BackgroundA midshaft clavicle fracture is a prevalent form of injury of the upper extremity that affects one's quality of life. Several treatment modalities facilitate fixation of the displaced midshaft clavicle to decrease nonunion and malunion of the clavicle fracture. Still, numerous factors influence choosing an optimal surgical intervention. Thus, this study investigates the functional outcome of two standard fixation techniques, titanium elastic nails (TENs) and locking plates, as a prospective comparative study for surgical management of displaced midshaft clavicle fractures. MethodsWe performed closed/open reduction and internal fixation in 62 patients (40 male and 22 female) with TENs and locking plates, respectively, which were followed up at regular intervals following the surgery (at two, six, 12, 24, and 48 weeks). The surgical outcome was assessed both from functional and radiological standpoints. The influence of surgical fixation on functional outcome was evaluated based on the Constant-Murley score and the fracture recuperation based on union times. ResultsWhen compared to plate fixation, TENs had lesser union times. Still, there was no statistical difference in union time between the two groups. The functional assessment graded by Constant-Murley score had a similar distribution of scores between the two groups. With a follow-up of twelve months, the Constant-Murley scores between the groups were not statistically different. While the average score for plate fixation was slightly higher than that of TENs, the nonunion rate was found to be similar in both groups. ConclusionSurgical interventions using both TENs and plate fixation are suitable for managing clavicle midshaft fractures as they have a similar functional outcome. However, considering early recovery with minimal surgical complications, TENs can be a preferred treatment choice for managing displaced midshaft clavicle fractures.

This study evaluates the outcome of anterior cruciate ligament (ACL) reconstruction with arthroscopy using the bone-patella tendon-bone method. We performed this procedure in 24 patients with the average age of 33.1 years (range: 17-51 years) between 2017 and 2019. Sixteen of the 24 patients were available for evaluation using the Lysholm Knee Score and International Knee Documentation Committee (IKDC) system. Based on the Lysholm score, there was a statistically significant improvement in knee function when comparing pre-and post-surgical scores (p< 0.001). Using IKDC guidelines, a majority of the patients have regained near normal to normal knee function. We conclude that ACL reconstruction using the bone-patella tendon-bone method can provide good functional outcome based on objective and subjective assessments.

Introduction: During anterior cruciate ligament (ACL) reconstruction, femoral tunnelling is one of the most imperative stage. The success of surgical reconstructions of the ACL depends on the accurate restoration of its anatomy. The significance of the location of the hole drilled in femur has been repeatedly highlighted in ACL reconstruction. Incorrect tunnel placement is not infrequent, and even with diligent training, and aids, surgeons may still have difficulty in correctly positioning tunnels intra-operatively. Usually susceptible are surgeons in initial phase of the learning curve. Objective: To determine the susceptibility of surgeons in initial phase of learning curve while drilling femoral tunnel. Methods: All patients diagnosed with ACL rupture at a single institution between August 2018 and September 2019 were considered for the study. The surgeons who were relatively new out of their fellowship and training programmes (average of less than one years of independent practice) performed all surgical reconstructions, the number of reconstructions done independently was also taken into consideration (average of less than five independent procedures done before commencement of this study). We used anatomic free hand technique using bony and anatomic indicators as our markers, assisted by ruler, to drill femoral tunnel. Every subject had an 128 slice 3D CT-Scan done in immediate post-op period. High resolution 3-Dimensional view was created of the knee to evaluate the tunnel location. The position of the femoral tunnel was evaluated using the Bernard and Hertel quadrant method. The Femoral tunnel location was expressed in terms of its distance from the notch and posterior wall of condyle, the results were expressed in terms of percentage. Results: A net total of 32 patients were included who underwent single bundle ACL reconstruction. In our study, measurement of femoral tunnel placement was - depth 37.1% and height 24.6%, represented as percentage depth (deep to shallow (t)) and height (high to low (h)). Our results were compared with other established studies. The value of height was near to that mentioned in literature; whereas the value of depth was shallower (or distal) when compared to established literature with average location being 10.7% shallower (or distal) to anteromedial bundle insertion mentioned in study by Colombet et al and 4.8% shallower when compared to study by Zantop et al. When compared to study by Bernard and Hertel the location is 12.3% shallower. The reason for comparison with anteromedial bundle is that in single bundle anatomical reconstruction Pearle et al , Segawa et al and Simmons et al advocate it to be anteromedial. Conclusion: The surgeons in initial phase of their learning curve may be more prone to shallow (non anatomic) location of femoral tunnel during single bundle ACL reconstruction. We infer that this discrepancy in proximal (deep) to distal (shallow) orientation is due to fear of posterior wall blow out, that is the violation of the posterior femoral cortex, a known intraoperative complication in ACL reconstruction.

A Hill-Sachs lesion, a posterolateral bony defect of the proximal humerus, occurs when the humerus head collides with the anterior region of the glenoid during an anterior shoulder dislocation. A posteriorly dislocated shoulder may cause a reverse Hill-Sachs lesion, which is a deficiency on the anteromedial part of the humeral head due to impaction. Avascular necrosis could result from this lesion if detection and repair are not carried out. The subscapularis tendon is separated from the smaller tuberosity using an open technique in the original McLaughlin procedure, which was initially described in 1952. In neglected cases of patients undergoing surgery after three weeks, there is no commonly accepted standard of care. Glenohumeral joint stabilization and early and full functional recovery are the two objectives of the procedure. This case report describes a modified McLaughlin surgery where the subscapularis tendon and lesser tuberosity are transferred to the reverse Hill-Sachs defect for stability. The clinical significance of our case report is that it accentuates the role of early detection and appropriate management of reverse Hill-Sachs lesion, which is often overlooked and missed in a case of posterior shoulder dislocation. The use of the modified McLaughlin procedure not only covers the defect with a bone chunk and the subscapularis tendon transfer over the head of the humerus but the stable fixation with the anchor and cannulated cancellous screw helps in early rehabilitation of the shoulder joint.

We present a case of a 17-years-old lady, with right ankle joint pain and swelling. The diagnosis of tuberculosis of the talus with involvement of the distal tibia and ankle joint was made with the help of X-rays, MRI, gene expert and core needle biopsy from the talus. She was treated with anti-tubercular chemotherapy and ankle immobilisation. Conclusion:Early diagnosis with radiological studies, gene expert and histopathology will help preventing further destruction of the joint surfaces due to this rare form of skeletal tuberculosis. This along with a conservative treatment with anti-tubercular drugs and protected weight bearing gives excellent functional results.