Background: Pediatric age group has the highest incidence of supracondylar fracture of humerus, the most common being the extension type. A precise evaluation and planning is required for deciding the modality of treatment for these fractures. They are most widely managed by utilizing two methods; crossed pinning and lateral pinning. The task at hand remains to determine the superiority of either of these techniques over the other. Materials and Methods: A prospective, single blinded, randomized control trial with 68 cases, out of which 46 were boys and 22 were girls was conducted. Mean age group of study was 8.4 years. Type III supracondylar fractures were included in this study based on Gartland classification. Detailed postoperative primary assessment for major loss of reduction and iatrogenic ulnar nerve injury was done. Clinical outcome, elbow range of motion, radiographic measurement, Flynn's grading and complications were the secondary parameters which were assessed. Results: Both groups exhibited no major loss of reduction. Change of Boumann angle was statistically insignificant. Metaphysial-Diaphysial angle, Flynn grade, carrying angle and total elbow range of motion between the two groups showed no statistically significant difference. Conclusion: Lateral pin fixation offers parallel results in terms of functional and radiological outcomes and nearly equal mechanical stability compared to medial-lateral pinning without the added shortcoming of possibility of iatrogenic ulnar nerve injury.

Malunited distal radius fractures treated with internal fixation devices put the physis at risk of iatrogenic injury, while conservative treatment with a cast usually leads to loss of reduction. While the AO external fixator can be used, the radial inclination cannot be controlled during reduction. The purpose of this study was to ascertain the anatomical and functional outcome of treating malunited distal end radius fractures with Joshi's External Stabilisation system applied as a bilateral uniplanar construct in the paediatric age group. Methods: Open reduction and external fixation with Joshi's External Stabilisation System were performed for 4 malunited distal metaphyseal fractures of patients below 16 years. Dorsal open wedge osteotomy with bone graft was performed at the fracture site and two k-wires were passed through both cortices proximal and distal to the site of fracture and reduction was achieved with two distraction rods placed radial and ulnar to the radius bone. The external fixator was removed after the union, and the wrist was mobilised. The patients were followed up till full ROM was achieved. Anatomical outcome analysis was done using Sarmiento's modification of Lindstrom criteria, and functional outcome analysis was done using Gartland and Werley demerit point system. Results: In our study, 4 patients underwent open reduction and external fixation using Joshi's External Stabilisation System and all showed fracture union with no complications. The mean age of the patient was 12.25 years . Meantime to osteotomy after injury was 10.25 weeks . Mean QuickDASH score improved significantly from 6.25 preoperatively to 1.25 postoperatively (p=0.003). Mean Radial inclination improved significantly from 6.25 to 18 (p=0.009). Ulnar variance improved significantly from 1.75 to 0.25 (p=0.01). Palmar tilt improved significantly from 32.5 to 6.25 (p=0.001). Conclusion:Our study shows good results with fixation using Joshi's External Stabilisation System for malunited paediatric distal metaphyseal fractures.

Introduction: Deep Vein Thrombosis (DVT) is one of the common and dreaded complication of joint replacements, hip and spine surgeries. The incidence of deep vein thrombosis among these cases is significant in spite of the various prophylactic measure such as physiotherapy and pharmacological measures. Materials and Methods:The study was conducted in our Institute between January 2014 to June 2017. The study included patients who underwent total hip and total knee replacements for various cases and spinal surgeries during the same year. We had a total of 195 patients in the study. Among these, 65 patients were given DVT prophylaxis by physiotherapeutic measure such as foot pump and pneumatic compression device and 130 were given combined physiotherapeutic and pharmacological prophylaxis by giving Low molecular weight heparin postoperatively. Post operatively patients were assessed for DVT both clinically and by Doppler Study Results: A total of 8 patients out of 65 among the physiotherapeutic alone group developed thrombosis [12%]. Among 130 patients who were given prophylaxis by combined measures 9 patients developed thrombosis [07%]. So the results of our study have shown that combined physiotherapeutic and pharmacological measure have an edge over the physiotherapeutic measure alone. Conclusion: Researches which have been done previously have shown that there is no difference in the incidence of DVT among patients treated by other physiotherapeutic and pharmacological measures alone. In our study the result of combined methods was found to be better than physiotherapy measure alone. Hence, the incidence of DVT among the replacement and spine surgeries can be reduced by combined modalities of prophylaxis.

