Aims This study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total knee arthroplasty (PS-TKA). Methods We retrospectively evaluated knee radiographs of 165 knees, which underwent fixed-bearing PS-TKA with patella resurfacing. The incidence of patella baja and changes in patellar height over a minimum of five years of follow-up were determined using Insall-Salvati ratio (ISR) measurement. We examined whether patella baja (ISR < 0.8) at final follow-up affected clinical outcomes, knee joint range of motion (ROM), and Knee Society Score (KSS). We also assessed inter- and intrarater reliability of ISR measurements and focused on the relationship between patellar height reduction beyond measurement error and clinical outcomes. Results The ISR gradually decreased over five years after TKA, and finally 33 patients (20.0%) had patella baja. Patella baja at the final follow-up was not related to passive knee ROM or KSS. Interestingly, when we divided into two groups - patella baja and patella normal-alta (ISR ≥ 0.8) - the patella baja group already had a lower patellar height before surgery, compared with the patella normal-alta group. The ISR measurement error in this study was 0.17. Both passive knee flexion and KSS were significantly decreased in the group with a decrease in ISR of ≥ 0.17 at final follow-up. Conclusion Patellar height gradually decreased over five years of follow-up after TKA. The reduction in patellar height beyond measurement error following TKA was associated with lower clinical outcomes. Cite this article: Bone Jt Open 2021;2(12):1075–1081.

Objective : Only a few cases of insufficiency fractures of the tibial plateau following bisphosphonate use have been reported. The authors report a case with bisphosphonate (BP) -related atypical insufficiency fracture of tibial plateau, which developed delayed union. Patient : A 65-year-old Japanese woman presented with left knee pain without any trauma. She had a 5-year history of risedronate use for primary osteoporosis. Initial X-rays were unremarkable, but magnetic resonance imaging (MRI) confirmed an insufficiency fracture at the left tibial plateau at 3 weeks after the initial visit. Risedronate treatment was stopped because we diagnosed her with a BP-related atypical insufficiency fracture of the tibial plateau. She was treated with rest, a lateral wedge insole and protective weight-bearing with a T-cane for 3 months. Result : At 3-month follow-up, the patient still had a pain and a delayed healing on radiographs. Six months later, X-rays showed that the fracture site had a sclerotic change, but MRI revealed delayed union. At 8-month follow-up, the fracture was healed without any symptoms. Conclusion : All clinicians need to be aware of the delayed healing of atypical insufficiency fracture related with prolonged BP use.

Fracture of shaft femur is a common injury in young boys and girls. Many controversy present about treating them between conservative and operative. In our study, we have evaluated outcome of fracture shaft femur in pediatric patients between 6-12 years of age treated with intramedullary nailing had high rate of union. There were 5-22 weeks of duration which were required for achieving full range of movements. There were only 8% of patient with limb length discrepancy and only 2 patients had angular deformity. Evaluation of final outcome is done according to "scoring system for a study of case of fracture shaft femur in children treated operatively was 80% excellent, 0% were good, 16% were fair and 4% were poor. Evaluation according to Flynn Criteria were excellent in 80%, 12% were satisfactory and 8% were poor. Thus, intramedullary nailing in fracture femur in pediatric patients is effective and safe method for achieving union and movements also.

Introduction: Fractures of the distal radius recently have become the focus of an intense resurgence in interest regarding optimal management. The overly optimistic attitude that a favourable outcome will eventuate, despite residual deformity must be tempered by the realization that the common factor predisposing to a suboptimal recovery is malunion. Moreover for the most frequently occurring intraarticular fractures, an increasing consensus exists that preservation of distal radial articular contours, that in many cases can be achieved only be open treatment, is an absolute prerequisite for successful recovery. Aim: To evaluate the outcome of volar plating using locked plates in intra articular fractures of lower end radius. Materials and Methods: This is prospective all inclusive study for outcomes of intra articular fracture lower end radius using locked plates as a type of implant for open reduction and internal fixation of the fracture fragments. All patients included for this study sustained distal radius fracture grade III to grade VIII according to Frykmann classification. At the final follow up patients were assessed using Gartland and Werley's Demerit Scoring System 6 for the result of plating of intra articular fracture of lower end radius. Results and Discussion:The results of present study were assessed using using Gartland and Werley's Demerit Scoring System . We observed that 60.47% patients showed excellent result, 34.89% patients showed good and 4.65% patients showed fair results. These results were quite comparable with other studies performed in the past. Conclusion: Based on our study, we conclude that plating in unstable intra articular fracture of distal end radius using locked plates had become an effective tool in the management of difficult injuries. With the development of volar fixed angle locking plates, this technique is advantageous in intra articular lower end radius fractures.

A 45-year-old man presented with severe left shoulder pain that was not associated with trauma. Plain radiography with the arm in an elevated position and ultrasonography demonstrated calcium deposits at the anterior acromial insertion site of left deltoid muscle. Conservative management could successfully relieve pain. At the 3-year follow-up, the calcification completely disappeared. To the best of our knowledge, calcium deposits at the acromial insertion site of the deltoid have not been reported in the literature. Clinicians who suspect calcific tendinitis but do not observe calcification around the rotator cuff should carefully palpate and examine other sites, such as the deltoid origin, and use ultrasonography or radiography.