Purpose. To assess the Ilizarov technique in treating large infected tibial defects by resection of the infected focus, its acute compression, and gradual distant site lengthening. Methods. 27 men (mean age, 39 years) with infected nonunion and large bone defects of the tibia underwent complete resection of the nonunion site, debridement, sequestrectomy, lavage, and Ilizarov ring fixator application. Patients underwent acute compression of the defect site, followed by distant site metaphyseal corticotomy for simultaneous lengthening. The mean length of resection was 10 (range, 6-17) cm. The mean follow-up was 27 (range, 25-39) months. Results. The mean lengthening achieved was 10 cm, mean union time 6.3 months, and mean duration of consolidation 10.2 months. Functional results were excellent in 19 patients and good in 5. The union time was longer in older patients. Conclusion. Acute compression and simultaneous lengthening can be used safely for treatment of large bone defects in the tibia. This avoids secondary Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects MP Magadum, CM Basavaraj Yadav, MS Phaneesha, LJ Ramesh

Surgical repair with a fibular strut, cortico-cancellous bone graft and Ilizarov ring fixation appears a suitable treatment option for C3 distal femoral fractures.

Background: Sleep restores physiology and neurochemical components of our body and is essential for physical and mental health. Sleep disorders (SDs) are associated with insulin resistance and metabolic disorders. The association between SDs and diabetes needs to be understood in the Indian population. Purpose: The purpose was to investigate the association between SD and diabetes in the Indian population. Methods: As a part of nationwide Niyantrita Madhumeha Bharata Abhiyaan-2017 (NMB-2017), a cross-sectional study was conducted and data was collected from seven zones of India, after screening through the Indian Diabetes Risk Score (IDRS). The sleep quality was assessed on a scale of 1 to 4 (very good = 1, very bad = 4). The time taken to fall asleep (sleep latency) was assessed on a scale of 0 to 5 (“0” = nil and “5” = >1.5 h). Stress was assessed by the perceived stress scale. Results: Bad sleep quality was positively (odds ratio 1.055, CI [1.001, 1.113], and P < .01) associated with self-reported known diabetes. Increased time taken to fall in sleep (sleep latency) was associated significantly with IDRS high risk (odds ratio 1.085, CI [1.008, 1.168], and P = .01), with an average sleep latency /time takes to fall in sleep (maximum range 5 [>1.5 h], mode 2 [10 to 30 min]) minutes. Moderate stress was significantly associated with bad sleep quality (odds ratio 1.659). Conclusion: A positive association of bad sleep quality and stress with diabetes, and an increased sleep latency in the IDRS high-risk population point to the role of modifiable risk factors. Behavioral modification and stress reduction by using yoga may be beneficial in the better management of diabetes.

Background The rise in prevalence rates of Type 2 Diabetes among Indians is well recognized. The research focus has been primarily to understand the changes in insulin sensitivity and beta cell dysfunction among Indians with Type 2 Diabetes. However, no data are available on the role of peripheral tissue, in particular intramyocellular lipid (IMCL) content and its impact on glucose homeostasis among Indians with prediabetes. Methods 28 male subjects (20-40 year) were studied. 13 with prediabetes (BMI ranging from 25.4 ± 2.9 kg/m 2) and 15 controls (BMI ranging from 24.6 ± 2.8 kg/m 2) were recruited. Body composition by dual energy X-ray absorptiometry (DXA), insulin sensitivity, insulin secretion rates were derived using the minimal model of C-peptide secretion and kinetics rates and skeletal muscle strength of the lower limb (quadriceps) was assessed using Isokinetic dynamometry. From muscle biopsy samples of the vastus lateralis, IMCL fat content (Oil red O staining) was determined. Results The prediabetes group were older compared to controls (P < 0.01), but had similar BMI. The muscle to fat ratio, plasma Insulin, C peptide, HOMA-IR and HOMA % B were also comparable between the groups. IMCL fat content (%) was significantly higher in the prediabetes group compared to controls (7.0 ± 0.7% vs. 2.0 ± 0.3%, P < 0.01). This difference persisted even after controlling for age. Overall the IMCL fat content (%) was positively and significantly associated with HbA1c (r = 0.76, P < 0.01). HOMA-IR was significantly correlated with central (android, trunk) adiposity (kg) (r = 0.71, P < 0.01) but not with IMCL (%). Conclusions This is the first direct evidence of existence of significantly higher lipid levels within skeletal muscle cells among normal and overweight young Indians with prediabetes. However, there was no association between IMCL and HOMA-IR among the prediabetes group.

Introduction: Segmental long bone fractures in high energy injuries are a challenging combination of bone and soft-tissue damage and loss. The state of the surrounding soft tissues and the local blood supply to the bone are the most important factors determining the tendency of the fracture to heal. Objectives: To study the efficacy and safety of various method of treatment in segmental fractures long bones and various complications associated with it. Materials and Methods:  20 patients with segmental fractures of long bones, satisfying the inclusion criteria, who were treated with various modalities of management were included in the study.The fractures were evaluated clinically as well as radiologically and the modality of management was based on the type of fracture and associated injuries. Out of 10 tibial fractures, 6 were treated with static intramedullary nail, and 2 with  external fixator 2 conservatively. Out of 5 femoral fractures,4 were treated with intramedullary nail. Out of 2 humerus fractures 2 were treated with dynamic compression plate technique. Out of 3 both bone forearm fractures 3 were treated with dynamic compression plate technique.