BACKGROUND Post-operative urinary retention following lumbar spine surgery can lead to detrusor dysfunction, urinary tract infections, prolonged hospital stay and a higher treatment cost. The incidence of POUR varies among different studies, (1,2,3,4,5) the risk factors for POUR in lumbar spine surgery remain unclear. Hence the aim of the study is to analyse the prevalence and incidence of postoperative urinary retention in patients undergoing posterior Lumbar spine surgeries and to evaluate the risk factors associated with development of postoperative urinary retention (POUR). METHODS All patients who underwent posterior lumbar spine surgery from June 2016 to May 2018 who satisfy the inclusion criteria were included in this prospective study. Patients with urinary incontinence, pre-operative catheterization, neurological deficit were excluded from the study. Risk factors were assessed, and univariate analyses was done. RESULTS A total of 203 patients underwent lumbar spine surgery in the study period of which based on inclusion criteria 123 patients were included in the study. On prospective analysis, 20 patients were found to have developed POUR. The incidence rate was 16.26%. Significant risk factors were analysed in which age of the patient, duration of surgery, patient with higher post-operative pain score, high blood loss were found to be associated with POUR. CONCLUSIONS The incidence of POUR in lumbar spine surgeries was found to be 16.26% in our study which significantly differs from various other studies. (4) Older age of the patient, prolonged duration of surgery, surgery with more blood loss, patient with higher post-operative pain score were significant risk factors associated with POUR.

BACKGROUND Distal femoral fractures of femur are one of the most challenging injuries to treat. Because of the proximity of these fractures to the knee joint, regaining full knee motion and function may be difficult. Closed management of these distal femoral fractures thus poses difficulties in obtaining and maintaining the reduction making operative management the preferred treatment. Hence the aim of the study is to analyze the short-term results in terms of union and functional outcome for distal femoral fractures treated with distal femoral locking compression plating.

Leprosy is the most common treatable cause of neuropathy in the world. [1] The social stigma in leprosy is mainly due to nerve function impairment and subsequent disability. Loss of common peroneal nerve function leading to paralysis of the anterior and lateral compartment muscle groups in the leg is common in leprosy. Surgical correction of foot drop in leprosy is done by anterior transposition of the tibialis posterior tendon. The aim of the study is to assess the functional outcome of tibialis posterior tendon transfer procedure and to identify factors that impact favourable outcome of tibialis posterior tendon transfer. METHODSOur study is a prospective study of 50 leprosy patients who underwent tibialis posterior tendon transfer between Jan 2012 to Dec 2015 in Tagore Medical College Hospital. In our study of 50 patients, 44 were males and 6 were females with sex ratio 22:3. The maximum number of cases who underwent surgery were between 26 to 35 age group; 45 cases were borderline tuberculoid type (90%) and 5 cases were borderline lepromatous type (10%); 44 cases underwent interosseous route tendon transfer and 6 cases by circumtibial route tendon transfer. RESULTSBy modified daf grading, 80% of patients in our study had good-to-excellent results; 43 patients (86%) in our study had normal heel-toe gait after surgery; 15 patients developed inversion deformity of foot and 5 patients developed talonavicular collapse. CONCLUSIONThe usefulness of tibialis posterior tendon transfer as a method of correction of foot drop in leprosy is well known. In our study the gains of normal gait, favourable foot at rest position and active range of movement in the dorsiflexion range were improved after tendon transfer surgery. In the long-term evaluation of this procedure where the follow-up ranged from 2 to 10 years, tibialis posterior transfer functioned well and did not develop major surgery related complications like neuropathy, loosening of transfer by stretching of tendon or occurrence of new deformities. Apart from improving the gait, tibialis posterior transfer helped prevent recurrent ulceration in anaesthetic feet also.

This new technique, a modification of the caudal approach of Soubrane, involves a posterior to anterior transection of the liver for laparoscopic major hepatectomies. It was conceived to enable a standardised technique, and to broaden the indications for laparoscopic resection particularly for larger tumours and with anatomical variations of the porta. Methods: As the initial step for a right hemihepatectomy the retrohepatic tunnel of Belghiti is developed and the caudate process divided as far superiorly as possible. Liver parenchyma is dissected away from the posterior aspect of the right hepatic inflow from medial to lateral, enabling safe stapling. Development of the retrohepatic tunnel and division of the posterior parenchyma is continued as the leading edge of the parenchymal transection, maintaining good surgical orientation especially for tumours close to the midline or cava. Similar concepts apply for a left hemihepatectomy, with dissection beginning in the in the Arantius groove. Results: 8 cases (6 right hemihepatectomy, 1 extended right hepatectomy, 1 extended left hepatectomy) have utilised this technique. I required conversion to a hybrid approach, and 1 case required transfusion. R0 resection was achieved in all cases. Average length of stay was 5 days. Comparison to 50 consecutive previous laparoscopic major hepatectomies demonstrates larger tumours and fewer conversions with the dorsal approach. Schematic and case videos will be presented. Conclusion: The dorsal approach to laparoscopic major hepatectomy is a novel technical variation that enables a safe, standardised technique and an expanded set of indications for a laparoscopic approach.

BACKGROUND AND OBJECTIVESSubtrochanteric fractures of the femur remain one of the most challenging fractures facing orthopaedic surgeons. Most of the fractures in the elderly results from trivial fall from standing or walking, while in the younger age group it is mainly due to road traffic accidents. Closed management of these subtrochanteric fractures thus poses difficulties in obtaining and maintaining a reduction, making operative management the preferred treatment. Hence, this study is intended to determine the effectiveness of intramedullary fixation of subtrochanteric fractures with the proximal femoral nail and the complications involved in the management of subtrochanteric fractures.