderly morbid patients the orthopedic surgeon is faced with a dilemma regarding the correct surgical choice, which should be one that can promise pain relief and rapid resumption of function and, at the same time, prevent mortality and reduce morbidity Conclusion: An appropriate form of therapy for fractures in femoral neck in older individuals with risk of clinical issues, particularly those of the cardiopulmonary character, is cementless hemiarthroplasty. With this technique, after cemented hemi-arthroplasty the risk of fat embolism and hypotension is reduced. Keywords: Uncemented Bipolar Hemiarthroplasty, Uncemented Femoral Prosthesis, Hemiarthroplasty In Elderly, Cardiac Dysfunction, Femoral Neck Fracture.

Objectives: The purpose of this research is to evaluate and contrast the functional results of Dynamic Compression Plating and Interlock Nailing for Humeral Shaft Fractures. Material and Methods: The design of this study was a prospective observational study. This study was conducted in DHQ Teaching Hospital Gujranwala and the duration of this study was from October 2020 to December 2022. We evaluated a total of 60 cases after receiving ethics committee permission from our institute. In DHQ Teaching Hospital Gujranwala, a study on instances of humeral shaft fractures needing surgical intervention was conducted. Results: In the plating group, 76.7% of the cases had outstanding results, compared to 56.7% in the nailing group. Moreover, the nailing group had a worse overall result (13.4% vs. 10%). Conclusion: Locking plating and intramedullary nailing had statistically similar results for individuals undergoing surgical intervention for humeral shaft fractures. In terms of union and function, both provide excellent and favourable results, but the dynamic compression plating group had a higher percentage of positive results and a propensity for union. Keywords: Humeral Shaft Fracture, Intramedullary Nailing, Dynamic Compression Plating