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BACKGROUNDMetaphyseal fractures of long bones of lower limb are difficult to manage. In our study, we have evaluated the radiological and functional outcome of minimally invasive plate osteosynthesis (MIPO) technique for metaphyseal fracture of femur and tibia. MATERIALS AND METHODSA total of 37 metaphyseal fractures of long bone of lower limb were included in the study. The fractures were treated with minimal incisions, both at proximal and distal ends of plate. The anatomical metaphyseal locking plate was then inserted subperiosteally and the fracture was bridged after which the plate was fixed. The patients were followed up and the progresses were evaluated at regular interval by Johner-Wruhs' criterion and lower extremity functional score. RESULTSAll the fractures united well. The mean time of union of distal femur, proximal and distal tibia are 18 (range 14 -24), 18 (range 14 -22) and 17 (range 16 -24) weeks respectively. The mean range of motion at knee of fracture around knee was 105°, while for fracture at ankle the range of motion was a mean dorsiflexion of 19° and mean 30° plantar flexion. According to Johner-Wruhs' criterion results were excellent in 14, good in 17, fair in 5 and poor in 1 patient. By LEFS system, 34 patients have no difficulty in doing their work, while only 3 patients have a little bit of difficulty. No patients required bone grafting. The complication rates were also low. CONCLUSIONFor metaphyseal fractures, MIPO can be regarded as an optimal treatment modality which achieves good bone union and functional results with minimum soft tissue damage.

BACKGROUND:Anterior knee pain has been described as the most common complication after intramedullary nailing of fracture shaft of tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be as one of the contributing causes of chronic anterior knee pain. The purpose of this prospective, randomized study was to compare the incidence of anterior knee pain after intramedullary nailing of a tibial shaft fracture with transtendinous and paratendinous incision technique. MATERIAL AND METHODS: From April 2012 to October 2013 eighty patients with closed tibial shaft fractures were admitted and treated in our institution. Patients were randomized for treatment with paratendinous or transtendinous nailing (as 24 patients did not complete their follow up or were lost in follow up, so 56 patients were analyzed finally). For assessment we used visual analogue scales to report the level of anterior knee pain. The scales described by Lysholm and Gillquist and by Tegner et al., were also used to quantitate the functional results. RESULTS: 12 of the 28 (42%) patients treated with transtendinous nailing. reported anterior knee pain whereas 8 patients out of 28 (28%), in which paratendinous technique was used had persistent anterior knee pain after minimum final follow up of 24 weeks, with no significant statistical difference. The Lysholm, Tegner functional scoring systems showed a significant difference between the two groups. CONCLUSION: Compared with a transtendinous approach, a paratendinous approach for nail insertion does not reduce the incidence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients. Since our study is small and have short duration of follow up, further larger studies and long duration of follow up is needed to establish the results.

<p>BACKGROUND: Indiscriminate use of intra-operative fluoroscopy can incur harm both to the patient as well as the surgeons. Orthopedic surgeons seldom do in skin marking prior to cleaning and draping of the operative site. This study aims to study the feasibility and utility of pre-operative skin marking with henna in conjunction with marker radiograph.</p><p>METHODS: Out of 54 patients undergoing spine surgery, vertebral level localization was done by fluoroscopy in 26 patients. In the rest of the 28 patients, preoperative marker radiograph with steel wires was taken in conjunction with henna line markings on the skin. These were correlated for vertebral level localization. Difference in time taken for vertebral localization by these two methods, and the difference in the number of fluoroscopic images required was observed and recorded.</p><p>RESULTS: Approximately 4 minutes were needed for level localization via fluoroscopic technique, whereas the henna marking technique did this in approximately 30 seconds. No adverse effects of henna application were observed during the study.</p><p>CONCLUSIONS: The use of preoperative skin marking with henna along with the appropriate marker radiograph can reduce the surgical time and radiation exposure without increasing the chances of a wrong level surgery in the spine.</p>