Atraumatic hip pain in growing children is of varied etiology from developmental to infection and tumor. Differential clinical presentation of symptoms and investigation modalities like blood parameters and radiological imaging remains inconclusive at times with differential diagnosis. Biopsy remains the final say in conclusive of establishing final diagnosis unless proved otherwise. Bony lytic lesion of proximal femur in children without systemic illness mimicking benign bone tumor initially (osteiod osteoma) turned out to be chronic osteomyelitis on histopathologically following CT guided biopsy of the lesion which alters the course of management.

Purpose There has been a long standing debate regarding superiority of cruciate retaining total knee arthroplasty over posterior stabilized total knee arthroplasty regarding the short-term outcomes as well as long-term survivorship. The proponents of both the techniques have published vast evidence in favor of their respective surgical method and early outcome in meta-analyses does not seem to be significantly different. The decision to select either design should depend on their long-term survivorship but the literature comparing their long-term survival is sparse.This meta-analysis was conducted in order to answer the following questions: (1) Does cruciate retaining total knee arthroplasty has a better long-term survival beyond 10 years.compared to posterior stabilized total knee arthroplasty? (2) Does cruciate retaining knee arthroplasty has higher complication rates compared to posterior stabilized total knee arthroplasty? Methods The present systematic review and meta-analysis study was carried out following PRISMA guidelines. The following databases: Embase, Web of Science, PubMed, Scopus, the Cochrane Library, Google Scholar, and CINAHL were used to search potentially interesting articles published from database inception until January 2022. Inclusion criteria for articles were: (1) retrospective comparative studies; (2) patients who had undergone a total knee arthroplasty; (3) publications evaluating the long-term survival of cruciate-retaining (CR) versus posterior stabilizing (PS) at a minimum 10 years’ follow-up; (4) publications evaluating complications of cruciate-retaining (CR) versus posterior stabilizing (PS) at a minimum 10 years’ follow-up; and (5) publications reporting sufficient data regarding the outcomes. We used a fixed-effects design in the case of I2 < 50% and P > 0.05; if not, we adopted a random-effects design [4]. We also performed subgroups and sensitivity analysis in order to assess the possible source of heterogeneity. Results Database searching identified 597 studies to be screened, of which 291 abstracts were revealed as potentially eligible and finally 7 articles were included. The forest plot showed that CR had significantly better survival than PS (OR = 2.17; 95% CI: 1.69–2.80) after 10 years. However, complication rate was not significantly different between CR and PS groups (OR = 0.86; 95% CI: 0.52–1.44; P = 0.57). Subgroup analysis showed that only the period of publication constituted a source of heterogeneity in survivorship outcome. Sensitivity analysis revealed that outcomes did not differ markedly, which indicates that the meta-analysis had strong reliability. Conclusion The results of this meta-analysis showed that cruciate retaining prosthesis may be preferred over the posterior stabilized design in view of longer survivorship it offers However, further randomized controlled trials are recommended to confirm this finding.

Trigger finger relatively a common hand problem with varied treatment options from conservative to surgical release done as outpatient and daycare procedure with its own applications and limitations. Our aim is to assess patient satisfaction among the different types of trigger finger release at different areas of health care. 60 patients (Female 60%: Male 40%) with single-digit trigger finger involvement (Ring finger28.33%, Thumb26.66%, Middle finger25%, Index finger18.33%) with a mean age of 49years were divided into four groups based on card selection. The mean Short Assessment of Patient Satisfaction SAPS score was highest amongst the group in which the procedure was done at the outpatient area under percutaneous needle release technique, while the mean lowest score was obtained from group IV in which the procedure was done at the operation theatre by open release technique as daycare. Patient satisfaction and compliance were found to be higher in the group who underwent a procedure at an outpatient area.

Radiation in orthopaedic surgeries was considered to be commonly hazardous, but also can be used as tool to improvise the surgical skills, limitations of exposure, risk analysis and making of alternate arrangements whenever required. We aim to analyse the number of times of imaging taken intra-operatively with C-arm for all acute closed lower limb fractures, which are all electively planned for intramedullary nailing ixation. It was a single centre, prospective randomized control double blind study, acute closed single plane fracture of lower limb like tibia shaft fracture, femur shaft fracture and intertrochanteric fracture electively posted for intramedullary nailing ixation were included. Total of 168 fractures, 38 intertrochanteric fractures (22.61%), 52 femur shaft fractures (30.95%), 78 tibia shaft fractures (46.42%) were electively planned for nailing ixation with intra-operative image guidance. Mean age was 42 which was statistically signi icant. Males were more than females, (89 male 52.97% and 79 female 47.02%) observed to be statistically not signi icant. Right lower limb 90 (53.57%) was observed to be more injured than the left lower limb 78(46.42%) which was statistically not signi icant (p<0.56). Mean imaging for intramedullary ixation in intertrochanteric fractures was 75 (17.30%) , femur 120 (37.76%) and tibia 95 (44.93%) was observed to be statistically signi icant. Radiation in orthopaedic surgeries can be otherwise and also be utilized by operating primary trauma surgeon with focus on average number of imaging for the elective nailing procedure as a self-monitoring tool for skill improvement with reproducible potential, radiation minimisation, call for help and technical improvisation for the future years, besides its occupational ill effects.

BackgroundOsteoid osteoma is the commonest benign osteogenic lower limb tumour with 25% involving the proximal femur 1 . A radiologist, with improvised skills on musculoskeletal imaging and its sequencing with higher imaging will greatly help in addressing the lesion and its location to narrow down the diagnosis 1,2 . However, the location of the lesion in proximal femur (intra or extracapsular) and its atypical clinical presentation sometimes surprises with tissue diagnosis warranting a biopsy at preprocedural level to establish a working diagnosis 3-6 . However, management of osteoid osteoma by techniques like computed tomography (CT) guided percutaneous radiofrequency ablation or percutaneous bone drilling have yielded promising results [7][8][9][10] . MethodA prospective case series was conducted at the Sri Ramachandra Institute of Higher Education and Research, Porur, India, from November 2016 to June 2019. All children below 18 years of age with hip pain and x-ray / CT scan suggestive of osteoid osteoma located in proximal femur, planned for percutaneous CT guided radio-frequency ablation, were included. Lesions other than proximal femur sites, different planned intervention and inconclusive diagnosis were excluded.