Background: Reverse obliquity intertrochanteric fracture is a challenging injury encountered by orthopaedic surgeons. The patients are usually osteoporotic, with multiple co-morbidities and poor tolerance for complications and re-operations. In such a difficult scenario an intramedullary nail is recommended to give a stable fixation. This study aims to compare results between fracture fixation by only intramedullary nailing and nailing with augmentation by cerclage wires. Material and Methods: This prospective study includes 53 patients from August 2016 to September 2018 that presented to our institute with a reverse obliquity intertrochanteric fracture. They were sequentially operated with either intramedullary nailing (IMN) or nailing with additional use of cerclage wires. Patients were followed up for a minimum of 12 months. Radiological union time, complications and functional outcome (using Harris Hip Score) were noted at 1 year. Statistical analysis was performed to compare the results in both groups. Results: The mean union time was 4.3±0.534 months in Group A and 3.8±0.534 months in group B. The mean operating time needed for cerclage-augmentation was 10 minutes more than IMN only. The incidence of complications like screw cut out, back out and non-union, re-operation rate was lower in cerclage group. But the incidence of deep infection at the fracture site was more in cerclage group. Cerclage group had good functional outcome which was statistically significant. Conclusions: The technique of using cerclage wires in addition to intramedullary nail in reverse obliquity intertrochanteric fractures for lateral wall reconstruction provides good radiological and functional outcomes. It also reduces many complications of the procedure. Only concerning factor remains the increased risk of infection at the fracture site.

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone.Keywords: Patella fracture, Tension band wiring, cerclage wiring

Background:The angle formed by median axis of the arm with fully extended and supinated forearm is known by the name of carrying angle(CA). Carrying angle is important as it allows forearms to clear hips in swinging movements while walking and while carrying objects. Objective: The aim of this study was to measure carrying angle of a sample population in the age group 18-30 years manually allowing comparison between measurements of dominant and non dominant limb and document any differences thereof. Material and Methods: Carrying angle measurements were carried out in 300 individuals in the age group 18-30 years using goniometer. Measurements were done in both the upper limbs with limb kept in full extension at elbow and supination at forearm during measurement. Results: After documentation of measurements our results showed significant difference in carrying angles of dominant and non dominant limbs. Our study also revealed variation of carrying angle between females and males with females having values greater in both dominant and non-dominant limbs as compared to males. Conclusion:Our study emphasized on the fact that carrying angle measurement was more in case of non dominant limb as compared to dominant limb and was more in case females than males.

Application of damage control orthopaedics in the management of type IIIopen tibia fractures in a hilly region of North India

<p class="abstract"><strong>Background:</strong> Objective of the research was to evaluate radiological and functional outcome in fractures of the distal radius treated by various surgical methods.</p><p class="abstract"><strong>Methods:</strong> 89 patients with distal radius fractures were randomly divided into three groups according to a computer-generated table of randomization. 40 patients were managed by K wire fixation. 22 patients were managed by external fixator. 27 patients were managed by volar plating technique. Anatomical restoration was evaluated by posterior-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate radial height (RH), radial inclination (RI) and volar tilt (VT). Functional outcome was evaluated using Mayo scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to Mayo score, in K-wire group 72.5% (n=29) patients had excellent to good outcome, 17.5% (n=7) had fair outcome while as 10% (n=4) patients had poor outcome. In external fixator group 72.7% (n=16) patients had excellent to good outcome while as 27.3% (n=6) had fair outcome. In volar plating group 81.5% (n=22) patients had excellent to good outcome while as 18.5% (n=5) had fair outcome.</p><p class="abstract"><strong>Conclusions:</strong> In our study we found that volar locked plating provides advantage in dorsally or volarly displaced intra-articular fractures with excellent to good radiological outcome. However, in type B (partial intra-articular fractures) fractures, volar locking compression plate (LCP) and external fixator provide almost equivocal results. Percutaneous pinning can be recommended for extra-articular or simple intra-articular fracture patterns, with a loss of volar and/or RI but without significant radial shortening.</p>