Introduction: Tibia is the most commonly fractured bone amongst all long bones of the body due to its position and lack of soft tissue protection. Treating tibia distal 1/3rd fracture is still a greater challenge because Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site and have associated significant soft tissue injury. Generally, associated with ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, non-union, and malunion. The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it fixed to give stability to syndesmosis and stability to same-level tibia fracture. Materials and methods: all patients of distal tibia fracture fulfilling the inclusion criteria from July 2011 to July 2017, were operated and followed up at every 4 weeks, till sign of union seen. Results: 72 patients (male 40, female 32) with Mean age of was 35.2 years (20-50 yrs), Fracture union was seen radiologically within 12 to 20 weeks, depending on fracture geometry. Conclusion:We found that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Careful planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is necessary to avoid varus, valgus, and antero-posterior tilt. Polar screw or temporary K-wire during surgery was found to be helpful. Same-level fibula fracture fixation with a plate or k-wire is effective for stability of reduction.

BACKGROUND Facet joint injuries are increasing day by day due to increase in road traffic accidents produced by rotation of head in flexion or extension. It commonly affects lower cervical spine due to anatomical considerations being a very mobile part between head and a fixed torso. The architecture of vertebra in lower cervical spine also predisposes to injury are combination of lower height, smaller anteroposterior diameter of the superior facet and a more horizontally oriented superior facet at C6 and C7 levels. 1 MATERIALS AND METHODS In our series of 19 cases, both unilateral and bilateral facet dislocation were taken into consideration either with or without fracture. Unilateral fracture dislocations were associated with less neurological deficit, but were difficult to reduce while bilateral fracture dislocations had more and many times permanent neurological deficit. Majority of our patients were treated by open reduction and internal fixation with Bohler's triple wiring and bone grafting to achieve fusion. RESULTS The goal of treatment is to preserve functional and anatomical continuity of spinal cord and nerve roots, restore spinal alignment, establish spinal stability and provide freedom from post injury pain or delayed neurological problem. In our series of 19 cases, 16 were treated operatively and they experienced better stability and pain relief. None of our cases showed post-treatment deterioration in neurological status. Improvement in neurological status was seen more in partial or incomplete loss cases, i.e. Franklin B or C. CONCLUSION Cervical facet fracture dislocations should be reduced, stabilised and fused as early as possible for better rehabilitation and chances of neurological recovery. Bohler's triple wiring seems to be cheap and reasonably good method of fixation.

Background: Objective of the study was to find out the advantages of traction and single-leg spica cast in treatment of isolated femoral shaft fracture in children. Study design was Descriptive and place of the study was Darbhanga Medical College and hospital, Laheriasarai, Darbhanga, Bihar, India.Methods: 24 patients, age below 10 years, with a mean age of 5.37 years range with closed isolated femoral shaft fractures were included in the Study. Patients having compound fractures and those with associated injuries were excluded from the study. Spica cast was applied under sedation after preliminary skin traction, however immediate spica was given in children less than 2 year and those who had less than 2 cm shortening on telescopy. Follow up was done in OPD after 1,4,8,12,24 weeks with check x-rays taken at every visit.Results: 24 children were included in the study, with a mean age of 5.37 years range (2 months to 10 years). Average duration of skin traction was 14.8 days range (0-21) days. Average duration of hospital stay was 16 days range (2-22) days. Average time for fracture union was 7.4 weeks range (4-12) weeks. At final follow-up, 2 patient had Limb -Length Discrepancy (LLD) of 1.5 cm, 2 had LLD of 1 cm, 4 had LLD of 0.5cm, while 18 children had no LLD. None of the patients had short legged gait. None of the patients needed cast removal for any cast related complication.Conclusions: Traction followed by spica cast is a safe and effective method for closed fracture shaft of femur with very low risk of complication and can be done in children in less than 10 years of age.

The incidence of HPV associated Head and Neck Squamous Cell Carcinoma (HNSCC) is increasing over the past 30 years. It is a growing public health concern. It has been reported that tissues of HPV associated HNSCCs over express p16INK4a. Therefore p16INK4a is used as a surrogate marker to detect HPV associated HNSCC. Immunohistochemical detection of p16INK4a is an easy and simple technique than molecular detection of HPVs. Hence we investigated the presence of p16INK4a in Oral and Oropharyngeal Squamous Cell Carcinoma (OPSCC). Aims: The objectives of our study are (1)To study the association of p16INK4a expression with OPSCC, thus with the HPV. (2) To compare the p16INK4a expression in oral cavity and oropharyngeal SCC. (3) To correlate the level of p16INK4a expression with different grades of OPSCC. Methods: A total sample of 35 cases were analysed during the period of June 2014 to August 2015. We performed IHC in sections of formalin fixed paraffin embedded tissue of OPSCC cases and correlated the various patterns of p16INK4a positivity with respect to histopathological diagnosis. Results: In the present study, 71.43% of the OPSCC cases were above 50 years of age. OPSCC was more common in males with male to female ratio of 8:1. 94.29% of OPSCC cases were positive for p16INK4a, of which the most common pattern was diffuse nuclear and cytoplasmic staining (37.14%). Conclusion: In the present study, increased number of OPSCC cases were seen over expressing p16INK4a (94.29%). Oropharynx was the commonest site for p16INK4a positivity (94.44%). Among the oral cavity SCC cases, tongue was the most common site involved (64%). Of the OPSCC cases, most cases (37.14%) had diffuse pattern of p16INK4a over expression. However, DNA detection based studies are needed to validate the utility of IHC detection of p16INK4a as a surrogate marker for HPV associated HNSCC.

Introduction: Cervical cancer is caused by persistent infection by high risk Human papilloma virus (HPV).Increasing expression of HPV viral oncogenes might be reflected by increased expression of p16. Hence immunohistochemical detection of p16INK4a is an easy and cost effective method than molecular detection of HPV. Aims: The purpose of this study were to evaluate the results of expression of p16INK4a in neoplastic squamous cell lesions of cervix in order to assess the association of HPV infection in those lesions and to study the pattern of expression of p16 and also to compare p16 expression in various histological types of cervical neoplastic squamous cell lesions by immunohistochemistry. Methods: Immunohistochemical analysis of p16 expression was performed on 26 paraffin embedded tissue samples, obtained from cervical biopsy including 2 early invasive squamous cell carcinoma (SCC), 6 large cell keratinizing SCC, 16 large cell non- keratinizing SCC and 2 cases small cell non-keratinizing SCC by using commercially available mouse monoclonal antibody to p16 (clone G175 – 405). Two parameters were evaluated in p16 expression: Percentage of p16 positive cells and reaction intensity of p16 immunostaining. The p16 expression was graded as negative; Grade 1, 2, 3 and its reaction intensity was graded as negative, weak, moderate and strong. Results: In the present study out of 26 cases, the incidence of large cell non- keratinizing SCC constituted majority of the neoplastic lesions of cervix (61.5%). Most of the SCC (96.15%) showed grade 3 scoring for p16 positivity except one case which showed grade 2 scoring. Majority of SCC cases (96%) showed strong reaction intensity for p16 immunostaining. Conclusion: In this study of 26 neoplastic sqaumous cell lesions, all patterns of cervical neoplasia showed p16 positivity. P16 may be useful as an adjunct in histological sections to detect HPV in those lesions.