Introduction: Non-union of the radius and ulna is a major complication of forearm fractures, accounting upto 10% of all forearm fractures. Multiple modalities are available for the treatment of non-union. Vascular grafts are a less sought-after surgical choice owing to the need of expertise and skills of surgeons. We discuss a case of gap non-union of fracture shaft radius treated with vascular fibula graft. Case Report: We describe a case of 45yr old lady with closed fracture of both bones of left forearm. She underwent open reduction and internal fixation with 3.5 small DCP (6 hole) two days following trauma. On subsequent follow up in 6 months the radius fracture showed signs of infected non-union with osteolysis at screw sites while the ulnar side showed signs of satisfactory union. The patient underwent debridement with implant removal and osteosynthesis with vascularised fibula for gap non-union as second stage. 3 and 6 months follow up showed improvement in DASH score as well as VAS score and fair return of regular activity. Conclusion: In management of gap non-union of Shaft radius with gap (>6cm) vascularised fibular graft provides excellent functional outcome with far less donor site complications.

Background: The management of pediatric forearm fracture has been a dilemma to surgeon. Conservative treatment with cast still is the preferred treatment. Never the less old children and proximal fracture warrants some form of internal fixation. Aims and Objective: The aims of this were to analyze the role of titanium elastic nailing system in fixation of pediatric forearm fractures and its associated complications. Materials and Methods: Over 3 years, 103 patients were enrolled in our institute. After obtaining consent and preanesthetic check-up, patients were scheduled for surgery, where internal fixation was done using titanium elastic nailing system. Patients were followed up every month for 3 months and then every 3 months interval for 8 months. The time to union and functional score were assessed using modified Flynn score. Results: Among the 103 patients, 63 (61.16%) were in the age group of 7–13 years. Mean age was 11.72±3.50 years (range 4–18 years). Seventy-eight (75.72%) patients were male and fall from height was the most common 66 (64%) mode of injury. Radiological union occurred in most 54 (52.42%) of the patients at average 5–7 weeks. As per the modified Flynn criteria, 82 (79.61%) cases had excellent functional outcome, 11 (10.67%) cases good, 4 (4.12%) fair, and 6 (5.82%) had poor outcome. Neuropraxia was seen in 8 (7.76%) cases and rupture of extensor pollicis brevis was seen in 4 (4.12%) patients and treated accordingly. All the patients regained full functional recovery. Conclusion: TENS is an effective, safe, reliable, and easily reproducible technique for the management of pediatric forearm fractures. It has advantage of preserving the fracture hematoma, providing relative stability to ensue early rehabilitation and minimally invasive nature.

Background & Aims: The diagnosis of abdominal tuberculosis has always been a challenge to the physician. The clinical presentation is subtle with many vague symptoms and nonspecific signs. We did this study to find the various diagnostic findings in a case of chronic abdominal pain and find out the efficacy of laparoscopy in diagnosing Koch’s abdomen. Materials and Methods: A prospective observational study was conducted on patients attending surgery department from Nov-2020 to Nov-2021 having clinical and radiological diagnosis of abdominal tuberculosis. Total 59 patients of suspected abdominal tuberculosis underwent diagnostic laparoscopy and started on anti-tuberculosis treatment. Result: The most common presenting symptom was abdominal pain present in 35 patients (59.32%). In CT scan, 31 of them were suggestive of abdominal tuberculosis and seven were inconclusive. Only 37 of them had positive (62.71%) histology for tuberculosis and 22 were negative (37.28%). The PPV and NPV of CT scan was 77.42% (95% CI=60.19-88.61%) and 85.71%% respectively. Out of 27, 20 mesenteric lymph nodes had positive histology for tuberculosis. 29 patients had caseating granuloma and 12 had non-caseating granuloma. All 18 histology negative patients had nonspecific chronic inflammation with reactive lymph nodes. Peritoneal fluid was aspirated and sent for CBNAAT from 30 patients (50.84%). 10 were positive (33.33%) for tuberculosis gene and 20 (66.33%) were negative. Conclusions: Performing laparoscopy in the majority of patients with suspected abdominal tuberculosis is a clinically rewarding idea. It has a high yield to establish the diagnosis of abdominal tuberculosis (65.78%) by sampling macroscopically pathological tissues. Keywords: Koch’s abdomen, Diagnostic laparoscopy, Koch’s abdomen

The neck of femur fracture is one of the commonest fracture amongst the elderly. Hemiarthroplasty is sought as the standard of treatment in these group of patients. Following surgery the resected head of femur is discarded. Though it has become a norm for routine histopathological evaluation of the head in total hip replacement but this is not the same in hemiarthroplasty. We studied 48 femoral head obtained after hemiarthroplasty in fracture neck of femur. Majority of our patients were female 28(58.33%) and the mode of injury in them was fall at home 19(67.85%) with mean waiting time for surgery 13±2.7days (Range 7.6-18.4days). We found degenerative osteoarthritis in form of Chondromalacia in 26(54.16%) patients among which males 15(57.69%) were the predominant variety presenting with a higher stage which was statistically significant in nature (P value= 0.014, χ2 value=5.994, df=1). Avascular necrosis was seen in 11(22.91%) cases. Though we found female (6) to be more affected but it was not statistically significant (P value=0.772, χ2 value=0.084, df=1). We found no cases of neoplasm or infection in our study. The histopathological study of the femur head didn't alter the further treatment plan of the patients. Hence we won't recommend doing a routine tissue study of the resected head in these group of patients without any prior positive history (like neoplasm) which will lead to savings over health expenses.

BACKGROUND Tibial shaft fracture is one of the commonest fractures encountered in orthopaedic clinics today. With recent trend being surgical management, it has increased the economic burden in developing countries like India. Thus, interest in functional cast bracing can manage many of the fractures safely with less cost and shorter hospital stay with equally good results. METHODS This prospective study included 30 patients with closed tibial shaft fracture with minimal displacements who were treated with 3 weeks of initial long leg cast followed by functional cast bracing as described by Sarmiento in 1967 with a below knee patellar tendon bearing (PTB) cast with encouraged progressive weight bearing for 6 to 9 weeks. Our goal was to achieve shortening of < 10 mm, angulations of less than 5 degrees in any plane with full range of motion at knee as per Sarmiento. RESULTS Union was seen in 25 (83 %) cases. Angulations of < 5 degrees was noted in any plane in 79 % cases. Varus and apex posterior angulations were the most common deformity. Shortening 10 mm was noted in 72 % cases with almost complete ROM of knee joint in all patients. Non-union was noticed in 2 (7 %) cases. CONCLUSIONS Functional cast bracing can still be an ideal method of management for many of the tibial shaft fractures and with better understanding of the technique and proper application, it can safely be used on other long bones as well. KEYWORDS Closed Fracture Tibia, Functional Cast Brace