IntroductionThe surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). MethodsThrough our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. ResultsWe have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. ConclusionLCP with ANVFG and AICBG is a reliable option for "complex" diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.

Background: Surgical treatment for perforation peritonitis is still believed to be demanding and complex in spite of the advent of better surgical technique, antimicrobial therapy and intensive care support improving the outcome of such cases. However, the specific details of the pre-operative, intra-operative and post-operative management have always been very controversial and debatable. This study aims to evaluate the efficacy of peritoneal cavity irrigation with imipenem solution in patients with perforation peritonitis and compare it with standard saline wash.Methods: This study was conducted in a tertiary care teaching hospital from November 2015 to April 2017 and included 90 patients aged between 12 and 60 years who are operated for perforation peritonitis. Patients are divided into 3 groups and underwent post laparotomy irrigation as follows saline and fluid drained, saline and then imipenem wash at a concentration of 1mg/ml and fluid drained after 5 minutes, saline and then imipenem wash at a concentration of 1 mg/ml and drain was clamped for 1 hour. The patients were then observed for post-operative complications.Results: There was a statistically significant reduction in post-operative wound infection (33.33%), intra-abdominal abscess (23.33%) and sepsis (23.33%) in group 3 when compared to other two groups. Group 3 had a much lower mortality rate (3.33%) when compared to the other two (16.67% and 6.67% respectively.)Conclusions: Addition of Imipenem to normal saline for intraoperative peritoneal lavage has much satisfactory post-operative outcome. Further studies with larger sample size are needed to accurately assess the statistical significance of the same.

Introduction: Hernia repair has been an ever evolving field of surgery. Newer modalities of treatment are being developed, with mesh repair becoming the cornerstone of management of hernia. As mesh related complications have increased in the last decade, there has been an evolution in the type of meshes being used. The aim of our study was to compare light weight mesh and heavy weight mesh in Lichtenstein tension free open inguinal repair. Methodology: A prospective study of 100 patients undergoing open inguinal mesh repair in Victoria Hospital, Bangalore, was conducted from August 2016 to March 2018. 50 patients received heavy weight mesh (HWM) and the rest 50, light weight mesh (LWM), after randomization. They were evaluated on post-operative day 7 for examination of wound, post-operative pain and with USG for seroma formation. Patients were reviewed again after 1 st and 6 th month for chronic pain and recurrence. Results: Out of the 100 patients, 52 required 2 days of hospital stay out of which 61.5% were with HWM. At 1 week, all the patients had seroma formation (USG) but clinically significant seroma formation seen in 25 patients. Of this, 10 patients belong to LWM and 15 patients to HWM group. At 6 months, 13 patients had chronic pain and 10 belonged to HWM group. No recurrences reported. Conclusions: LMW and HMW for inguinal hernia repair had similar outcomes with a non-significant trend favouring LWM in terms of decreased seroma formation and lesser incidence of chronic pain at the end of 6 months. However, these results would be required to be validated in larger studies.

BACKGROUNDEven today there is a dilemma whether clavicle fractures should be treated conservatively or surgically. Several factors predispose to nonunion like inadequate conservative treatment, fracture comminution, re-fracture, distal-third fracture, marked displacement or shortening of >2 cm and primary open reduction. Generally, surgery is indicated in nonunion associated with pain and functional disability of the shoulder. Excellent rates of union have been reported after plating and grafting by many authors. STUDY DESIGN: Treatment and Outcome Study.

Introduction: Acetabular component placement is a crucial determinant in outcomes following total hip arthroplasty. Malalignment predisposes to impingement, increased rate of dislocation, wear of the bearing, osteolysis, and revision after THA. The study aimed to determine how reliably the transverse acetabular ligament could be identified during primary THA and its validity as a guide for acetabular component placement within the safe zone in THA. Materials and Methods: In this prospective study, 52 patients undergoing total hip replacement during the period from August 2014 to January 2017 in Bowring and Lady Curzon Hospital and Victoria Hospital, Bangalore were included; in whom the acetabular component positioning was done using transverse acetabular ligament as a guide. 22 cases were done via modified lateral approach, while 30 cases were done via posterolateral approach. Acetabular reaming was done by placing the reamer parallel to TAL, starting with a reamer the diameter of the native femoral head. Following serial reaming, the final component is placed such that TAL should embrace it. The anteversion and inclination/abduction of the acetabular component was measured post-operatively by anteroposterior radiographs. Results: TAL was identified in all cases, irrespective of the surgical approach used. The mean planar anteversion was 19.84° (± 3.8°), and the radiological inclination was 43.65° (± 3.2°). Anteversion was within the safe zone in 96.15% (n=50) of the cases, while inclination was within the safe zone in 84.6% (n=44) of the cases. Conclusion: Transverse acetabular ligament can be reliably used as a guide in achieving patient-specific anteversion of the acetabular component within safe zone. A simple, reproducible technique, devoid of complex instrumentation. However, as inclination is influenced by factors in addition to TAL, TAL alone cannot be used for determining inclination of acetabular component positioning.