Background: Supracondylar humerus fractures are one of the commonest fractures in the paediatric age group. Displaced supracondylar fractures of humerus in children is commonly treated by closed or open reduction and K wire fixation. Cross pinning and lateral pinning are the commonest configurations used for fixation. The configuration of wires is debatable although cross pinning is biomechanically more stable, there is a risk of iatrogenic ulnar nerve injury. Recent studies suggest lateral pinning if properly done has equal stability and there is no risk of iatrogenic ulnar nerve injury. functional outcome of displaced supracondylar fractures of humerus in children treated with cross pinning Inclusion criteria included Age less than 16 yrs, Gartland type II and type III fractures and Cases managed by closed or open reduction and stabilized by Kirschner wires. Patient with Age more than 16 years, Gartland type I fractures, Compound fractures, Patient presenting with associated neurolovascular deficit were excluded. Materials and Methods: This is a randomized prospective study from November 2019 to April 2021. A total of 30 patients of displaced supracondylar fracture aged between 2-12 years without any compound injury were enrolled for the study. The cosmetic and functional outcomes were evaluated by Modified Flynn's criteria. Results: As per Modified Flynn's criteria, all patients treated with cross pinning had satisfactory results. There was no statistically significant difference with regard to functional outcome, cosmetic outcome and loss of reduction. There was one case of iatrogenic ulnar nerve injury in cross pinning group. Conclusion: cross pinning provides good stability and functional outcome. Cross pinning has a definitive risk of iatrogenic ulnar nerve injury.

Introduction: Mucoid degeneration of the anterior cruciate ligament (ACL) is a less common entity. The primary pathology is the damage to the functional synovial lining protecting the ACL with no significant preceding trauma. Two types are described i.e., cystic (synovial and mucoid cysts) and infiltrating (mucoid degeneration). These lesions can be asymptomatic. When symptomatic, the patient complained of posterior knee pain with restriction of flexion in the knee. The diagnosis is confirmed by Magnetic Resonance Imaging of the Knee. Recent trends include arthroscopic procedures, including ACL debridement, i.e. partial resection. Total resection can be required in a few cases with ACL reconstruction. Inclusion Criteria: Diagnosed cases of ACL mucoid degeneration on MRI. Exclusion Criteria: Post-traumatic knee injuries-meniscal or ligamentous or bony, ACL synovial or mucoid cysts. Materials and Methods: A total of 18 patients diagnosed with ACL mucoid degeneration were included in the study. The study was conducted from August 2019-August 2021. The patients were assessed clinically with history and clinical examination. MRI was advised in patients with clinical suspicion of ACL mucoid degeneration. Results:The study sample consisted of 18 patients (7 females and 11 males) with ages ranging from 30 to 55 years (mean age, 43.2 years) in males and 35 to 55 years (mean age, 41.5 years) in females. On clinical assessment, exacerbation of pain was more commonly related with terminal flexion in 10 patients (58.8%) as compared to terminal extension (7 patients, 41%). No motion-related exacerbation of pain was seen in 1 case. 17 patients had an extension deficit. No complaint of instability was seen except for 2 cases. Postoperatively an average improvement of the Visual analogue scale by 4 was seen. No flexion or extension deformity was noted. No patient had any major complication. On follow up Anterior Lachman test was grade 1 in 16 cases and in others it was same as opposite non-affected knee. A complete resection of ACL with reconstruction using hamstring graft was done in 1 patient. The same patient showed a pain improvement of 4 scales on VAS. The patient however had episodes of instability. Conclusion: A clinical suspicion of mucoid degeneration of ACL with confirmatory classical appearance on MRI are key to diagnosis. Symptomatic pain relief is better provided with ACL debridement with mild laxity in upcoming future.