Spondylolysis is an important cause of low back pain in children and adolescents, especially in those involved in athletic activities. Spondylolysis is caused either by a fracture or by a defect in the pars inter-articularis and can be unilateral or bilateral. Among the various hypotheses regarding the etiopathogenesis of pars lysis, the occurrence of chronic micro-fractures secondary to repetitive extension and rotational stresses across pars remains the most convincing explanation to date. The majority of these patients remain asymptomatic. Imaging contributes to the staging and prognostication of the lesions, planning the line of management, and monitoring the response to treatment. Nonoperative treatment with activity restriction, braces, graded physiotherapy, and rehabilitation forms the cornerstone of management. Surgery is indicated in a specific cohort of patients whose symptoms persist despite an adequate conservative trial and includes spinal fusion and pars defect repair techniques. Patients who demonstrate good pain relief after diagnostic pars infiltration can be considered for pars repair. Patients aged ≤25 years, those with an athletic background, unilateral pathologies, and those without associated spondylolisthesis, instability, or disc degeneration are ideal candidates for pars repair. The overall outcome in spondylolysis is good, and 85% to 90% of athletes return to sports at 6 months following conservative or surgical line of treatment. In this current narrative review, we comprehensively discuss the etiology, patho-anatomy, natural history, clinical features, diagnostic modalities, and management of spondylolysis with special emphasis on direct repair techniques of pars.

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BACKGROUND Management of segmental long bone defects is a challenging task. Attempting limb reconstruction in the presence of significant bone loss usually involves surgery, which is technically difficult, time-consuming, physically and psychologically demanding for the patient, and with no guarantee of a satisfactory outcome. Amputation, external fixators, vascularised fibular grafts, acute limb shortening, and various quantities of allograft and autograft have historically been the mainstays of treatment. For the past 4 decades, Vascularised Fibular Grafting (VFG) and distraction osteosynthesis with ring external factor (Ilizarov technique) stood the test of time to become standard techniques for the management of large long bone defects. More recently, Masquelet described the use of a cement spacer placed within the osseous void followed by staged bone grafting within the induced biomembrane formed around the spacer as a potential treatment strategy to manage these large defects. The main aim of the study is to compare the efficacy of the two philosophically different methods, conventional distraction osteosynthesis, and Masquelet technique in the management of tibial bone defect incurred due to traumatic bone loss, traumatic fractures complicated by infection, and chronic osteomyelitis of tibia. METHOD Prospective observational study on male and female patients admitted in the Department of Orthopaedics in our tertiary level hospital from November 2012 to September 2014. All patients who have tibial bone defect incurred due to traumatic bone loss, traumatic fractures complicated by infection, and chronic osteomyelitis of tibia are included in the study. Children of age less than 5 years and elderly patients of age more than 85 years are excluded from the present study. Patients with tibial bone defects resulting from injury or surgical intervention are selected into the study and assigned either group D or group M. The patients in group D (n=15) are treated by conventional distraction osteosynthesis while the patients in the group M (n=10) are treated by Masquelet's technique. Patient demographics, radiological bone union rates, time taken to achieve bone union, and infection rates and their statistical significances are compared to come to a scientific conclusion. RESULTS The study was done over a period of 2 years (November 2012 to September 2014). During this period, we observed 25 cases of tibial bone defects, which were managed by either distraction osteogenesis (Group D:15 cases) or Masquelet technique (Group M:10 cases). In our study, the mean age of group D and group M were 40.9 years (SD±9.89) and 37.8 years (9.13) respectively. In the present study, most of the patients belong to male gender in either groups (8 in group M and 13 in group D). Female gender has 2 patients in either group. In the present study, we observed trauma with infection (46.66%) and trauma (40%) were common aetiological causes for tibial bone defects. There was no significant difference in defect size between the two groups (p=...

