Background: The number of anterior cruciate ligament (ACL) injuries reported in skeletally immature athletes has increased over the past 2 decades. The reasons for this increased rate include the growing number of children and adolescents participating in competitive sports vigorous sports training at an earlier age and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. There is a growing need for a consensus and evidence based approach for management of these injuries to frame a dedicated age specific treatment strategy.Methods: This article does a systematic evidence based literature review of management of Pediatric ACL injuries seen in several forms: tibial eminence avulsion fractures partial ACL tears and full thickness ligament tears and its outcome analysis.Results: The mechanism of Safe and effective surgical techniques for children and adolescents with ACL injuries continues to evolve. The numerous age matched techniques are extensively discussed. Neuromuscular training can reduce the risk of ACL injury in adolescent girls.Conclusion: This review outlines the current state of knowledge on diagnosis treatment and prevention of ACL injuries in children and adolescents and helps in guiding the treatment through a dedicated algorithm.

Introduction:Osteoporosis is de ned as a disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk especially in elderly. e association between vitamin D de ciency and osteoporosis and impact of vitamin D de ciency on treatment of osteoporosis is rarely studied in detail in Indian population. e present study was planned to nd out correlation between vitamin D levels and osteoporosis severity and to evaluate the role of vitamin D supplementation in the treatment of osteoporosis in Indian population.Material & Methods: is is a randomized controlled study of total 80 patients with osteoporosis and Vitamin D levels < 20ng/ml were randomly allocated to one of the two groups as follows: Study Group I (n=40): In this group apart from usual treatment of osteoporosis which include ibandronic acid 150mg once a month for 6 months along with calcium (500mg), the patients were given 60,000 IU of vitamin D once weekly for 6 months in oral nano solution form. Placebo Group II (n=40): In this group no additional Vitamin D supplementation was given, rest of the anti osteoporotic treatment was same as Group I. e patients were followed up at 3 months, 6 months and at 1 year period with Bone mineral Density (BMD) and serum vitamin D levels evaluated at each follow up visit. BMD evaluation was done by Dual Energy X-ray Absorptiometry ( DEXA) . A T-score was used for evaluation of BMD. T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult. According to the World Health Organization (WHO), a T-score of -1.0 or above is normal bone density , a T-score between -1.0 and -2.5 means you have low bone density or osteopenia. a T-score of -2.5 or below is a diagnosis of osteoporosis. e lower a person's T-score, the lower the bone density. e data was analyzed using Statistical Package for Social Sciences version 15.0. Proportional data were compared using chisquare test whereas mean differences were compared using Student "t"-test. Within group change were studied using paired 't'-test. e con dence level of the study is kept at 95%, hence a "p" value less than 0.05 were considered signi cant. Results: Age of patients ranged from 60 to 78 years. Maximum number of patients were of 66-70 years (41.3%). Majority of patients were females (n=51; 63.7%). Female to male ratio was 1.75:1. At baseline, mean T-score values were -2.93±0.24 in Group I and -2.89±0.19 in Group II. At baseline, mean vitamin D levels were 12.55±2.35 ng/ml and 11.88±2.39 ng/ml respectively in Groups I and II. At 6 months, mean T-score values were -1.47±1.27 in Group I and -2.30±0.67 in Group II. On evaluating the data statistically, the difference between two groups was found to be signi cant (p<0.001). e mean vitamin D levels were 26.44±7.25 ng/ml and 13.58±2.26 ng/ml respectively in Groups I and II. us mean levels were higher in Group I as compared to that in Group II and this difference signi cant statistic...

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To study whether the nutritional status of the patient has any effect on the outcome of fracture healing. To correlate various clinical and biochemical parameters for assessment of nutritional status with union of fracture. Material and Methods: One hundred and two patients having diaphyseal fractures of various long bones were followed prospectively for two years. The patients were categorized into 'malnourished/ undernourished' and 'nourished' status according to the anthropometric markers like body mass index, triceps skin fold thickness and mid arm muscle circumference; and biochemical markers like Hemoglobin, serum albumin, serum transferrin, serum ferritin and creatinine-height index. These fracture was evaluated clinically and radiologically for healing. This union time or quality of union was correlated with the anthropometric and biochemical parameters. Results: Femoral diaphyseal fractures were the commonest fracture identified (n=35, 34. 31%) followed by radius and ulna (28%), tibia and fibula (25%) and humanus (12%). High velocity road traffic accident was the most common mechanism of injury seen in 49 fractures (48.04%) followed by fall from height (40%) and Domestic trauma (12%). None of the biochemical parameters showed any correlation for fracture healing. Only Serum Albumin, Creatinine-Height index, Serum transferrin could show significant correlation with malnutrition and poor fracture healing. Conclusion: Thus our study concluded that serum albumin, serum transferrin and creatinine-height index were good biochemical indicators to predict union time. Anthropometric markers, so commonly considered for assessing deficiency in nutrition, do not correlate with fracture healing significantly and are meant for screening only. Altering the nutritional status while fracture treatment can promote healing.