Background:Multiligamentous injuries of knee are a complex problem in orthopaedics. Combined ACL-PCL injuries are uncommon, usually associated with knee dislocations. Extremity vascular status is essential because of possible arterio-venous compromise. These complex injuries require a systematic evaluation and treatment. Single setting simultaneous arthroscopic ACL and PCL reconstruction or a staged approach can be adopted to treat these cases.Objectives:To evaluate functional outcome of simultaneous arthroscopic ACL and PCL reconstruction with hamstring tendon autograft in multiligamentous knee injuries.Patients and Methods:This prospective study was performed on 20 patients with combined ACL-PCL injuries who underwent simultaneous arthroscopic ACL-PCL reconstruction with hamstring tendon. Evaluation of functional outcome was by IKDC and Lysholm-Tegner scores.Results:In 20 patients, mean age 34 years, return to full-time work and to full sports was 8 weeks and 6.2 months respectively. All patients had full range of motion except 2 patients with < 5 degrees flexion loss; 90% had negative Lachmann test; 95% had negative pivot shift and 10% patients had mild posterior drawer at 90 degrees (1+) at final follow up. Mean IKDC score was 90 (range 81 - 94); mean Tegner activity score was 7 and mean Lysholm knee score was 89. 85% returned to preinjury activity level and a 90% satisfaction rate.Conclusions:Simultaneous arthroscopic ACL and PCL reconstructions using hamstring tendon for combined ACL and PCL injuries is a clinically effective, safe, time saving and cost-effective procedure with better patient compliance and reproducible for a timely return of motion, strength, and function with favorable outcome.

BackgroundScapula fractures occur in approximately 1% of all fractures and constitute about 3% - 5% of all injuries of the shoulder joint.ObjectivesThis study aimed to evaluate the clinical outcomes of 20 surgically treated patients with displaced glenoid fractures after stabilization with distal radius plate.MethodsBetween 2012 and 2015, at 2 centers (HMCH & SHCE) of Bhubaneswar Odisha, we stabilized 20 scapular intra-articular fractures surgically with distal radius locking plate and studied the outcome of the surgeries. The outcome of the 20 fractures was determined using the Constant and Murley score. Both shoulders were assessed and the score on the injured side was given as a percentage of that on the uninjured side.ResultsThe median score was 88% (mean 65%, range 30 to 100). The median score for strength was 21/25 (mean 19, range 0 to 25) and that for pain 11/15 (mean 11, range 5 to 15). The median functional score was 16/20 (mean 15, range 0 to 20). The mean range of active abduction of the shoulder was 135° (20 to 180), the mean range of flexion 138° (20 to 180) and the mean range of external rotation 38° (0 to 100). Five patients showed excellent result; 11 patients showed good result; three patients showed fair result and one patient had poor outcome according to the Constant-Murley score. A superficial infection settled with antibiotics after operation in one patient whose score at final follow-up was 96%. In one patient, delayed healing was reported because of infection. One patient with stiffness of the shoulder at six weeks underwent manipulation under anesthesia with a follow-up score of 81%.ConclusionsVarious fixation modalities have been described in the literature, however fixation of intra-articular fracture of glenoid with distal radius locking plate for articular reconstruction in the presented series provides good functional outcome with early restoration of the range of motion of the shoulder.

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<p class="abstract"><strong>Background:</strong> Pilon fractures are serious injuries with many devastating soft-tissue complications associated with them. Deciding a definite treatment plan has always proved a challenge. Comparative studies between the various surgical techniques used for pilon fractures are uncommon and consensus is yet to be reached regarding the best surgical option. Purpose of this study is to retrospectively compare the operative results (complications, functional and radiographic outcomes) of pilon fractures treated either with internal fixation or Ilizarov ring fixators.</p><p class="abstract"><strong>Methods:</strong> Forty-six patients with pilon fractures were retrospectively studied; twenty-one of them had minimal invasive fixation by ankle spanning Ilizarov fixators and 25 patients had internal fixations by either minimal invasive plate osteosynthesis (MIPO) or by open reduction.  The patients were followed-up for a mean of 34 months (range, 24-51 months).<strong></strong></p><p class="abstract"><strong>Results:</strong> The internal fixation group had a higher incidence of soft-tissue complications and deep infections. In comparison the Ilizarov group had only superficial pin-tract infections but no other soft-tissue complications. Although the Ilizarov group had a higher incidence of malreduction and malunion in their series compared to the internal fixation group, there was no significant difference in the AOFAS ankle function score (p-value 0.2922) between the two groups after a follow-up of 2-4 years.</p><p><strong>Conclusions:</strong> The moderately long term functional outcome appears to be similar in both internal fixation and Ilizarov groups. But the Ilizarov technique is less likely to cause any serious peri-operative soft-tissue complications or deep infection. Familiarity of the surgeon with a particular technique should also be considered during surgical decision making. </p>