The ostrigonum is a small bone present on the posterolateral aspect of the talus. It is formed from a separate ossification center which fails to unite with the talus itself. Incidence is about 3-15%. The diagnosis can be difficult to make as symptoms and physical exam findings mimic those that occur with problems related to an accessory soleus muscle, flexor hallucislongus, posteriortibialis, or peroneal tendons, arthritis involving the posterior tibiotalar or subtalar joints, or ostrigonum syndrome. Misdiagnosis of such injuries may result in inadequate management including immediate weight bearing and prolonged symptoms

Background: Distal femoral fractures reportedly account for less than 1% of all fractures and comprise between 4%-6% of all femoral fractures. The current method of open reduction and internal fixation has become evident in the recent years with good results being obtained with the AO blade plate, dynamic condylar screw and other implant systems like intramedullary retrograde nails and recently locking compression plate. Controversy still remains regarding the optimum device for distal femur fixation. Objectives: To compare functional outcomes of fractures of distal femur operated with distal femur locking compression plate and distal femur nail using range of motion at knee and Neers knee scoring system and to compare rate of complications associated with both treatment modalities. Materials and methods: In this retrospective study, 60 patients with displaced distal femur fractures presented to our hospital were studied from January 2012-june 2017. 30 patients underwent fixation with locking compression plate and rest 30 underwent distal femur nailing. Outcomes were measured and assessed at 1 months, 3 months and 6 months using Neers knee scoring system. Results: Union was achieved in all patients with mean time to radiological union being 20 weeks in retrograde nailing patients and 24 weeks in locking compression plating. Neer scores were graded as excellent in 51.7 % in retrograde nailing patients and 56.6 % in plating patients. Mean range of motion was more (115 degree) in retrograde nailing patients compared to locking compression plating patients (114 degree) at the end of follow up. Conclusion: There were no statistically significant differences found in functional outcome of the patients between the two surgical methods. Locking compression plate is better implant in comminuted intra-articular fractures of distal end of femur, particularly in elderly patients with osteoporotic bone. Retrograde intramedullary nailing is a good operative technique for extra-articular distal third femoral fractures. However, both techniques require sufficient surgical experience and appropriate preoperative planning.

With a reversing ageing pyramid and an increasing incidence of osteoporosis,

Background: Pneumoperitoneum refers to the presence of air within the peritoneal cavity. The most common cause is a perforation of the abdominal viscous, a perforated ulcer, although a pneumoperitoneum may occur as a result of perforation of any part of the bowel. The exception is a perforated appendix, which seldom causes a pneumoperitoneum. The aim of present investigation was to know the various clinical features of acute abdomen in established cases of pneumoperitoneum and to study the various surgical techniques used in the management.Methods: This study is an analytical study of 103 patients admitted in emergency surgical wards. The relevant history, clinical examination, relevant investigations, and treatment were obtained by pretested proforma.Results: The symptoms such as abdominal pain, abdominal distension, fever, and vomiting were present in our study. The most common symptom was an abdominal pain in almost all cases the overall mortality in our study was 6.79% most of them is due to colonic and duodenal perforations. In most of the cases, the cause of death was diagnosed as septicemia.Conclusions: The incidence of GI Perforations can be reduced by educating the patients with appropriate medical management of peptic ulcer, tuberculosis, typhoid fever and also avoiding factors such as smoking and Alcohol.