BACKGROUND Longest bone of human body is femur, which by itself forms the skeleton of the thigh. It is composed of body, upper extremity and lower extremity. The upper extremity is made up of a head, a neck and two shafts called 'the greater' and 'the lesser' trochanter. Surgical neck of femur connects upper extremity to body. Fracture neck of femur occurs commonly in elderly age group and females, typically occurs due to low-energy trivial falls and may be associated with osteoporosis. 1,2,3,4 The prevalence of fracture neck of femur doubles after the fifth decade of life. The incidence of fracture neck of femur has increased in recent decades. 5,6 This fracture remains even today a challenge, as far as treatment and results are concerned. There are certain anatomical features peculiar to this fracture, which need consideration. Femoral neck fractures usually are entirely intracapsular, and common to all intracapsular fractures, the synovial fluid bathing the fracture may interfere with the healing process, because the femoral neck has essentially no periosteal layer, all healing must be endosteal. Angiogenic inhibitory factors in synovial fluid also can inhibit fracture repair. These factors, along with the precarious blood supply to the femoral head, make healing unpredictable and results in frequent non-unions. Because of the anatomical configuration of the bone and action of various groups of muscles, this fracture is subjected to a very high degree of shearing strain. Because of these factors, a displaced fracture neck of femur doesn't unite, unless it is reduced and internally fixed. Even undisplaced fractures can get displaced and go in to non-union. This study is done to evaluate the demographic details, types of fractures and injuries leading to fracture neck of femur. MATERIALS AND METHODS Twenty-five patients admitted in department of orthopaedics and traumatology of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation were screened and enrolled for this study. This study was conducted from May 2010 to October 2012. Detailed history and clinical examination were conducted. Patients satisfying inclusion and exclusion criteria were enrolled. Fracture neck of femur was confirmed by radiological evaluation. All the data was presented in numbers and percentages. RESULTS In our study, 52% were between 40-60 yrs. age group and 48% were from 60-70 yrs. Age group. Females were 56% and 44% were males in this study. Left side fracture neck of femur (60%) was more common than the right side (40%). Fracture neck of femur due to a trivial fall was observed in 40% of cases and 60% was due to road traffic accident. Fracture neck of femur type II occurred in 4%, type III in 44% and type IV in 48% of patients. CONCLUSION This study concludes that fracture neck of femur is commonly observed in elderly patients and females were affected more than the males due to low bone density. Left side fracture neck of femur was more common. Type III and type IV fracture neck of femur contributed in major...

BACKGROUND Fracture neck of femur as well as hip fractures in general, represent a major challenge to today's healthcare systems, probably due to higher mortality and morbidity, frequent lengthy hospitalisation and post-operative complications. Problems of the hip joint, whether due to trauma or arthritis need considerable skill and judgment on the part of the surgeon. Bipolar hip replacement offers a durable and versatile solution for many problems of the hip, in which replacement of the head and neck of the femur results in a rapid return of function and a painless hip. The aim of the study is to evaluate the efficacy of bipolar hip prosthesis in treatment of intracapsular fracture neck of femur in the elderly and physiologically younger patients. The emphasis is on treating with bipolar hip prosthesis in physiologically younger patients. MATERIALS AND METHODS Twenty-five patients of age 40 to 70 years were referred to Department of Orthopaedics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation. They were screened and enrolled for this study. Patients were counseled and an informed consent taken for enrolment in the study after fulfilment of inclusion criteria. Upon enrolment into study, all patients were subjected to clinical and laboratory investigations as necessary. All surgeries were performed under standard aseptic precautions through Moore's/Southern Exposure and Hardinge approach. All patients were followed-up at regular intervals. RESULTS In our study, uncemented technique was used in bipolar hemiarthroplasties for 21 patients. Five cases had associated injuries. Leg length discrepancy (3) and sciatic nerve injury (1) were immediate complications of surgery. Early complications were haematoma (2) and deep infections. Late complications were sinking (2 patient) and death of a patient. The Mean Harris Hip Score was 86. Fair, good and excellent results were observed in 16%, 60% and 16% of the study patients. CONCLUSION Bipolar hip prosthesis offers a long-term solution in patients with intracapsular fractures of the neck of femur due to multiple advantages. The procedure offers advantages like painless mobility, ease of rehabilitation and return of function.