Background: Calcaneum is the most common tarsal bone fractured. The treatment is difficult and rehabilitation can be time-consuming, and still the outcome is highly unpredictable. This makes calcaneal fractures a huge socio-economic burden to society. This made us search for a variable, like Bohler's angle, which we could relate with functional outcome in patients with intra articular calcaneal fractures. Material and method: 42 patients who had intra-articular fracture of a calcaneum were selected. All the patients were investigated preoperatively with x-rays and CT scanning. The Bohler's angle was calculated on the lateral radiograph manually with the help of goniometer and a record was prepared for future references. Randomization was done and all patients were managed with open reduction and internal fixation with plate with or without bone graft. Bohler's angle was measured post operatively and at follow up on 4 weeks, 6 weeks, 8 weeks and after 3 and 6 months and 1 year. Assessment of the patient with Functional recovery was done with American orthopaedic foot and ankle score (AOFAS) minimum 6 months after injury. Result: Our study of 42 calcaneal fractures confirms that there is statistically significant difference between the functional outcome of patients regarding correction of the Bohler's angle obtained during surgery. When Bohler's angle is restored within normal limits, in an operated calcaneus fractures, fewer complications and statistically significant better results were observed. We also confirmed that autologous bone graft is beneficial in achieving and maintaining restoration of calcaneal height and anatomic reduction. Conclusion: In view of the excellent results obtained with restoration of Bohler's angle, we advocate the use of Bohler's angle as a key to achieve excellent result in displaced calcaneal fracture and also use of autologous bone graft in achieving and maintaining normal Bohler's angle.

Introduction: Giant cell tumour (GCT) is a benign osteolytic, locally aggressive lesion. Seen in young adults at the epiphysis. The most common site is long bones (85-90%). GCT of the metatarsal in elderly patients is very rare. Case Report: A 60-year-old male came with complaints of pain and swelling over right foot dorsal aspect since for the last past one 1 year. There was no history of trauma. X-ray foot showed an osteolytic lesion in the right third metatarsal with thinning of the cortex. MRI and fine-needle aspiration cytology confirmed the diagnosis of GCT. The patient was managed by excision with the 3rd ray amputation. At present, 1.5 years follow-up, the patient is having no pain, difficulty in walking and no evidence of clinical and radiological recurrence . Conclusion: Giant cell tumours could also present at uncommon sites, and they should be considered in the differential diagnosis of lytic lesions of the metatarsals. Excision with ray amputation of the involved metatarsal helps in complete removal of the lesion and helps in early weight-bearing. This is the viable alternative treatment option in managing the metatarsal GCT in elderly patients. Keywords: Giant cell tumour, third metatarsal, ray amputation.

Introduction: Chronic tendoachilles (TA) tears are commonly missed injuries in elderly population with associated comorbidities and they usually occur as low-energy injuries. Appropriate surgical management helps in getting a better functional outcome in elderly patients. Case Series: We present a series of three cases of chronic TA tear in elderly patients managed surgically. Two patients had an insertional tear and they were managed with flexor hallucis longus (FHL) transfer and fixed with interference screw in the calcaneum. Another patient was managed with end-to-end suturing using fiber wire. All the patients are having good functional outcome without any wound complication or re rupture. Conclusion: Early diagnosis, meticulous repair, and handling of soft tissues and TA tear help in getting a better outcome in elderly patients. The final functional outcome depends on intraoperative stability of the repair, ankle physiotherapy, and wisely selection of the treatment method, which mainly depends on the location of the tear. Reconstruction with FHL tendon using interference screw in calcaneum helps to repair the insertional tears in elderly patients. Keywords: Tendoachilles tear, flexor hallucis longus graft, steroid, elderly patients.

Introduction: Achilles’ tendon is the largest tendon in the body, Tendon is an anatomical structure with inherent less blood supply and so more prone to injury and notorious healing outcomes. The management options for tendoachilles injury depend on the location of the tear, degree of retraction of the torn ends, and patient-related factors. Intraosseous lipoma is very rare benign tumor of bone accounting for 0.1% of all bone tumors. Most common site being proximal femur involvement of calcaneum is very rare presentation. Symptomatic patients with significant heel pain need operative intervention in the form of curettage alone or in combination with filling cavity with bone graft or bone graft substitutes. Many people use PMMA bone cement to fill the void. Case Report: A 65-year-old male presented with chronic heal pain and difficulty in walking. On clinical examination and radiological investigation, calcaneal intraosseous lipoma was confirmed along with insertional tendinopathy of tendoachilles and haglund syndrome causing tear at insertion into calcaneal tuberosity. We managed this patient in single-stage surgery using tendoachilles split approach for removing haglund deformity and double row anchor suturing for tendon reattachment. Repair was augmented with flexor hallucis longus (FHL) graft fixed using interference screw in the calcaneum. Lipoma was approached with separate medial approach. Cortical window created, lipoma curettage was done, and cavity filled with hydroxyapatite bone graft substitute. Conclusion: Tendoachilles split approach with double row suture anchor repair along with FHL graft gives good clinical outcome in insertional tendinopathy of tendoachilles with haglund syndrome. Curettage of intraosseous lipoma with filling the void using bone graft substitute such as hydroxyapatite gives good results and pain relief.