Background: Osteochondroma is the most common benign skeletal neoplasm and is found most often in long bones, especially in the distal femur and proximal tibia. They usually present as painless swelling near the joint and can be complicated by mechanical irritation, compression or injury of adjacent structures, fracture, malignant transformation, and post-operative recurrence. Locking of the knee refers to flexion of the knee without complete extension and passive extension is limited resulting in significant pain. Excision is a successful form of the treatment for symptomatic osteochondromas. Case Report: A case of osteochondroma of the proximal tibia illustrates extra-articular cause of locked knee secondary to the incarceration of pes anserinus tendons by the lesion. Conclusion: Surgical excision of the bilobed pedunculated posteromedial proximal tibia osteochondroma and restoration of the gracilis and semitendinosis to its normal anatomic position resulted in the complete resolution of symptoms.

Background: Clavicle fracture is one of the common fractures accounting for 2.6-12% of all fractures and 44-66% of shoulder fractures. Mid-clavicle fractures account for almost 80% of clavicle fractures. Most of the these fractures were treated conservatively in past but recently there has been an increasing tendency for operative management. Though many studies have been conducted to assess the benefit of primary surgical management against conservative management, no consistent results have been obtained to show which one is better. So, this study was carried out to compare the radiological and functional outcome following conservative management to that of operative management with open reduction and internal fixation (ORIF) with plating for displaced midshaft clavicle fractures. Methods: In a single centre, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and arm sling. Outcome was analysed in terms of functional outcome and radiological union by standard follow-up, Constant and Murley shoulder score and plain radiographs. All sixty patients completed six month follow up and there was no difference between two groups with respect to patient demographics, mechanism of injury and fracture pattern. Result: There was no significant difference in Constant shoulder score between the two groups. The mean time of union was 14.57 weeks in operative group compared to 16.04 weeks in nonoperative group (p value=0.191). There were two non-union in nonoperative group compared to none in operative group. The complications in operative group were mainly hardware related (four had loosening of screw, two had implant failure and one had infection). At six months after surgery patient were more likely to be satisfied with the results in operative group compared to nonoperative group (p=0.02). Conclusion: Six months after a displaced midshaft clavicular fracture, nonoperative treatment resulted in higher malunion and non-union rate but similar functional outcome and union time compared to operative management. However, patients were more likely to be satisfied in operative group compared to nonoperative group.

Introduction: Primary total hip replacement (THR) surgery for the neck of femur (NOF) fracture in a case of below-knee amputation with distal femur shaft non-union is rare. Case Report: This case describes the traumatic right NOF fracture in a 49-year-old male patient with distal femur shaft non-union. The patient has a history of ipsilateral below the knee amputation along with right distal femur shaft fracture managed with retrograde femur nailing 10 months back following a road traffic accident. The NOF fracture was managed by primary THR as the definitive procedure after distal femur nail removal and distal femur plating with allograft for non-union. Conclusion: Primary THR with distal femur plating and allogenic bone grafting in such cases provides satisfactory outcomes. It allows for early ambulation and rehabilitation of the patient. Key words: Primary total hip replacement, Below-knee amputation, Distal femur non-union.

Introduction: Titanium elastic nailing (TENS) with wedge osteotomy for the management of monostotic fibrous dysplasia (FD) of tibia is done in a 6-year-old male patient. Case Report: This is a case describing monostotic FD of right tibia in a 6-year-old male patient. The patient’s parents noticed a diffuse swelling in the right leg a few days after birth. It was managed conservatively till 3 years of age when the patient started complaining of pain in his right leg and difficulty in walking and running. The patient developed gradual and progressive anterior bowing in the right leg in the next 3 years. The patient was diagnosed with monostotic FD of the right tibia based on clinical and radiological findings. Wedge osteotomies were done in the tibia and fibula with TENS nailing as a definitive procedure for this patient. Discussion: Management of monostotic FD of the right tibia with TENS nailing and wedge osteotomy can be a possible modality of definitive management with complete pain relief and deformity correction. Conclusion: Correction of deformities secondary to FD requires meticulous pre-operative planning and execution. But with proper planning, even major deformities as in our case, procedures as simple as wedge osteotomy and TENS nailing can give excellent outcomes. Keywords: Fibrous dysplasia, monostotic, titanium elastic nailing.

Background: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The management of these fractures depends upon age and type of injury Aim: To compare the outcome in comminuted radial head fractures(Mason type III) based on mayo elbow scoring and handgrip strength test when managed with radial head excision, radial head fixation or radial head replacement Material and Methods: We did a prospective comparative study comprising 60 patients between age 20-60 years with Mason type III radial head fractures. The patients were randomised using the admission day of the week placing 20 patients each in arthroplasty , excision and in the fixation group. The patients were followed up for 18-24 months postoperatively. Results were evaluated by the Mayo’s elbow performance and Handgrip strength score at 6 months and 18 months and were statistically evaluated by one-way ANOVA test. Results: As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 83.25 and 11.50, for excision it was 76.25 and 11.38 & for fixation, it was 68.75 and 17.83 respectively. At 18 months follow up, mean and standard deviation was 90 and 12.56 for arthroplasty, 83 and 9.92 for excision & 76.25 and 21.69 for fixation respectively. As per handgrip strength score at 6 months follow up, mean and standard deviation of the scores in arthroplasty was 31.1 and 4.37, for excision it was 28.75 and 4.27 & for fixation, it was 27.15 and 5.94 respectively. At 18 months follow up, mean and standard deviation was 32.95 and 4.006 for arthroplasty, 30.7 and 4.06 for excision & 28 and 6.75 for fixation respectively. The difference between the results according to both Mayo’s score as well as Handgrip strength test was statistically significant (p < 0.05). Conclusion: Our study shows that long and short-term results of radial head replacement are better than radial head excision and radial head fixation in comminuted radial head fractures based on mayo elbow scoring and hand grip strength score. Keywords: Radial head fracture, Radial head replacement, Mason classification