Background: Osteoarthritis (OA) is one of the major cause of morbidity, having a substantial influence on health quality of life, imposing enormous burden of cost on the health care system. It is a chronic degenerative disorder that is characterised by articular cartilage degeneration. It can be caused by aging, heredity and injury from trauma or disease. Primary symptoms of OA include joint pain, stiffness and limitation of movement. Disease progression is usually slow but can ultimately lead to joint failure with pain and disability. Stromal vascular fraction (SVF) derived from adipose tissue is a rich source of pre adipocytes, mesenchymal cells (MSC), endothelial progenitor cell, T cells, B cells, mast cells as well as adipose tissue macrophages. It can be easily obtained from loose connective tissue that is associated with adipose tissue by lipoaspiration under local anaesthesia. SVF is isolated without using any enzymes or chemicals and its autologous grafting is done in a single surgical sitting. Here, we evaluated safety and clinical efficacy of freshly isolated Autologous SVF cells in patients with grade 2-4 degenerative osteoarthritis (OA). . Methods: A total of 116 joints mainly knee OA were treated with autologous grafting of SVF done in a single surgical sitting. A total of 116 joints studied out of which 80 joints were followed up for 12 months, 88 joints followed for 9 months, 110 joints followed for 6 months and finally all 116 joints were followed for minimum 1 month for safety and efficacy. Results: Modified KOOS clinical score was used to evaluate clinical effect and was based on pain, non-steroid analgesic usage, limping, extent of joint movement, and stiffness evaluation before and at pre-operative, 1 Month post-op, 6 months post-op and 12 Months post-op after grafting. No side effects, systemic infection or cancer was associated with Autologous grafting of SVF. There was a significant improvement from pre-op to post op in all the followed patients. Average KOOS score improved from pre-operative 46.4 to post-operative 12 months average 77.9 i.e. very significant improvement in all grades. All sub-scale parameter for pain, symptoms, activity of living and quality of life showed significant improvement. Higher grade of OA were associated with comparatively slower healing. Conclusions: Autologous grafting of SVF in single surgical sitting is a novel and promising treatment approach for patients with degenerative OA. This treatment method was found to be minimal invasive, safe and cost-effective treatment modality for osteoarthritis.

<p class="abstract"><strong>Background:</strong> Distal femur is a complex fractures and most of times a personalized approach is needed for these fractures. Over a period of time variety of approaches and implants have been used for these fractures. The use of retrograde femur nail for fixing femur fracture, using entry from inter-condylar notch of femur, is a known method of treatment, but most surgeons are apprehensive of making an entry from the knee joint because of possible complications like knee pain, arthro-fibrosis, infections etc .The aim of this study was to investigate its effectiveness in fixation of distal 1/3^rdfracture of femur with special emphasis on the outcome and inherent surgical challenges<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study of 40 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from July 2010 to January 2016, after obtaining required approval from the Institutional ethical &amp; research committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that mean age of patients was 35.8 years (18 years to 62 years) where 87.5% were male and 12.5% were female. Average duration of healing was 17.75 weeks (ranging from 10 weeks to 36 weeks) with 100% healing achieved. Mean knee range of motion was 124.5 degree (70 to 140 degree), rate of knee pain 10% (4/40), re-operation rate 5% (2/40), infection rate 2.5% (1/40), and fat embolism 2.5% (1/40)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Retrograde femoral nailing is a reliable alternative to antegrade nailing or plate fixation for diaphyseal fracture distal one third femur, and may be in some situations even advantageous when antegrade nail entry is challenging like ipsilateral hip fractures, previous implant in hip &amp; proximal femur, ipsilateral pelvi-acetabular injury, bilateral femoral shaft fracture, floating Knee injuries, poly-trauma and obese patients<span lang="EN-IN">.</span></p>

The aesthetic appearance of the thumb hasn't been analysed to a similar extent as thumb function which would aid during reconstructive surgeries of the thumb and first web space and analyse its outcome. The purpose of this study is to determine the relative length, girth, nail width of thumb with respect to the index finger and intermetacarpal distance. Measurement of the 1 st web space arc radius has been done to tackle the problem of webbing which is not addressed by IMD and palmar abduction angles. A total of 482 hands in 241 subjects were studied to measure the relative length of the thumb with respect to the index finger, the relative nail width of thumb with respect to index finger, the relative girth of IP joint of thumb with respect to PIP joint of index finger and Intermetacarpal distance was calculated. The 1 st web space arc radius was calculated by the "best arc fit" with the thumb in maximum radial abduction using a radius gauge. The data collected was analysed by age, gender, laterality of the hand and the height and weight of the child. Hands of subjects of which with a mean age of years were analysed. The relative Thumb length, girth and nail width remained independent of age. It has been observed that the reliability of the measurements between the right and left web space arc radius measurement is significant . The provided would help reconstructive surgeons analyse aesthetic outcomes of reconstructive surgeries intraoperatively and post operatively. A correlation between the 1 st web space arc radius of right and left hands would help predict the expected post-operative outcome.

<p class="abstract"><strong>Background:</strong> Femoral component rotation in total knee arthroplasty (TKA) is essential for patella-femoral tracking, flexion gap balance and normal kinematic function of the knee. The two referencing techniques used for sizing and adjudging the femoral rotation are anterior referencing (AR) and posterior referencing (PR).The current study was designed so as to identify which referencing system determines the femoral rotation more accurately<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> This study involved 34 consecutive patients (22 females and 12 males) with 60 osteoarthritic knees (bilateral=26; unilateral =8) who satisfied the inclusion criteria. The trans-epicondylar axis, was taken as gold standard to adjudge the correct femoral rotation and was marked as E. The axis of rotation as per anterior instrumentation (A), and as per posterior instrumentation (P) were marked and compared as to which of the axis (A or P) was parallel to E.<strong></strong></p><p class="abstract"><strong>Results:</strong> A was always parallel to E, however P was parallel to E in 42 knees. In 18 knees (6 with valgoid deformity, 12 with hypertrophic osteoarthritis involving the medial femoral condyle), P and E tend to converge laterally, suggestive of excessive internal rotation<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Anterior referencing determines femoral rotation more accurately than posterior referencing for knees with severe valgoid deformity or those with hypertrophic osteoarthritis involving the overgrowth of medial femoral condyle<span lang="EN-IN">.</span></p>

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. This study was aimed at evaluating the outcome of hemiarthroplasty, by assessing the quality of life and degree of function in the operated limb.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Out of 30 patients treated in this manner, all cases were available for follow-up period of 6 months. Patients of age 60 years and above, diagnosed with fracture neck of femur, were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of patients belongs to age group 60-69 years was 56.7% Females were more common 56.7% than males in the present study. About 13.3% patients sustained the injury due to a fall from a height and 23.3% due to a road traffic accident. About 20 patients (60%) had a stay of less than 20 days in hospital. In our study Harris hip score, at end of six month ranged from 35 to 94.6. At final 6 months follow-up by Harris hip scoring system, 53.33% had excellent result, 33.3% had good results, 16.67% had fair results and 6.67% had poor results. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The mortality and morbidity are not high, operative procedure is simple, complications are less disabling. Early functional results are satisfactory.</span></p>